May 1997
Volume 61 |
Number 5
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WASHINGTON REPORT
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| Early FY98 Budget
Deal Doubtful as Congress Takes Spring Recess |
Michael Scott,
Director
Governmental and Legal Affairs
Following an embarrassing last-minute glitch in the House, Congress
recessed in late March for two weeks without any clear blueprint
in hand for achieving a budget agreement with the Administration.
The glitch was created by the defection of 11 conservative GOP
members from the leadership's bill on financing of House operations
(including the planned investigation of campaign finance abuses).
Differences were resolved only after a fairly ugly display of
varying viewpoints within the GOP rank and file, and a public
characterization by one of its members of Speaker Newt Gingrich
(R-GA) as "road kill."
Although the major newspapers report the existence of a budget-related
dialogue among the President, House Ways and Means Chair Bill
Archer (R-TX) and Senate Majority Leader Trent Lott (R-MS), it
is clear that at the time of the recess, the two sides remained
far apart both philosophically and as to actual numbers. With
respect to Medicare budget savings, the President appears principally
interested in a "fix" lasting throughout the remainder
of his term and slightly beyond, while GOP congressional leaders
want to focus, now, upon fundamental reforms of the program.
At the time of the recess, there was some talk in GOP circles
of splitting up the budget reconciliation process into three parts,
with Medicare budget reconciliation coming first, as early as
May or June. This approach would be designed to force the President
either into a politically painful veto of a moderate bill designed
to save the solvency of the program, or approving a bill going
further in terms of budget savings than at least the liberal portion
of his constituency would like.
There is by no means uniform GOP acceptance of this approach
and the situation remains fluid, the only certainty being that
both sides truly want to find a way to make a deal. This is the
kind of situation that frequently leads to nonpublic deal-making
among the principals and too little or no real opportunity for
those affected by the deal to attack it.
For this reason, ASA has taken advantage of the congressional
recess to meet on treatment of the anesthesiology conversion factor
with a large number of staffers for members of the three committees
critical to Medicare issues, House Ways and Means, House Commerce
and Senate Finance. ASA's position on this issue appeared in the
last
issue of the NEWSLETTER, and by the time this column
appears, many participants in the ASA Legislative Conference held
on April 13-15 in Washington, D.C., will also have met with their
legislators to advance the ASA position.
Resource-Based Practice Expenses: The Beat Goes On, and Gets
Louder
In late March, the surgeon-led Practice Expense Coalition gave
the amplifier another turn louder at hearings of the Ways and
Means health subcommittee and the Practicing Physicians Advisory
Council dealing with the status of efforts by the Health Care
Financing Administration (HCFA) to develop defensible resource-based
practice expenses by next January 1, the implementation date Congress
set four years ago. The coalition now seeks to persuade Congress
to suspend the January 1 effective date indefinitely and send
HCFA back to the drawing board to develop more credible data than
it preliminarily published last January. The American Medical
Association (AMA) is on record as favoring a one-year delay in
the effective date in order to permit HCFA to develop better data.
A member of the Coalition, ASA has supported the Coalition's
view, and the ASA Administrative Council has authorized the contribution
of funds by ASA in support of the Coalition's lobbying efforts.
As previously reported in this column, ASA is conducting its own
survey of direct and indirect anesthesiology practice expenses
with the assistance of Abt Associates Inc. and will use the results
of that survey to evaluate whatever recommendations HCFA develops
for the specialty.
HCFA Sets Timetable for NPI Regulations
Acting pursuant to the mandate of last year's Health Insurance
Portability and Accountability Act, HCFA has published its rule-making
schedule for establishment of a unique health identifying number
for each health care provider, known as the National Provider
Identifier (NPI). Beginning December 1, 1997, Medicare claims
submitted without an NPI will not be processed.
According to HCFA's current intention, all providers enrolled
in the Medicare program will automatically receive NPIs soon after
August 1. The system will allow NPIs of physicians in a group
practice to be linked to the group's NPI. The NPI will be linked
to a central database maintained by HCFA, which will contain substantial
personal and professional information on each provider. The AMA
has expressed concern as to the security of the database against
unauthorized disclosure of information, and the upcoming HCFA
regulations are expected to deal with this issue.
Managed Care Review Panel Appointed by President
On March 26, President Clinton announced appointment of a 34-member,
blue-ribbon advisory commission to assess the need for federal
regulation of private health care plans. The President previously
had announced his intention to appoint such a commission during
last fall's presidential campaign. Appointment of such a commission
was favored by the Patient Access to Specialty Care Coalition,
of which ASA is an active member.
The commission will be co-chaired by Health and Human Services
Secretary Donna Shalala and Acting Labor Secretary Cynthia Metzler.
It is expected to issue a report to Congress by March 30, 1998.
Several bills are currently pending in Congress purporting to
deal with a variety of managed care excesses, but in general,
the GOP leadership tends not to favor federal regulation of private
health maintenance organization practices. Whether the report
of the commission will lend cohesion to the pending bills, all
of which are opposed by the managed care industry in favor of
its own self-policing efforts, remains to be seen next year.
June Dates Set for 1998 Legislative Conference
Because of continuing difficulties in recent years in obtaining
congressional speakers and arranging Capitol Hill visits, the
ASA Administrative Council has approved, as an experiment, moving
the 1998 Legislative Conference from the traditional "Sunday
through Tuesday" format to a "Monday through Wednesday"
format. The dates for the 1998 Legislative Conference will be
June 15-17, with most Hill visits planned for Wednesday, June
17.
Problems with the traditional format arise from the fact that
Senators and Representatives frequently do not return to Washington
from their home states until noon on Tuesday when the first votes
for the week are often scheduled. Although this change in the
Legislative Conference schedule calls for physicians to be away
from their practices for one additional weekday, the one-day shift
in the meeting format may serve to enhance the effectiveness of
the conference and the advancing of ASA's legislative agenda.
Shortly following the 1998 meeting, the Administrative Council
will assess the desirability of making the shift permanent, based
upon comments of meeting participants and other relevant factors.
At present, the meetings for 1999 and 2000 remain scheduled in
a "Sunday through Tuesday" format, subject to possible
change after the results of the 1998 meeting are known.
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