AANA Federal Government Affairs
HOTLINE
Number 2005-29 Week of Monday, December 19, 2005


In This Issue:


* House OKs Budget Package Reversing 2006 Medicare Payment Cuts; Senate Action Pending
* House OKs Health Spending Bill Including CRNA Education Funding; Awaiting Senate Action
* Health Information Technology Bill Passes Senate
* DoD Introduces EHR System to be Used in Combat and Hospitals
* Amendments




>> House OKs Budget Package Reversing 2006 Medicare Payment Cuts; Senate Action Pending


A $40 billion budget savings package narrowly adopted by the House of Representatives early December 19th (H Rept 109-362, S 1932) would replace the 4.4% Medicare Part B payment cuts scheduled to take effect January 1, 2006, with Part B payments equal to 2005 levels. CRNAs are affected by the payment cuts and the relief just as anesthesiologists and other physicians are, having in common the ability to bill Medicare Part B for services provided to Medicare beneficiaries. But don’t count the proverbial chickens; the Senate has not acted on the package yet. Until the Senate passes the measure, anticipated sometime Dec. 20 or 21, and the President signs it into law, the relief from Part B cuts is not assured.

Considering that Medicare estimates 2006 Part B allowed charges for anesthesiologists and CRNAs’ anesthesia services at approximately $2 billion, this turnaround would provide about $88 million more Medicare funding for anesthesia services in 2006 than would otherwise have been allocated, holding case volume, mix and time constant.

The mammoth 774-page measure, approved on a 212-206 House vote, is also important for what it excludes. The measure does not include any anti-CRNA “poison pill” provisions, which the AANA has been long watching guard against. And the measure does not include provisions establishing Medicare “pay-for-performance” measures for healthcare providers including CRNAs. As a vigorous advocate for improving patient safety, the AANA had expressed support for such provisions pending in legislation in the House and Senate, on the condition that the nurse anesthesia profession had a “place at the table” as such measures and standards are being developed for anesthesia services.

In addition to provisions relating to Medicare, the budget reconciliation package includes language touching just about every part of the Federal government. Among the issues additionally of interest to CRNAs is how the measure treats federal student financial aid, though the measure does not apparently change the rules governing educational accreditation programs such as the Council on Accreditation of Nurse Anesthesia Educational Programs (COA). Additional analysis of the just-unveiled and House-adopted package will be forthcoming.

The package is not universally supported, as indicated by the close party-line vote by which it passed in the House. The measure contains numerous provisions to which some senior legislators are known to strongly object, and Senate passage is not assured.

Read the conference report, http://rules.house.gov/109/text/s1932cr/109s1932_text.pdf; however, it is 9.7MB of technical language, not all of which addresses Medicare

Read a story about the package from the December 19th Washington Post, http://www.washingtonpost.com/wp-dyn/content/article/2005/12/19/AR2005121900159.html

See how your legislators voted, at http://clerk.house.gov/cgi-bin/vote.asp?year=2005&rollnumber=670




>> House OKs Health Spending Bill Including CRNA Education Funding; Awaiting Senate Action


Following severe proposed cuts and long delays, the House narrowly okayed on December 14th the big FY 2006 Labor, HHS and Education final spending package that includes at least $3 million for CRNA education (HR 3010, H Rept 109-337) during a very tight budget year. However, Senate passage awaits on this, the largest of Congress’ annual spending bills, and is not assured.

For CRNAs specifically, the Conference Report has Title VIII advanced education nursing (AEN) education-funding levels at $57.637 million, compared with $58.160 million from FY 2005, a cut of $523,000 from last year but some $15 million greater than what was proposed in the Administration’s 2006 budget. Total FY 2006 funding for Title VIII nurse education accounts is $151.191 million, up $530,000 from 2005 levels.

The AANA had fought for the CRNA educational funding, for advanced practice nursing, and for nurse education funding in general, through testimony to the relevant committees of Congress, advocacy during AANA Midyear Assembly, and other activities. Funding at least $3 million for CRNA education provides resources for nurse anesthesia traineeships, and predominantly for competitive grants to establish and expand nurse anesthesia educational programs.

If the Senate does not pass the bill, then all bets are off. With many holidays approaching, the House of Representatives has left Washington and may be called back only under extreme circumstances. Meanwhile, a “continuing resolution” keeps the Department of Health and Human Services running until December 31, 2005.

See how your legislators voted http://clerk.house.gov/evs/2005/roll628.xml

Read the conference report http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=109_cong_reports&docid=f:hr337.109.pdf

Look over the Title VIII programs eligibility and other information at http://bhpr.hrsa.gov/nursing/




>> Health Information Technology Bill Passes Senate


On Friday (November 18th), the Senate passed a bill (S 1418) that would promote the use of healthcare information technology to help ensure patient safety and reduce costs. Of particular importance to CRNAs is the bill’s commitment to helping reduce medical errors. The legislation, sponsored by Senate Help, Education, Labor and Pensions Committee Chair Mike Enzi (R-WY), includes provisions of a bill (S 1355) co-sponsored by Enzi and Senator Edward Kennedy (D-MA) and a second bill (S 1262) co-sponsored by Senator Hillary Rodham Clinton (D-NY) and Senate Majority Leader Bill Frist (R-TN). The bill would authorize into statute an Office of the National Coordinator of Information Technology within HHS. Under the legislation, HHS would award grants to hospitals, group physician practices and other healthcare providers to help increase the use of health IT systems. The bill also would clarify that current medical privacy rules would apply to health information stored or sent electronically. Frist said, “This bill will do as much as anything we have done in this Congress ... to cut waste and inefficiency out of our healthcare system” (CQ Today, 11/18).

View the bill, http://thomas.loc.gov, type in "S 1418”




>> DoD Introduces EHR System to be Used in Combat and Hospitals


During the week of November 21st, the Department of Defense (DoD) introduced a $1.2 billion electronic health records (HER) system known as Ahlta that is being used by about half of the military's 60,000 medical practitioners nationwide. With many CRNAs practicing in the military and with Healthcare Information Technology (HIT) before Congress, the military system could eventually be used as a model for all practitioners. The system will cost about $100 million annually and is expected to reduce healthcare costs and medical errors for more than nine million service members, retirees and their families. Ahlta is designed to run on military hospital computers, hand-held devices and laptops for medical units in combat areas, according to William Winkenwerder, assistant secretary of defense for health affairs. The system is expected to be fully implemented by December 2006. Winkenwerder called the system “a major accomplishment in military medicine.” The military operates 800 clinics and 70 hospitals in the US (Washington Times, 11/25).

Read more, http://www.washtimes.com/business/20051124-093203-8745r.htm




>> Amendments

* The Senate will be in session this week, while the House breaks. The Senate will be taking up the Deficit Reduction Omnibus Reconciliation Act of 2005 (S 1932), while the House adjourned Sunday morning around 5am for the holiday break and will not gavel in until the start of second session of the 109th Congress on January 31st.

* IOM calls for universal pay-for-performance criteria. On Thursday (December 1st), the Institute of Medicine (IOM) released a report entitled, Performance Measurement: Accelerating Improvement. In the report, the IOM argues that the healthcare industry across the board must be using the same tools and procedures, including a universal set of performance measures, in order for pay-for-performance to gain broad success. The report also calls on HHS to establish a National Quality Coordination Board to develop a set standardized performance measures.

Read the report, http://www.nap.edu/books/0309100070/html/R1.html

* Purcell and Brighthaupt featured on CNN’s American Morning. Frank Purcell, AANA Senior Director of Federal Government Affairs and AANA Lobbyist Assistant Donna Brighthaupt are being featured on the television news network as part of CNN’s “New You Resolution.” Announced on CNN’s morning show November 15th, the pair will be followed on the morning show beginning early January as they both try and reach their wellness and physical fitness goals for the upcoming new year.

Read more, http://www.cnn.com/2005/HEALTH/11/14/participant.emails/index.html

* Stay tuned for possible CRNA grassroots advocacy action the next few weeks, as Congress works on legislation affecting CRNAs’ Medicare payment and funding for nurse anesthesia educational programs.

* For up-to-date Congressional floor & committee schedule information, see http://thomas.loc.gov/.




>> For More Information


The AANA Federal Government Affairs Hotline is published for the nurse anesthetist members of AANA each week Congress is in session by the AANA Office of Federal Government Affairs, Washington DC, 202-484-8400, info@aanadc.com, Frank Purcell, Senior Director. © 2005 American Association of Nurse Anesthetists.