Hematologists on the Hill: ASH Committee on Practice Meets With Members of Congress
By Larry Solberg, MD, PhD
Dr. Solberg is Chair of the ASH Committee on Practice.
The ASH Committee on Practice participated in a successful Capitol Hill Day last May, in which members of the Committee met with Congressional members to discuss Medicare and physician reimbursement issues. The day started in the office of Senator Max Baucus (D-MT) who chairs the Senate Finance Committee and has responsibility for the Medicare program. Our committee also met with Billy Wynne, Health Counsel of the Senate Finance Committee on Health and Welfare. The basic message from our committee to Congress was simple: For the sake of our patients and the hematologists who see them, we need Congress to avert the scheduled 10.6 percent physician payment cuts. The Senator's staff discussed some of the broad policy challenges in the Medicare program for physician reimbursement, particularly the need to eliminate the sustainable growth rate (SGR) formula mechanism, which is used as a vehicle for physician payment updates, and replace it with a process that accurately reflects the true cost of practice. Other specific reimbursement issues confronting hematologists, such as reimbursement for radioimmunotherapy agents and cognitive services, were discussed. Thanks to ongoing communication between the Society and Congress, in addition to grassroots advocacy, Sen. Baucus' staff was well aware of ASH's concerns and assured us that he would work "to make the legislation right for hematologists."
Following that discussion, members of the Committee on Practice dispersed throughout the hallways of the Senate and House of Representatives office buildings to attend various meetings. One particularly poignant visit was when Committee members Sam Silver, MD, PhD, David Henry, MD, and Loann Peterson, MD, ran into Sen. Arlen Specter (R-PA) getting off the elevator. Sen. Specter is the ranking member on the Appropriations Subcommittee on Labor, Health and Human Services, and Education; he has been one of the Society's most vocal champions for increased funding for biomedical research and other health-care issues. The ASH members approached Sen. Specter and identified themselves as members of the American Society of Hematology. Sen. Specter smiled and said he liked hematologists and then proceeded to lead our doctors off to the side of the hallway where he wanted to talk with them himself. Drs. Silver, Henry, and Peterson explained their concerns with Medicare and that they were counting on his help.
Since the May Practice Committee Hill Day, the Senate and House of Representatives passed the Medicare Improvements for Patients and Providers Act of 2008 over President Bush's objections and veto. The new law replaced the scheduled Medicare cut with a .5 percent payment update for the remainder of 2008 and extended reimbursement for radioimmunotherapies. Sen. Specter also worked closely with Sen. Tom Harkin (D-IA) to pass a supplemental appropriations bill that included an additional $150 million for the NIH and is working on a second appropriations supplemental bill offering additional monies to the NIH. While the Committee on Practice's Capitol Hill Day cannot claim sole credit for these accomplishments, clearly, the opportunity to influence legislation is enhanced when ASH members come to Washington to share the Society's perspectives on Capitol Hill.
I encourage all ASH members to join the ASH Grassroots Network and participate in Society advocacy efforts. I would like to invite all hematologists who will be attending our 50th anniversary ASH meeting in San Francisco to attend our Practice Forum on Saturday, December 6, 2008, at 6:00 p.m. The forum will give hematologists an opportunity to hear from ASH leadership for Government Affairs and Practice — specifically how 2009 looks and what impact the elections may or may not have on our practice environment.
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Disability Issues Give Presidential Campaign a New Spin
By Belinda Avalos, MD
Dr. Avalos is Professor of Internal Medicine in the Division of Hematology/Oncology at The Ohio State University.
Editor's Note: This is the third in a series of articles (read the first and second articles for more information)illustrating how hematologists can become involved with the presidential election. ASH members are encouraged to take advantage of and create new opportunities to become involved in the election and particularly to share their views about health-related issues with the candidates.
Did you know that patients with cancer and a wide spectrum of other disorders including epilepsy, diabetes, multiple sclerosis, and HIV are routinely found not to be disabled and therefore not covered by the Americans with Disabilities Act (ADA)? That's what an audience of nearly a thousand heard at the first-ever National Forum on Disability Issues held in Columbus, OH, on July 26, 2008, the 18th anniversary of the signing of the landmark ADA into law by George H. W. Bush, the 41st president. The forum was a non-partisan venue moderated by broadcast journalist Judy Woodruff that featured Senator Tom Harkin (D-IA) as a live surrogate for the presumptive Democratic presidential nominee, Sen. Barack Obama. Sen. John McCain, the presumptive Republican presidential nominee, appeared via a satellite link from Arizona.
As I sat in the audience noticing those surrounding me with spinal cord injuries, cerebral palsy, Down syndrome, congenital limb deformities from thalidomide, blindness, and deafness, I could not help but wonder how the courts currently define "disabled." Sen. Harkin, a chief sponsor of the ADA and Sen. Obama's senior disability advisor, explained how a series of Supreme Court decisions have narrowed the scope of who is currently considered disabled. Mitigating measures must now be considered in determining whether an individual's impairment substantially limits a major life activity. This means that the use of medications, prosthetics, or other auxiliary devices that enable individuals to more effectively cope with their physical impairments can render them ineligible for protection under the ADA. Sen. Harkin discussed a new bill, the ADA Restoration Act (S. 1881), which he is co-sponsoring. The bill passed in the House last month by a strong non-partisan majority and is expected to be voted on soon by the Senate. This bill aims to reverse many of the Supreme Court's actions by changing the language of the ADA. Finally, Sen. Harkin sought support for the Community Choice Act, a bill co-sponsored by him and Sen. Obama that allows individuals who are eligible for nursing home services or other institutional care to choose whether they wish to receive their care in their own home or community or in an institutional setting.
Next up was Sen. McCain via satellite. He pointed out that the problem with the ADA is not with the interpretive decisions made by the Supreme Court, but rather with the original language contained in the bill. His suggestion was that changes be made to the language. Sen. McCain also voiced his opposition to the Community Choice Act because of concerns regarding funding for the program. He instead emphasized the importance of reforming Social Security to keep it from going "broke" in order to preserve other supplemental programs, such as SSI and SSDI.
After hearing both sides, I was struck by the contradiction posed by much of the existing legislation regarding the disabled. Despite the many transformations in streets, buildings, and transportation in the past 18 years that have helped to integrate people with disabilities into mainstream society, one wonders whether the more successful a person is at coping with a disability, the less likely they are to be protected by the ADA. The disabled represent roughly 20 percent of the voting population with approximately 37 million eligible voters, yet 60 percent are unemployed or under-employed and living below the poverty level.
About the ADA
The Americans with Disabilities Act took effect July 26, 1992.
Under the ADA, private employers, state and local governments, employment agencies, and labor unions are prohibited from discriminating against qualified individuals with disabilities in job application procedures, hiring, firing, advancement, compensation, job training, and other terms, conditions, and privileges of employment.
An individual with a disability is defined by the ADA as a person who:
- Has a physical or mental impairment that substantially limits one or more major life activities
- Has a record of such an impairment
or
- Is regarded as having such an impairment
An employer is required to make an accommodation to the known disability of a qualified applicant or employee if it would not impose an "undue hardship" on the operation of the employer's business.
Employers may not ask job applicants about the existence, nature, or severity of a disability.
Source: The U.S. Equal Employment Opportunity Commission |
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Headlines From Washington
Congress Adds Additional FY 2008 NIH Funding
In July, Congress gave final approval to supplemental appropriations legislation that included $150 million in additional fiscal year (FY) 2008 funding for the National Institutes of Health (NIH). As this issue of The Hematologist went to press, Senators Tom Harkin (D-IA) and Arlen Specter (R-PA) were seeking to build on this victory and were leading efforts to include an additional $500 million in a second FY 2008 supplemental appropriations bill that congressional leaders hope to act upon in September.
FY 2009 NIH Funding at a Standstill
Despite a stated desire by congressional leaders to make significant progress on FY 2009 spending bills prior to the start of the new fiscal year on October 1, the FY 2009 appropriations came to a virtual standstill over the summer. The Senate Appropriations Committee approved a draft FY 2009 Labor-HHS spending bill on June 26 that included a $1.025 billion increase for NIH above the current year's funding level and the President's FY 2009 budget request of $29.3 billion. However, a House Appropriations Committee markup of its version of the FY 2009 Labor-HHS appropriations bill that included $30.38 billion in funding for NIH was ended abruptly amid a partisan dispute over an unrelated bill. House Appropriations Committee Chairman David Obey (D-WI) has since indicated that, as a result of the partisan divide, there will likely not be any additional House action on FY 2009 spending bills. Because of the breakdown of the process in the House, it is unlikely that final FY 2009 appropriations bills — including Labor-HHS — will get completed this year and will instead be postponed until the next Congress.
The Society encourages all members to visit the ASH Advocacy Center for the latest news on NIH funding and to take action to support increased funding for NIH.
Medicare Legislation Becomes Law; Physician Advocacy Efforts Successful
Congress overrode President Bush's veto of the Medicare Improvements for Patients and Providers Act of 2008 on July 15, 2008. As a result, the mid-year 2008 Medicare Physician Fee Schedule (MPFS) rate of -10.6 percent has been replaced with a +0.5 percent update, retroactive to July 1, 2008, and physicians will receive a 1.1 percent increase in fees on January 1, 2009.
Physicians began receiving payment at the 0.5 percent update rates around July 26. For additional information, visit the Medicare Web site.
Congress used this bill as a venue to push forward many of its priorities, including adopting electronic health records, expanding coverage on the "Welcome to Medicare" visit, creating a physician feedback program around value-based purchasing, and increasing bonuses for participation in the Physician Quality Reporting Initiative.
ASH thanks all members who participated in the Society's advocacy efforts to stave off this Medicare crisis. Because this bill does not create a long-term fix for the sustainable growth rate (SGR), ASH will continue to work on this issue to provide stable and appropriate physician payment in the future.
NIDDK Announces October Workshop on Iron Overload: Mechanisms, Measurement, and Management
The Hematology Program at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is planning a two-day workshop on "Iron Overload: Mechanisms, Measurement, and Management." This workshop will take place October 27-28, 2008, in Annapolis, MD, and will address evolving insights into genetic determinants and molecular mechanisms that promote iron overload. The workshop will also review advances in the non-invasive, organ-specific clinical measurement of iron overload and current state-of-the-art prevention and treatment of iron overload. This workshop is designed to promote interactions and discussion among workshop participants, define key unanswered questions, and highlight priorities and directions for future research. The program will include presentations by invited speakers and speakers selected from submitted abstracts, together with poster presentations.
Registration information is available. Individuals who wish to attend this workshop are also invited to contact Amy Amerson of The Scientific Consulting Group at 301-670-4990, or e-mail her at aamerson@scgcorp.com.
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