Endos influence Capitol Hill

Congress Passes Two Society Policy Priorities, Repeals SGR, and Renews SDP

On April 14, the U.S. Senate permanently repealed the flawed Medicare formula known as the SGR in an overwhelming 92-8 vote. The action came just hours before a 21% cut to Medicare reimbursement was slated to take effect and follows the passage of companion legislation in the U.S. House of Representatives. The Medicare Access and CHIP Reauthorization Act of 2015 includes an annual increase of 0.5% through 2019; consolidates various quality improvement programs; incentivizes physicians to participate in alternative payment models like accountable care organizations; and provides a framework of a new system by which to compensate physicians for Medicare services. The Centers for Medicare and Medicaid Services (CMS) is now tasked with determining how this framework should be put into practice.

The Society has advocated for the permanent repeal and replacement of the SGR for many years: Our members have lobbied for the passage of this legislation on Capitol Hill, and staffhave met with and provided comments to the Congressional committees as they developed a framework to replace the current system. As the CMS moves forward in its rulemaking process, Society members will have a number of opportunities to weigh in on how this system could work best for endocrinologists. The Society will provide additional information and details for member feedback so that we can help influence implementation.

The Society also successfully worked to have the Congress include the renewal of the Special Diabetes Program (SDP) in the Medicare Access and CHIP Reauthorization Act of 2015. This has been a top priority for the Society. Several weeks ago, members of the Advocacy and Public Outreach Core Committee (APOCC) and Research Affairs Core Committee (RACC) were on Capitol Hill advocating for the renewal of this program, which allocates $150 million for research on type 1 diabetes and an additional $150 million for education and prevention programs for American Indian and Alaska Native populations with type 2 diabetes. The inclusion of this program in the legislative package was critical to ensuring the continuation of key research, education, and prevention programs on diabetes.

Thank you to all of our members who took action over the last few months to help push this legislation over the finish line. Your advocacy efforts make all the difference. To learn more about how you can get involved with the Society’s advocacy programs, please email Meredith Dyer, associate director, Health Policy at mdyer@endocrine.org.

Endocrinologists Take to the Capitol for ES Hill Day

The spring is always hectic in Washington, D.C. It is the time of year when tourists flock to D.C. for cherry blossoms, school trips take in the historic sites, and Congress is hard at work on several legislative deadlines, including the federal budget, appropriations, and repeal of Medicare’s flawed physician payment system. On March 25, RACC and APOCC members participated in a Hill Day focused on research-related topics (our clinician Hill Day will occur later in the year) and the day was a smashing success! Our members talked with about 30 congressional offices about increased funding needs for the NIH, renewal of the SDP, and the importance of including sex differences in basic research.

Our members were well received, and their messages resonated. Several offices said they would not only support our requested level of funding for NIH ($32 billion) but also work with us to push for a redoubling of the NIH budget. Our meetings helped solidify the inclusion of the reauthorization of the SDP in the Medicare Access and CHIP Reauthorization Act of 2015 that was passed April 14. All of the offices we visited were very interested in the sex differences issue and willing to work with us on legislation. In addition to the reaction we got from congressional offices, it was wonderful to see our members infected with “Potomac Fever.” While it is easy to be cynical about Congress, when you come here and participate in the process, it is exciting to see work actually being done. ES members interested in participating in grassroots advocacy are encouraged to contact Mila Becker, senior director for advocacy and policy programs at mbecker@endocrine.org.

Society Participates in Workshop on Type 1 Diabetes Research

On April 8-9, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) conducted a workshop on research supported by the “Special Statutory Funding Program for Type 1 Diabetes Research.” Otherwise known as the SDP, this program is a special additional source of research funds appropriated by Congress specifically for type 1 diabetes research and administered by the NIDDK through the Diabetes Mellitus Interagency Coordinating Committee (DMIC). The SDP has “enabled the creation of unique, innovative, and collaborative research consortia and clinical trials networks.” The SDP is currently authorized through fiscal year (FY) 2015; this meeting evaluated proposals in anticipation of continued funding through FY16.

During the workshop, scientific and lay experts discussed opportunities for new research projects and continuation of existing research programs in type 1 diabetes. Workshop participants evaluated basic, translational, and clinical research proposals spanning a variety of topics. Topics included several research areas in addition to resource development projects, workforce development, and Small Business Innovation Research/Small Business Technology Transfer (SBIR/STTR). Endocrine Society members Richard Bergenstal, MD, Robert Eckel, MD, Irl Hirsch, MD, Michael S. German, MD, Georgeanna Klingensmith, MD, and Robert Sherwin, MD, participated in the workshop.

Meaningful Use Rules Outline Changes to the Program for 2015 and Beyond

The CMS released a Notice of Proposed Rule Making (NPRM) on March 20, which outlines the requirements for Stage 3 Meaningful Use for eligible professionals (EPs), eligible hospitals, and critical access hospitals in the EHR Incentive Programs. The CMS believes that the provisions in the rule will provide more flexibility to EPs by:

• Establishing a single, aligned reporting period for all providers based on the calendar year
• Allowing providers the option to start Stage 3 of meaningful use in either 2017 or 2018 (required in 2018), which gives providers an extra year to begin participation in the program than under current regulation
• Simplifying meaningful use objectives and measures and reporting requirements by allowing flexible measures under health information exchange, consumer engagement, and public health reporting that would fit their own patient population or practice
• Reducing the overall number of objectives to eight to focus on advanced use of EHRs
• Removing measures that are redundant or received wide-spread adoption
• Aligning clinical quality measure reporting with other CMS programs

The reaction from the medical community has been mixed, with some citing their appreciation that the CMS is attempting to align the requirements of the incentive program and provide greater flexibility. However, there continues to be concern that the requirements are too arduous, the timelines are too aggressive, and much of the ability to meet the requirements is based on patient use of their electronic health records. The Endocrine Society will be submitting comments on the NPRM, which is expected to be finalized this fall.

In a separate Proposed Rule released on April 10, the CMS outlined modifications to the Meaningful Use program in 2015 through 2017. This proposed rule would change the EHR Incentive Program reporting period in 2015 to a 90-day period aligned with the calendar year. In addition, this proposed rule would modify the patient action measures in the Stage 2 objectives related to patient engagement by reducing the requirement for patients to use technology to electronically download, view and transmit their medical records from 5% of EPs’ patients to just one patient. Finally, it would streamline the program by removing reporting requirements on measures that have become redundant, duplicative, or topped out through advancements in EHR function and provider performance for Stage 1 and Stage 2 of the program. The proposals are expected to be finalized as soon as this summer.

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