LEGISLATIVE UPDATE
The AACVPR held its first true “Day
on the Hill” on Thursday, March 3 rd with approximately 85 AACVPR
members meeting with Senators and Congressional staff to discuss
support for our efforts to establish benefit categories in the
Medicare statute for both cardiac and pulmonary rehabilitation.
Attendees were handpicked and
invited to participate based upon their geographic location so a
“constituent” relationship could be established with key health
policymakers in both the House and Senate. The Association is focusing
on Senators who sit on the Finance Committee and House members who sit
on either the Ways & Means Committee or Energy & Commerce Committee
because these are the committees with jurisdiction over all Medicare
legislation. The initial focus on the House side is even more
targeted, zeroing in on members of the respective health subcommittees
of each committee. Attendees volunteered to come to Washington, many
at their own expense, to be briefed for several hours on the right and
wrong way to talk with Congressional staff, to stay on message despite
distractions, and how to condense the message into a few brief
minutes.
Overall, the initial effort was very
successful and the Association is already considering making the
effort an annual one, fully aware that there will always be issues to
bring to Congress. With enough planning and notice, the Association is
confident even more members will attend the “Day on the Hill” next
year.
In terms of what was accomplished,
we are certainly moving in the right direction. Senator Mike Crapo
(R-ID) has signaled his intent to take the lead on the legislation,
and several key senators, both Republican and Democrat, have indicated
their desire to support the effort. On the House side, a few
Congressmen indicated that they might be willing to take the lead on
the House side, but additional discussions with Senator Crapo’s office
were needed to discuss overall strategy before a final decision was
made.
In the
short term it is unlikely that a formal bill will be introduced in
either the Senate or House, but we are not worried about that
decision. This will likely be a long political process, and it is
unclear what legislative vehicle, if any, will surface in the next few
months that would carry varied Medicare provisions.
Because there are so many
political options facing Congress, we regard this as a critically
successful first step in forcefully putting our issue on the radar of
key health policy legislators.
Based
upon decisions made with the input of Senator Crapo and others, it may
become critical for all AACVPR members, your patients, and others to
get involved in a true grass roots effort, but now is not the
time! No Medicare legislation ever moves forward without
official cost estimates from the Congressional Budget Office (CBO) and
CBO is currently concentrating on the huge Federal budget, scoring
(estimating) every line of President Bush’s budget so that the
Congressional Budget Committees can complete their work on formal
budget resolutions. We are confident that our provisions eventually
will be “scored” by CBO, but until that time part of our effort must
hold back in a “hurry up and wait” mentality.
In February, the leadership of
AACVPR, along with AHA and ACC, once again met with CMS officials,
trying to convince the Agency to reign in its fiscal intermediaries
that have overinterpreted some of the
instructions included in 35-25 in light of the varied OIG reports. A
few FIs clearly are as fearful of
sanctions as cardiac programs themselves, and to protect themselves
have come out with virtual meat cleaver approaches to physician
supervision. In some regions, program medical directors (not required
under current CMS regulations) are being instructed to see all program
participants personally to evaluate the patients’ progress and NOT
bill Medicare for those legitimate Part B services. While CMS clearly
conceded that it appeared that some contractors had perhaps gone too
far, they were once again unwilling to reign in the rogue
FIs. There were even hints that perhaps
AACVPR and others should pursue legal remedies.
Clearly, one legal remedy is to seek
legislative relief from the Congress, and that is precisely what we
are doing. As the process moves forward, it is likely that the
legislative updates will become more frequent.
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For those of you who were not able to
attend the de-briefing Thursday afternoon, here are some key points:
Virtually
all Hill meetings that addressed the CBO scoring issue heard the basic
explanation that CBO is pre-occupied with scoring the President’s
budget, a process that is not only huge and time consuming but also
has an end poi
Given information from several key
meetings, in the short term AACVPR will continue to “hurry up and
wait” for the CBO scoring. There is a possibility that we will pursue
scoring by an outside economic consulting firm that specializes in
health care scoring (the mere existence of these
companies signals that CBO scoring is often an issue). Such a
move can be costly and AACVPR would be seeking support from other
groups on both the cardiac and pulmonary sides IF the decision is made
to secure an outside estimate. FYI, some of these companies have an
excellent reputation for working with CBO, modeling their
methodologies after CBO methods, and Congressional offices sometimes
use private sector
estimates as a baseline for negotiating with CBO.
We
will be meeting with Senator Crapo’s staff shortly to select a lead
Republican on the House side and, if appropriate, lead Democrats as
well. We will also discuss whether or not we should move forward with
a private sector estimates
Senator Crapo has established a $100
million threshold for introduction of the bill, which means a cost
estimate under $100 million is within his comfort zone. We are very
confident we can meet that threshold.
Next steps:
In the short term we are very much in a “hurry up and
wait” mode. If you had promised additional utilization data or other
information to the Congressional staff, that would be another
opportunity to maintain the communication. Additionally, it is always
advantageous to meet with members of Congress in the home district
whenever possible, and the message is the same.
Senator Crapo may
very well decide to wait until a viable cost estimate is available
before formal introduction of legislation. That free standing
legislation ultimately would be melded into the actual legislative
vehicle that rises to the surface, whether it is a reopening of MMA, a
budget reconciliation bill, or other means for Medicare legislation to
move forward.
Depending on the
guidance from Crapo, we may very well expand the grass roots efforts
to all AACVPR members, asking them to write to their members in
support of the legislation. Again, we simply have to rely on Senator
Crapo and his staff to indicate to us when it is time to “pull the
trigger” for additional letter writing, e-mails and phone calls.
As a last
note, please know that you have made an important contribution to the
profession as well as the AACVPR through your participation. The
AACVPR is strongly leaning toward making this event an annual event
every Spring. There will always be issues
to bring to the attention of Congress, and it is very exciting to see
the real potential of AACVPR..
