Report from AcademyHealth Congressional Plenary Session

Report from AcademyHealth Congressional Plenary Session

Budget Threat to AHRQ, Health Care Fraud and Thwarting Bundled Payments for Drugs

Despite their strong sense of connection to the Agency for Healthcare Research and Quality (AHRQ), the country's health services researchers have failed to express adequate public support for that agency at a time it is being threatened with closure by Congress, according to top Congressional committee staffers at the AcademyHealth National Health Policy Conference.

Hoag Levins is the Editor of
Digital Publications at the Uni-
versity of Pennsylvania's Leon-
ard Davis Institute of Health
Economics (LDI).

During the Q&A, AcademyHealth President and CEO Lisa Simpson took to the audience microphone to emphasize the importance of AHRQ and her organization's concern about efforts in Congress to terminate the agency. She asked the six top Congressional staffers who made up the Congressional Plenary panel about the future of AHRQ.

One told her that AHRQ "can probably do a better job" in communicating to Congress the specifics of its value and unique qualities that justify its survival.

'Lacks natural constituencies'
Another said that AHRQ lacks the "natural constituencies" that many other health-related federal agencies have and that one reason for this is that the research community itself has not been publicly vocal enough in its support of AHRQ.

Curiously, after the panel discussion had been in progress for a while, one of its members announced that the entire session was "off the record." This was unusual because normal "off the record" press protocol holds that "off the record" is a "prearranged agreement [that] must be agreed to beforehand, never after."

Meanwhile, nothing said in the hour and a half session seemed particularly political sensitive or revelatory. Indeed, the committee staff members were clearly very guarded in their comments.

Here are some of the general points of the session:

Medicare's siloes
The staffers of both parties appeared to concur that Medicare is mired in an antiquated and rigidly siloed structure -- Parts A through D -- that dates to the 1960s era of medicine. One panelist cited the analogy of employer insurance that would require employees to purchase hospital insurance from one company, a separate policy to cover office visits from another company, a third policy from another insurer for prescription drug coverage, and a fourth policy from yet another company covering a variety of things left out of the previous three policies. "It doesn't make a lot of sense today," noted one panelist.

A second panelist urged researchers in the audience to "think in other ways" and develop data to support ways of moving beyond the Medicare siloes.

At an audience microphone, chiropractor and board member of the Integrative Healthcare Policy Consortium Nancy Gahles asked the panel about the little-publicized Section 2706 of the Affordable Care Act that prohibits a health plan or insurer from "discriminating" against "any health care provider who is acting within the scope of that provider's license or certification under applicable State law."
'Alternative Medicine' funding

Requiring payment for alternative medicine practitioners
Lobbied into the law by the Complementary and Alternative Medicine (CAM) industry, the wording is interpreted by them as prohibiting health plans and insurers from refusing to pay for the services of acupuncturists, chiropractors, massage therapists and other alternative medicine practitioners.

One Congressional panelist noted that many states "aren't aware" of section 2706 and will soon be getting further federal guidance on this issue.

Another audience question came from Commonwealth Fund Vice President of Federal and State Health Policy Rachel Nuzum, who asked the Congressional staffers what "promising and specific" issues currently on their plate with might require additional scientific research.

One panelist pointed out that mental health and traumatic brain injury were subjects of high interest and that staffers were interested in getting any relevant scientific information that would illustrate that "there's an issue there."

Another panelist pointed out that two questions constantly asked around Capitol Hill are how to dramatically reduce health care fraud and how to effectively reduce spending.

A third said that per capita home health care spending in Miami is more than $5,000 at the same time the national average is $500 and that this is good evidence of a fraud problem that "we need to know more about."

Thwarting bundled payments for drugs
Another area of research mentioned was bundled payment programs like one that included efforts to control the overuse of the drug Epogen in cases of end-stage renal disease. The staffer noted that initially, the bundling program reduced use of the drug by 25% but then the pharmaceutical company raised its prices 22%, nearly wiping out all the savings. "We really need help" to figure out how to manage this kind of open-ended system, the staffer said.

Two other areas of potential new research that interest the staffers are the reform of post-acute care reimbursement and the Medicare wage index. A panelist explained that many areas of the country have facilities ranging from long-term acute care hospitals (LTCHs) to home health agencies but that the payments for patients with identical post-acute care needs varies wildly. The staffer said it would be very helpful to have a way to direct patients to more appropriate care settings at consistent reimbursement rates. The staffer said this would be an "enormous task" but "something we're very interested in doing."

Gaming the system
The Medicare Wage Index is a geographically-sensitive factor that adjusts Medicare reimbursements to reflect the varying wage levels in geographically separate health care labor markets. It is common for hospitals to jockey -- sometimes through their Congressional representatives -- to have their Wage Index category reclassified so that they can bill Medicare at a higher rate. The Congressional staffer said that more than a third of hospitals have been reclassified to a rate higher than the prevailing one in their area. The constant squabbling over this issue creates winners and losers among hospitals in a way that has, according to the staffer, created "a huge mess."