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July 8, 2011


Washington Letter
July 8, 2011
Newsletter of the American Thoracic Society's Washington Office

1150 18th Street NW
Suite 300
Washington, D.C. 20036
Telephone:(202) 296-9770


CMS Issues Proposed Rules for 2012 Hospital Outpatient Programs and Physician Payments

This month, the Centers for Medicare and Medicare Services (CMS) issued  proposed rules for Medicare payments to hospitals outpatient programs and physicians for 2012.  These proposed rules include a number of proposed program changes that will have broad effects on the provider community and specific areas of interest and concern for the pulmonary, critical care and sleep communities.

The biggest news – which will not come as a surprise to regular readers - is the 29.5 percent cut in Medicare physician reimbursement caused by the flawed sustainable growth rate factor.  Unless Congress acts to avert the cut, physicians will see significantly reduced payments for Medicare services.  CMS Administrator Berwick went to great lengths to express the Administration’s hope and expectation that Congress would take steps to avoid such a cut.

Other items of interest to the pulmonary, critical and sleep community include new CPT codes for smoking cessation services and new quality group measures for COPD and sleep apnea.

The proposed hospital outpatient rule includes a significant cut in Medicare reimbursement for pulmonary rehabilitation services from $62/hour to $38/hour.  The ATS is extremely concerned with this CMS proposal and will be registering our concerns with CMS.  The ATS is currently working with sister organizations to analyze the proposed changes in the pulmonary rehabilitation reimbursement and prepare a detailed response.

The ATS will review both proposed rules in detail and submit comments to CMS reflecting the needs and concerns of the pulmonary, critical care and sleep community.


EPA Issues Cross State Air Pollution Rule

This week the, Environmental Protection Agency issued the long awaited Cross State Air Pollutions Rule.  This rule will reduce air pollution that is created in one state that blows downwind to create an air pollution problem in other states, and improve the lives of more than 240 million Americans.  

“The ATS is very pleased that the EPA has taken this important step to reduce interstate air pollution.  The CSAPR will save lives and lower health risks for everyone in the Ohio Valley and Eastern seaboard by preventing polluters from being able to duck air pollution control requirements when their pollution drifts across state lines,” said ATS president Nicholas S. Hill, MD.

Despite improvements in air quality, air pollution continues to be a problem in the U.S.  Both ozone air pollution (smog) and particulate matter pollution (soot) continue to cause significant health problems in the U.S., substantially adding to the number of asthma attacks, emergency room visits, heart attacks, missed school and work days and premature deaths each year. Several east coast states have taken extraordinary measures to comply with air pollution standards, but still can’t meet EPA standards because of air pollution blowing in from neighboring states.  The rule will address this problem by reducing the pollution at its source. 

The action EPA finalized today will reduce air pollution at its source and will result in improved air quality in neighboring states and improved health for their inhabitants.

This rule replaces EPA’s 2005 Clean Air Interstate Rule. The final rule will yield $120 to $280 billion in annual health and environmental benefits in 2014, including the value of avoiding 13,000 to 34,000 premature deaths. This far outweighs the estimated annual costs of CSAPR.

The ATS has long supported the EPA taking a strong leadership role in air pollution transport policy.  The ATS participated in meeting with Office of Management and Budget at the White House to encourage the administration to move forward with the EPA rule.  And ATS also participated in the 2006 Tennessee Valley Authority vs. North Carolina court case, which allowed North Carolina to use state common law to require out of state power plants to reduce emissions. 

Emission reductions will take effect quickly, starting January 1, 2012 for SO2 and annual NOX reductions, and May 1, 2012 for ozone season NOX reductions. By 2014, combined with other final state and EPA actions, the Cross-State Air Pollution Rule will reduce power plant SO2 emissions by 73 percent and NOX emissions by 54 percent from 2005 levels in the CSAPR region.

For more information, please see the EPA information sheet at www.EPA.gov/airtransport.


ATS Leadership Meets with NIH-EPA-VA-AHRQ

ATS Leadership recently traveled to Washington to meet with the directors of NIH institutes, including the National Heart, Lung and Blood Institute (NHLBI), National Institute of Allergy and Infectious Diseases (NIAID), National Institute for General Medical Sciences (NIGMS), National Institute of Nursing Research (NINR) and the Fogarty International Center (FIC), the Environmental Protection Agency (EPA), the VA Research program and the Agency for Healthcare Research and Quality (AHRQ). The series of annual meetings serves to build the ATS’s relationships with these key institutes and agencies in addition to providing a direct forum for the ATS to push for the expansion of pulmonary, critical illness and sleep research.

These annual leadership meeting are part of ATS’s ongoing efforts to advocate for the needs of the pulmonary, critical care and sleep community.


House and Senate Committees Pass VA Funding Bills

The House and Senate Appropriations committees each passed legislation providing funding for the VA research program.  The House bill provided $531 million for the VA research program, a cut of $50 million from current funding but an increase of $22 million above the President’s budget request.  The Senate measure provided $581 million for the VA research program, essentially level funding and $72 million above the President’s request.

The ATS will continue to urge Congress to provide additional funding to the VA research program.

House Panel Votes to Slash EPA Funding

This week, the House Interior-Environment Appropriations subcommittee, chaired by Rep. Simpson (R-ID) passed the FY2012 Interior-Environment spending bill. The bill provides funding for the EPA and the NIEHS’s Superfund program. The FY2012 bill approved by the subcommittee proposed to cut $1.5 billion from the EPA’s budget, a cut of about 18 percent, putting total funding for the agency at $7.1 billion.  Nearly $1 billion of the cuts are in water programs that typically provide federal assistance state and local government to upgrade water and sewer infrastructure.  Other targeted cuts include a $102 million cut state implementation grants, a $46 million cut to greenhouse gas regulation and capping the agency’s staff at 1992 levels.

The NIEHS’s Superfund research program, which studies the health effects of hazardous waste, fares somewhat better than the EPA, with a $2 million cut proposed under the FY2012 Interior-Environment bill, putting total program funding at $79 million.

In addition to the steep cuts, the Subcommittee also included a number of legislative riders to limit EPA’s authority including provisions to:

  • Prevent EPA from requiring public reporting of green house gas emissions;
  • Prevent EPA from requiring emissions permits for major sources of green house gas; and
  • Bar state or federal lawsuits regarding green house gas emissions.

Additionally, the bill includes a provision that would prevent any EPA air, soil or water rule that would establish a standard at or below the natural background level of the pollutant.  While this provision is seemingly benign, if taken to the extreme level could prevent nearly all future EPA standards.  As it is written, the provision would allow a natural event such as a volcanic eruption – which can result in extremely high air pollution levels – to be considered the “background level” and any standard stricter than the volcanic eruption would be null and void.

The next step for the FY2012 Interior-Environment bill is consideration before the full Appropriations Committee next week. Although the House may ultimately pass the Interior-Environment spending bill with these steep funding cuts to environmental programs and legislative riders, the Senate is unlikely to consider such a bill.




The Washington Letter is written by the American Thoracic Society government relations office and emailed to all ATS members living in the United States. The letter keeps clinicians, scientists, and patients abreast of legislative, judicial, and regulatory issues in pulmonary, critical care, and sleep medicine. Each week's edition is archived on the ATS Web site, www.thoracic.org. If you have any questions or one more information about becoming involved in advocacy, please contact the ATS Washington office at 202-296-9770.