March 8, 2013

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AACP Advocacy Updates and Alerts

March 8, 2013 

Sequestration in place: Federal agencies are now implementing the funding reductions authorized in the Budget Control Act of 2011 (BCA). Federal grantees and contractors have or will soon receive a letter from The Office of Management and Budget (OMB) stating that cuts are being implemented. The extent and how the cuts will impact individuals are not stated in the letter. The OMB issued a memo on March 1, directing the federal agencies to implement the cuts across each of the agencies programs, projects and activities as set forth in the Balanced Budget and Emergency Deficit Control Act of 1985. Federal agencies are now determining how the $85 billion in funding reductions to discretionary funded programs, projects and activities. The Medicare program is the only entitlement program that will be subject to funding reductions authorized in the BCA.

Federal agencies are attempting to share their approach to reducing program, project and activity funding with the public and stakeholders. The National Institutes of Health, the National Science Foundation, and the Department of Education have placed documents on their respective Web sites that describe how the agency will address the reduction in funding. The Office of Management and Budget sent a report to Congress describing how the federal agencies would be implementing the funding reductions.

Next up, the CR: The federal government is currently operating under a continuing resolution (CR), PL 113‐125, that funds these agencies at FY12 levels through March 27. On Monday, the Chairman of the House Appropriations Committee introduced legislation, HR 933, that continues funding of federal agencies discretionary programs for the remainder of FY13 at a level of $982 billion. This funding total maintains the cuts from sequestration and reduces FY13 funding from the $1.043 trillion authorized in the Budget Control Act of 2011 that established budget caps for discretionary spending through 2021. The House passed the CR on Wednesday, March 6, 2013.

The Senate Appropriations Committee Chairwoman, Barbara Mikulski, has stated her interest in passing the 12 appropriations bills instead of providing agency funding through a continuing resolution. It is expected that the Senate will ultimately pass the House CR.

…and then the Budget: The House and Senate Budget Committees continue to work toward development, debate and potential passage of budget resolutions establishing funding targets for FY14. House Budget Chairman Paul Ryan is expected to introduce his FY14 budget package next week. Senate Budget Chairwoman Patty Murray is expected to introduce her FY14 budget package next week as well. The President’s budget recommendation was supposed to be submitted to Congress the first Monday in February. It is now anticipated the President’s budget will be submitted toward the end of March.

HHS publishes final rule for essential health benefits: The U.S. Department of Health and Human Services published a final rule that includes the list of benchmark health insurance plans. Each state selected a plan that will serve as the standard for all health plans in the health insurance exchanges. In most states this standard is based on the plan with the largest enrollment in a plan that provides a small group product. The final rule was published in the February 25, 2013 edition of the Federal Register.

AHRQ compiles patient safety strategies: The Agency for Healthcare Research and Quality (AHRQ) has complied 22 patient safety strategies into Making Health Care Safer II, an Updated Critical Analysis of the Evidence for Patient Safety Practices. This compilation of evidence‐based approaches to improving patient safety also includes recommendations for further research where gaps in knowledge increase healthcare risk.

Help pharmacies improve patient safety: The Agency for Healthcare Research and Quality (AHRQ), as part of its patient safety strategies, makes a survey available to pharmacies to determine the patient safety culture of individual organizations. Experiential directors and continuing education faculty should consider this as an essential resource to share and implement with their pharmacy partners.

Provide comments on patient safety data format: The National Quality Forum (NQF) is seeking public comment on the common format for submitting patient safety data. This version 1.2 of common format for acute hospital reporting of patient safety data is a result of review and refinement by the Agency for Healthcare Research and Quality (AHRQ) based on the public comments received on an earlier version of the common format for acute hospital reporting. Providing patient safety data, for events that include "…all patient safety concerns including incidents, near misses or close calls and unsafe conditions," in a common format improves provider, institution and patient capacity to reduce the risk of such events. The data is also used by Patient Safety Organizations that are authorized to assist hospitals with high readmissions rates address the root cause of those rates.

CMS announces 20 new CCTP partners: On Thursday, the Centers for Medicare and Medicaid Services (CMS) announced 20 new partners in the Community‐based Care Transitions Program (CCTP). The CCTP was authorized in the Affordable Care Act (PL 111‐148) and is a component of the Partnerships for Patients strategy for improving care quality for Medicare beneficiaries. With the twenty new sites there are a total of 102 CCTP partners. Community‐based organizations, with priority given to area agencies on aging, are paid a flat fee for all‐inclusive care that focuses on reducing readmission, efficient and effective transitions from one care setting to another and using existing community resources to improve patient care across the continuum of care for Medicare beneficiaries.

If your institution is part of the new or existing CCTP sites, or if your institution was part of the development team or will be part of the CCTP evaluation team please share that information with Will Lang.

Moving from FFS to value‐based payment: The National Commission on Physician Payment Reform released a report on March 4, 2013 that offers recommendations for improving health care quality by changing the way physicians are paid. The Report of the National Commission on Physician Payment Reform includes 12 recommendations that "provide a five‐year blueprint for transitioning to a blended payment system that will yield better results for both public and private payers, as well as patients."

Two recommendations are of particular interest:

Recommendation #1 "Over time, payers should largely eliminate stand‐alone fee‐for‐service payment to medical practices because of its inherent inefficiencies and problematic financial incentives."

Recommendation #8 "Fixed payments should initially focus on areas where significant potential exists for cost savings and higher quality, such as care for people with multiple chronic conditions and in‐hospital procedures and their follow‐up."

AACP members engaged with partners in the development of integrated care delivery systems should find the report a useful resource.

Share your work!: The Patient‐Centered Primary Care Collaborative (PCPCC) is seeking examples of how health professionals are being educated to participate in primary health care homes. Pharmacy faculty are asked to share their curricula and other educational materials with others by going to the PCPCC Web page and completing the form. Faculty may submit their information through April 30, 2013.

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