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Health­care groups’ mes­sage to deficit panel: Spare us

Modern Healthcare - - Front Page - Jes­sica Zig­mond and Rich Daly

Health­care in­dus­try groups are less con­cerned about the lineup of the newly ap­pointed fed­eral deficit-re­duc­tion “super com­mit­tee” than they are about that team’s game plan for Nov. 23.

In the mid­dle of Wash­ing­ton’s Au­gust re­cess, health­care as­so­ci­a­tions are pre­par­ing to ed­u­cate mem­bers of Congress—and espe­cially the six se­na­tors and six rep­re­sen­ta­tives ap­pointed to the high-pro­file debt panel— when they re­turn af­ter La­bor Day about how cuts to their re­spec­tive seg­ments would have dis­as­trous con­se­quences on pa­tients, physi­cians, hos­pi­tals and the econ­omy at the lo­cal and fed­eral lev­els.

The ma­jor­ity and mi­nor­ity lead­ers in the House and Se­nate chose the 12 com­mit­tee mem­bers: Sens. Max Bau­cus (D-Mont.), John Kerry (D-Mass.), Jon Kyl (R-Ariz.), Patty Mur­ray (D-Wash.), Rob Port­man (R-Ohio) and Pat Toomey (R-Pa.), and Reps. Xavier Be­cerra (D-Calif.), Dave Camp (R-Mich.), James Cly­burn (D-S.C.), Jeb Hen­sar­ling (RTexas), Fred Up­ton (R-Mich.) and Chris Van Hollen (D-Md.).

The Bud­get Con­trol Act—the leg­is­la­tion that de­fused the debt-ceil­ing stale­mate this month—tasked the super com­mit­tee, as it’s known, with sub­mit­ting a pro­posal by Thanks­giv­ing that iden­ti­fies at least $1.5 tril­lion in deficit re­duc­tions through cuts or tax in­creases (Aug. 8, p. 6). If Congress fails to ap­prove the pro­posal, au­to­matic cuts of $1.2 tril­lion—or the trig­ger—split be­tween do­mes­tic and de­fense spend­ing will take ef­fect. Medi­care cuts, lim­ited to providers, would be capped at 2%.

“I think all of this is so fluid and so dif­fi­cult to pre­dict what will hap­pen,” said Dr. Atul Grover, the chief advocacy of­fi­cer for the As­so­ci­a­tion of Amer­i­can Med­i­cal Col­leges. “I’m not con­fi­dent at all GME (grad­u­ate med­i­cal ed­u­ca­tion) will be spared,” he added. “I think if they make smart pol­icy de­ci­sions, GME will be spared.”

Grover said Kerry has pre­vi­ously taken a stand op­pos­ing cuts to teach­ing hos­pi­tals, and he de­scribed Bau­cus as a mod­er­ate who likes to reach across the po­lit­i­cal aisle.

More specif­i­cally, Grover high­lighted how aca­demic teach­ing hos­pi­tals also serve as eco­nomic en­gines in the states rep­re­sented by super-com­mit­tee mem­bers. For in­stance, Toomey rep­re­sents Penn­syl­va­nia—home to UPMC, West Penn Al­legheny Health Sys­tem, and a new med­i­cal school in Scran­ton. Port­man, a for­mer di­rec­tor of the Of­fice of Man­age­ment and Bud­get, rep­re­sents Ohio, home to the Cleve­land Clinic and the Ohio State Univer­sity Health Sys­tem. And then there is Van Hollen, the rank­ing mem­ber on the House Bud­get Com­mit­tee, whose district in­cludes em­ploy­ers Johns Hop­kins Hos­pi­tal

“We op­pose any fur­ther re­duc­tions in pay­ment for hos­pi­tal ser­vices un­der Medi­care.”

—Amer­i­can Hos­pi­tal As­so­ci­a­tion

and fed­eral agen­cies such as the Na­tional In­sti­tutes of Health and the Food and Drug Ad­min­is­tra­tion.

Grover said his group has spent the past months help­ing mem­bers of Congress un­der­stand that cut­ting GME does not just cut the num­ber of providers to­day, but will com­pro­mise the num­ber of providers who are pro­duced in the fu­ture. Mean­while, there is also the threat of cut­ting in­di­rect med­i­cal ed­u­ca­tion, re­ferred to com­monly as IME. This fund­ing, Grover said, could af­fect the level of trauma ser­vices in a teach­ing hos­pi­tal, which in­cludes mak­ing sure spe­cial­ists and nurses are avail­able around the clock. “That is an ex­pen­sive propo­si­tion,” he said. “If you’re not get­ting sup­port for those po­si­tions, you’re go­ing to see trauma cen­ters close in the short term.”

Other health­care providers of­fered sim­i­lar fears about pro­grams that af­fect their work. The Na­tional As­so­ci­a­tion of Pub­lic Hos­pi­tals and Health Sys­tems, for ex­am­ple, op­poses across-the-board cuts to Med­i­caid FMAP rates or blend­ing rates to a com­mon lower rate, said Beth Feld­push, vice pres­i­dent of advocacy and pol­icy at NAPH. The group also op­poses cut­ting or elim­i­nat­ing provider taxes un­der the Med­i­caid pro­gram and sup­ports a plan to ex­pand pa­tient ac­cess to lower-cost drugs in the in­pa­tient set­ting. That ap­proach, Feld­push said, is part of leg­is­la­tion in­tro­duced by Rep. Cathy McMor­ris Rodgers (R-Wash.), and has been scored by the non­par­ti­san Con­gres­sional Bud­get Of­fice to save the govern­ment money.

Groups such as the Amer­i­can Hos­pi­tal As­so­ci­a­tion, America’s Health In­surance Plans and the Phar­ma­ceu­ti­cal Re­search and Man­u­fac­tur­ers of America were re­luc­tant to com­ment specif­i­cally on the se­lec­tions or qual­i­fi­ca­tions of the var­i­ous mem­bers of the super com­mit­tee, opt­ing in­stead for state­ments sup­port­ing their re­spec­tive po­si­tions on the process. A spokesman for PhRMA said the as­so­ci­a­tion will re­main fo­cused on ed­u­cat­ing fed­eral lawmakers about the Medi­care Part D pro­gram, which the as­so­ci­a­tion said in a state­ment saves Medi­care about $12 bil­lion a year.

AHIP is like­wise seek­ing to pro­tect Part D, which is ad­min­is­tered by pri­vate in­sur­ers, as well as Medi­care Ad­van­tage and sup­ple­men­tal cov­er­age, and Med­i­caid man­aged care.

Not sur­pris­ingly, the AHA said that re­gard­less of the super com­mit­tee’s com­po­si­tion, “We op­pose any fur­ther re­duc­tions in pay­ment for hos­pi­tal ser­vices un­der Medi­care,” ac­cord­ing to a state­ment from Matt Fen­wick, an AHA spokesman. “Amer­i­cans de­pend on the care Medi­care pro­vides and cuts would jeop­ar­dize care for se­niors,” the state­ment con­tin­ued.

Mean­while, the Med­i­cal Group Man­age­ment As­so­ci­a­tion is firm in its stance that any fis­cally re­spon­si­ble pro­posal from the panel must in­clude a re­peal of the con­tentious sus­tain­able growth-rate for­mula for physi­cians.

“I think they’ll con­sider it be­cause you have

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