Congress Bolsters Health-Care Initiatives - Lawmakers Seek More Value and Accountability From Medical Programs
By SARAH LUECK
Wall Street Journal
December 11, 2006
WASHINGTON -- As Congress ended its session, lawmakers authorized billions of dollars in spending to shore up government health initiatives -- from funding for Medicare and medical research to antibioterrorism efforts -- passing legislation that included provisions aimed at injecting more transparency and accountability into the programs.
Congress agreed to pay physicians a bonus in exchange for more data on the quality of care provided to Medicare's elderly and disabled beneficiaries. In addition, the National Institutes of Health stands to get a boost in funding for research, but also must set up an electronic tracking system that would help Congress monitor how its grants are used.
States and local governments will continue to receive federal grants to help them prepare for health emergencies, such as a bioterrorism attack, but they will have to show the federal government that they are making progress, or risk losing the money.
The changes underscore that as the government's health-related responsibilities grow Congress and many policy makers want more for its money. And in the face of big disagreements over how to solve some major health issues on the horizon, lawmakers are pushing incremental changes that could pave the way for broader solutions down the line.
This is clearest in Medicare, the federal health program that covers more than 40 million elderly and disabled people. Congress agreed to erase a scheduled reduction in payments to physicians, but it made a 1.5% bonus payment available only to physicians who report to Medicare how they perform on certain specified barometers of health-care quality. Initially, the payments will be based on whether the physician reports the data, but the system lays the groundwork for higher payments to better-performing physicians.
Among the information Medicare officials will collect: whether doctors provide aspirin and beta blockers to patients having heart attacks, and whether elderly patients are screened for their risk of falls. These practices are considered indicators of good patient care.
Hospitals, too, will have greater responsibility for reporting quality-of-care data. While most hospitals already have been doing quality reporting on inpatient care, the new legislation requires them to do so for outpatient services to receive the full payment scheduled under law for those services. Congress added an additional wrinkle to the program in the latest legislation, requiring the Department of Health and Human Services to consider ways that the hospital data could be made available to the public.
The quality-reporting provisions may well prompt criticism from health-care providers. Already, the American Medical Association, while praising the payments Congress awarded its physician members, said it has "concerns" about the quality-reporting system.
The Medicare changes were part of a tax bill Congress passed before heading home.
Separately, the House and Senate also worked out their differences on a complex package of health legislation that lumped reauthorization of the Ryan White CARE Act, which funds state-level treatment of people with HIV and AIDS, with a reorganization of the NIH and anti-bioterrorism initiatives.
The NIH provisions, a top priority of House Energy and Commerce Chairman Joe Barton (R., Texas), would provide the $30 billion-a-year agency a boost of about $4.5 billion in the next two years. Congress still must appropriate the funds.
Mr. Barton has criticized the NIH for being a "hodgepodge of different interests," and insisted on greater collaboration and transparency at the agency. In addition to a new requirement to track grants electronically, the legislation calls for the NIH director to send biennial progress reports to Congress on research activities. The legislation also sets up a "common fund," valued at $1.5 billion next year, which the NIH director controls and can spend on research involving more than one of the agency's institutes.
On bioterrorism, Congress passed new requirements for the secretary of health and human services to set benchmarks for states and localities receiving federal grant money to prepare for health emergencies. States also must begin matching the funds in 2009, and they must perform regular drills and exercises to identify weaknesses in their emergency-response systems and report what they find to the federal government.
The health package also calls for a $1 billion in grants to biotechnology firms developing drugs and vaccines for bioterrorism-related illnesses and infectious diseases. The money, a response to criticism of the government's beleaguered $5.6 billion Bioshield program, is intended to help companies through the so-called Valley of Death, a period in the start-up process when they need to conduct costly research and scale-up manufacturing capabilities but don't yet have products that translate into government contracts or private investment. Congress also gave the federal government more flexibility to award periodic payments when the companies meet predetermined milestones.
Congressional action "sends a signal" that the government is committed to funding the bioterrorism sector, said John Clerici, a lawyer at McKenna Long & Aldridge who represents biodefense clients. The bill would benefit many of the small biotech firms focusing on this type of research and was supported by some venture-capital firms because they have invested in the sector or would like to.
Crucial to getting the health package through Congress was an agreement to redistribute funds in the State Children's Health Insurance Program, which provides grants to help states cover low-income children. Mr. Barton initially objected to a plan that would have given unspent SCHIP funds from one group of states—including Texas—and given them to other states that are facing shortfalls in their programs, such as Massachusetts and Rhode Island. But the final deal capped the money shifted away from Texas at $20 million, and Mr. Barton agreed to move the other health legislation through the House. He also won Senate passage of his NIH changes.
Congress also changed the funding formula in the Ryan White program, which provides grants to states and cities for treatment of people with AIDS. Now, cases of HIV—not just full-blown AIDS—also will be counted when the federal government is deciding how to dole out the money, a move that shifts resources to states, including many in the South, with relatively newer epidemics of the disease. Lawmakers from states with more long-running epidemics, including New York, New Jersey and California, had objected to the change. The final agreement lessened the blow to those places.
