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An Affiliate of

Health Policy & Reimbursement Committee

Carey Krepel (Chair)

Lora Rutt  



This committee shall be responsible for tracking and providing the membership with updated information on reimbursement issues.  Information for the membership shall be provided through the newsletter, workshops, and individual program consultation. The President shall appoint the chairperson who will appoint the committee members.  In addition, the President shall appoint a Legislative Contact Person whose focus is Medicare/Medicaid and a Reimbursement Contact Person whose focus is managed care and other private payers.  One or both of these contact persons shall serve as chairperson of this committee.


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.

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.

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Last updated: July 28, 2011 | Webmaster