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LOBBYING REPORT |
Lobbying Disclosure Act of 1995 (Section 5) - All Filers Are Required to Complete This Page
2. Address
Address1 | 1000 NORTH OAK AVENUE |
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City | MARSHFIELD |
State | WI |
Zip Code | 54449 |
Country | USA |
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5. Senate ID# 57830-12
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6. House ID# 352550000
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TYPE OF REPORT | 8. Year | 2013 |
Q1 (1/1 - 3/31) | Q2 (4/1 - 6/30) | Q3 (7/1 - 9/30) | Q4 (10/1 - 12/31) |
9. Check if this filing amends a previously filed version of this report
10. Check if this is a Termination Report | Termination Date | |
11. No Lobbying Issue Activity |
INCOME OR EXPENSES - YOU MUST complete either Line 12 or Line 13 | |||||||||
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12. Lobbying | 13. Organizations | ||||||||
INCOME relating to lobbying activities for this reporting period was: | EXPENSE relating to lobbying activities for this reporting period were: | ||||||||
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Provide a good faith estimate, rounded to the nearest $10,000, of all lobbying related income for the client (including all payments to the registrant by any other entity for lobbying activities on behalf of the client). | 14. REPORTING Check box to indicate expense accounting method. See instructions for description of options. | ||||||||
Method A.
Reporting amounts using LDA definitions only
Method B. Reporting amounts under section 6033(b)(8) of the Internal Revenue Code Method C. Reporting amounts under section 162(e) of the Internal Revenue Code |
Signature | Digitally Signed By: Brent V. Miller. Director of Federal Government Relations |
Date | 07/16/2013 |
LOBBYING ACTIVITY. Select as many codes as necessary to reflect the general issue areas in which the registrant engaged in lobbying on behalf of the client during the reporting period. Using a separate page for each code, provide information as requested. Add additional page(s) as needed.
15. General issue area code BUD
16. Specific lobbying issues
The Budget Control Act of 2011(PL 112-25) required mandatory across-the-board reductions in Federal spending effective January 1, 2013, known as sequestration. The American Taxpayer Relief Act of 2012 postponed sequestration for 2 months,but after this time elapsed, President Obama issued a sequestration order on March 1, 2013. Under this order Medicare FFS claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will incur a 2 percent reduction in Medicare payment.
Consolidated and Further Continuing Appropriations Act, 2013, HR 933. Funding for the federal government was set to expire on March 27, under the terms of a six month continuing resolution (HJ Res 117) approved September 28, 2012. The Continuing Resolution kept in place spending targets established in the 2011 debt limit deal known as the Budget Control Act. It also left in place provisions calling for mandatory sequestration of federal spending applied to domestic and discretionary spending.
The House Republican fiscal 2014 budget blueprint, (H. Con. Res. 25), called "the Path To Prosperity" written by Rep. Paul Ryan. The fiscal year 2014 budget resolution (H. Con. Res. 25) would turn Medicare into a premium support system beginning in 2024 for those born in 1959 or later. In addition, the House proposal would block-grant Medicaid and cut program spending by $810 billion over 10 years and repeal large parts of the Affordable Care Act. It would keep the taxes associated with the health care reform law, however, as well as the $716 billion in Medicare cuts it contains.
The Senate Budget Resolution (S. Con. Res. 8) written by Senator Patty Murray, (D-WA) chair of the Senate Budget Committee would reduce Medicare spending but does not include structural program reforms. The Senate resolution contains $275 billion in largely unspecified healthcare cuts over 10 years, calling for accelerating delivery system and payment reforms, reducing waste and fraud, and encouraging greater provider engagement. The Senate budget would also repeal the Medicare physician sustainable growth rate, but offers no replacement mechanism. The Senate budget would cut $1.85 trillion from the federal deficit and replace the sequestration required by the Budget Control Act until 2021 by raising $975 billion in new tax revenue over the next 10 years while enacting new spending cuts, including the healthcare cuts.
AmeriCorps Funding: Afterschool Health Services Program
The primary focus is an Afterschool Health Services Program, which provides the infrastructure for communities to work collaboratively to improve health of youth in afterschool settings. This approach recognizes afterschool programs as a credible venue for health improvement as our nation moves forward with health care reform. This approach also takes into account the research base that demonstrates that a quality education is a number one determinant to good health. Marshfield Clinic will support legislation to implement quality services in afterschool settings that include case management of individual youth to promote academic success, personal/social development and health/wellness. This will include access to clinical services designed to meet the identified needs of enrolled youth i.e. early and periodic screening, well-child visits, immunizations, behavioral health appointments/treatment plan compliance, dental screening and sealants, asthma case management; Evidence-based programs, practices and policies targeting identified health priorities i.e. alcohol and other substance use and addiction, high-risk sexual behavior, intentional and unintentional injuries and violence, overweight, obesity and lack of physical activity, tobacco use and exposure; Release of information forms and written consents signed by parents prior to services.
AmeriCorps Funding: Healthy Lifestyles Program
There is a need for strategic action at the federal level to counter the obesity epidemic in our nation. Chronic diseases related to obesity such as diabetes, heart disease, high blood pressure and certain cancers are the leading causes of premature death and disability. Unless the obesity epidemic can be curbed, the life expectancy of future generations will be compromised. Programs, practices and policy approaches that have been effective in the adult population such as employee wellness and policies promoting physical activity must be implemented early in life to redirect obesity inducing habits and behaviors in children. Marshfield Clinic will support legislation to implement policies that take a comprehensive approach to obesity prevention, addressing nutrition and physical activity in a broad variety of environments including communities, businesses and schools.
Community Health Center Funding Dental Access
Wisconsins current record of providing dental care to children from poor households is among the worst in the nation. In 2010, by matching a $10 million contribution from Security Health Plan, the State of Wisconsin partnered with Marshfield Clinic to build a rural dental education outreach facility. The facility is needed to support plans to develop residency and post-baccalaureate training programs and a dental student programs. This is part of a larger initiative, the primary purpose of which is to improve the oral and general health of underserved residents in rural and small urban communities. Marshfield Clinic in partnership with Family Health Center of Marshfield, Inc. is currently operating 8 dental clinics and has another one in planning. The dental facilities provided access to more than 41,000 predominately low-income uninsured or publically insured residents last year. Marshfield Clinics proposed dental education programs could expand this to over 120,000 low-income patients in our system alone, while helping to train Wisconsins future rural dental workforce.
17. House(s) of Congress and Federal agencies Check if None
U.S. HOUSE OF REPRESENTATIVES, U.S. SENATE, Health & Human Services - Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC)
18. Name of each individual who acted as a lobbyist in this issue area
First Name | Last Name | Suffix | Covered Official Position (if applicable) | New |
Brent |
Miller |
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19. Interest of each foreign entity in the specific issues listed on line 16 above Check if None
LOBBYING ACTIVITY. Select as many codes as necessary to reflect the general issue areas in which the registrant engaged in lobbying on behalf of the client during the reporting period. Using a separate page for each code, provide information as requested. Add additional page(s) as needed.
15. General issue area code MMM
16. Specific lobbying issues
Many aspects of the Affordable Care Act promote changes that are consistent with the mission of the Marshfield Clinic:
Extends health insurance to the uninsured
Establishes the Patient-Centered Outcomes Research Institute to support comparative effectiveness research
Imposes necessary regulations on Insurers banning rescissions and exclusions for pre-existing medical conditions limits
Expands Medicaid Eligibility to 133% of FPL
Creates state based Health Insurance Exchanges for individuals between 133% - 400% of Federal Poverty level (FPL)
Increases practice expense payments,
Calls for IOM study to Correct Geographic payment disparities
Calls for CMS to establish a Value Index to align payment with quality
Establishes Bonus payments for primary care, efficiency, quality
Calls for Value Based Purchasing for all providers
Calls for the establishment of Accountable Care Organizations
Establishes a Center for Medicare and Medicaid Innovation to test innovative payment and delivery models
The following are key elements of the health policy agenda of the Marshfield Clinic:
Value Based Purchasing
The concept of value-based health care purchasing is that buyers should hold providers of health care accountable for both cost and quality of care. Value-based purchasing brings together information on the quality of health care, including patient outcomes and health status, with data on the dollar outlays going towards health. It focuses on managing the use of the health care system to reduce inappropriate care and to identify and reward the best-performing providers. Recommendations:
Medicare and other payors must capture the data on performance measures utilizing available claims-based data, and/or data recoverable through enhanced IT functions, and validate performance improvement.
Implement quality/efficiency based payments for physician services as soon as possible.
Implement bundled payments for episodes of care.
Implement FFS reimbursement for the value added through care management and coordination of services.
Improve reimbursement for primary care services.
Comparative Effectiveness/Evidence Based Medical Informatics Research
Evidence-based medicine relies upon the judicious use of current best evidence in making decisions about the care of individual patients. Key to effective implementation of value-based purchasing initiatives is the systematic development of data that links the health of populations to the medical services the population receives. The application of health information technology and genomic information in population- and community-based health care delivery systems coupled with the development of wellness programs has the potential to substantially improve health and personalized health care on a national basis. Recommendation: Promote evidence-based medicine as the basis for coverage decisions.
Advance Care Planning -- Medicare and Medicaid must incorporate advance care planning to respect and inform all caregivers of a patients healthcare choices at the end stages of their lives. It is important that the Federal programs improve the continuity of care and quality of life while maintaining respect for patients wishes. Understanding and honoring patients wishes at the end of life is paramount to ensure they are receiving appropriate care that is aligned with the personal choice and goals. Advance care plans are not necessarily a one-time conversation, but an ongoing dialogue between a patient and health provider. Honoring patient desires and wishes at the end-of-life reduces the burden on family members that would otherwise have to make those difficult decisions. An advance care plan must be easily accessible in their medical record. Research indicates that engaging patients on their end-of-life care and following their wishes and desires may reduce healthcare costs. We urge Congress to incorporate advance care planning discussions with health providers as a covered Medicare and Medicaid annual wellness benefit. There may or may not cost savings achieved depending on an individual patients wishes. More importantly, the discussions are necessary to assure that an individual patients desires for care at the end of life are being met and respected.
Variations in Health Care Service and Distribution
Research conducted the Medicare Payment Advisory commission and the Dartmouth School of Medicine has documented glaring variations in how medical resources are distributed and used in the United States. Medicare pays many hospitals and their doctors much more than what it pays the most efficient and effective health care institutions to treat chronically ill people, yet they still get worse results. The extent of variation in Medicare spending, and the evidence that more care does not result in better outcomes, should lead us to ask if some chronically ill Americans are getting more care than they actually want or need. Caring for people with chronic disease now accounts for more than 75 percent of all health-care spending. Over-use and overspending is not just a Medicare problem-the health-care system as a whole lacks efficient, effective ways of caring for people with severe chronic illnesses. If the U.S. health care system mirrored the practice patterns of the most efficient/effective health care institutions, Medicare and other payors could save billions of dollars annually.
Sustainable Growth Rate
We believe that the longstanding challenges inherent in fee for service reimbursement under the resource based relative value system, and the financial problems associated with the sustainable growth rate (SGR) formula must be addressed to assure access to Medicare benefits and the future solvency of the Medicare program. We recommend that Congress repeal the SGR formula, and link future updates to measures that reflect the cost and value of providing health care services. Congress must also take steps immediately to create increased incentives for preventative care, care coordination, and primary care services. Physician spending is currently only a fraction of total health care spending but it affects nearly all other aspects of health care delivery. We recommend that Congress utilize the leverage of physician spending to deal with the misaligned incentives in the Medicare program that lead to higher costs and inefficiencies throughout the spectrum of health care delivery. On Feb 7, the House Energy and Commerce & Ways and Means Committees released an outline of a collaborative Medicare Physician Payment Reform Effort. Their leaders are united in a collaborative efforts to repeal the Sustainable Growth Rate (SGR) formula and advance a permanent solution for Medicare physician payment. Their proposal seeks to: Repeal the SGR and provide a period of predictable, statutorily-defined physician payment rates; Reform Medicares fee for service (FFS) physician payment system to reward physicians who provide high quality care; and Build upon the improvements made in Phase 2 by also rewarding physicians who deliver efficient care.
Medicare Payment Inequities-- In the traditional fee-for-service system Medicare currently reimburses for units of service, in a manner that promotes service utilization without regard to quality. This has had the effect of economically stimulating growth in the numbers of supply-sensitive services provided by physicians. The Update formula for physician services is inequitable because it treats all physicians and regions of the country alike regardless of their individual volume influencing behavior. If the problem of cost is related to the volume of services provided, shouldnt payment be volume adjusted for specific localities? Why should conservative practices and States be punished for the excessive volume of other localities?
Payment Equity for Physician Work -- There is no difference in the work of physicians in different locations regardless of where the work occurs. We believe that physician work should not be adjusted for geographic location. What is the rational for paying physicians more in many geographic areas when those same areas have apparently ample numbers of physicians and their wages are trending below physician wages in other areas? Should the Medicare program subsidize physicians who chose to live in high cost areas? Recommendation: the geographic adjustment of physician work should be eliminated entirely on a Budget neutral basis.
Medicare Advantage Performance Measurement --The Medicare Advantage program provides a capitated reimbursement to health plans for all Medicare benefits provided to enrolled beneficiaries. We believe that mechanisms for rewarding value in the Medicare Advantage program should offer incentives for those plans that demonstrate superior patient care performance. We recommend that performance bonuses should be provided for plans that: Achieve predetermined quality performance targets; Adopt health information technology; Meet standards for care coordination; and Provide data on comparative effectiveness. Security Health Plan of Wisconsin, Inc., was one of only two health plans in the nation to be recognized for the second year in a row with the highest rating of 5 stars from the Centers for Medicare and Medicaid Services (CMS) for its Advocare Medicare Advantage plans for 2012. Only eight other plans across the nation this year received a 5-star rating from CMS. The ratings, now available on the Medicare website, are the result of an annual assessment by CMS of Medicare health plans' clinical quality, consumer satisfaction and other beneficiary experience areas. We fully support the continuation of this program, and the financial rewards provided to health plans that perform at the highest level.
Medicare Advantage Call Letter
On Feb 15 2013, CMS released the "Call letter"- its annual advance notice regarding 2014 Medicare Advantage and Part D plan rates. In the Call letter: CMS described changes in the MA national per capita growth percentage for aged and disabled enrollees, and change in fee-for-service per capita costs; coding adjustment for MA plans; payment rebate amounts for plans; and an updated model of its CMS-HCC risk adjustment formula to reflect updated data and clinical revisions to diagnoses. Analysts have projected that the combined effect of the many changes could lead to Medicare Advantage payment adjustments netting negative 8-10%. Marshfield Clinic expressed the concern that the combined effect of the slate of reductions in the Call Letter will destabilize the Medicare Advantage program and undermine beneficiaries faith in their plans. The Clinic recommended: that CMS delay implementing any change to the county FFS rebasing methodology; override the SGR formula, consistent with the emerging consensus regarding a shift to payment for value; recommended a delay in implementing a new HCC risk adjustment model; recommended postponement of changes to the star ratings calculations.
Medicaid Block Grants On March 21, the House approved Rep. Paul Ryans budget proposal for FY 2014, entitled "The Path to Prosperity. Ryan's proposal does not have the force of law but of special interest is Ryans proposal for Medicaid block grants which will come before the Energy and Commerce Committee. Under the Ryan proposal, starting in 2014, the federal share of all Medicaid payments would be paid to the states as a block grant. Chairman Ryan has projected savings to federal government that would result from reduced funding to states.
Premium support On March 21, the House approved Rep. Paul Ryans budget proposal for FY 2014, entitled "The Path to Prosperity. Ryan's budget does not have the force of law but tees up consideration of various reform proposals which may be considered later this year. With regard to health care, the Ryan plan calls for a major withdrawal of the federal government from the financing of health care. One health provision of the proposal calls for conversion of the current Medicare to a premium support program. For those born in 1959 or later the traditional Medicare program starting in 2024, would be converted to a defined contribution program which has been described as a premium support program.
Dual Eligibles -- Conflicting requirements in Medicare and Medicaid pose a barrier to care coordination for 9 million beneficiaries who are eligible for both Medicare and Medicaid (dual eligibles or duals). The lack of alignment and cohesiveness between the programs can lead to fragmented or episodic care for dual eligibles and misaligned incentives for both payers and providers, resulting in reduced quality and increased costs to both programs. Total annual spending on dual eligibles is estimated to be $300 billion annually. The Patient Protection and Affordable Care Act (PPACA) presents an array of new and enhanced options to improve care for these beneficiaries through better care integration, improved quality measures, and increased access to home and community-based long-term services and support. We would support better alignment of benefits and incentives to improve access to care for dual eligibles and prevent cost-shifting. Changing the incentives to encourage integrated care will result in better health outcomes at a lower cost.
Accountable Care Organizations --The Affordable Care Act seeks to improve the quality of health care services and to lower health care costs by encouraging providers to create integrated health care delivery systems. These integrated systems will test new reimbursement methods intended to create incentives for health care providers to enhance health care quality and lower costs. One important delivery system reform is the Medicare Shared Savings Program under section 3022 of the Affordable Care Act, which promotes the formation and operation of accountable care organizations (ACOs). Under this provision, groups of providers meeting the criteria specified by the Secretary may work together to manage and coordinate care for Medicare beneficiaries through an [ACO]. An ACO may receive payments for shared savings if the ACO meets certain quality performance standards and cost savings requirements established by the Secretary.
Adequate Funding for CMS -- The problems facing the Medicare program stem from the nations earliest attempts to make health care services broadly available nationwide without disturbing the economic incentives that were then in place. Congress must ensure that CMS has adequate funding to provide oversight of its many programs, including its measurement of resource and input costs and full implementation of the Affordable care Act.
Telemedicine in Medicare -- Changes to Medicare law and regulation are needed to improve equity in access for Medicare beneficiaries to services delivered via TeleHealth. Medicare beneficiaries should be allowed to receive services in telemedicine sites located in urban areas. The necessary changes would remove restrictions on originating sites by removing the rural requirement and the list of originating sites and allowing any certified Medicare facility to provide the services; current requirements that physician must bill for services from the originating site should be removed; restrictions on eligible practitioners should be removed to allow all Medicare approved practitioners to provide telemedicine services; and there should be no restrictions on which Medicare services may be provided through telemedicine. The current payment structure also does not meet Medicares burden of equity. Legislatively, all carve out restrictions on Medicare payment for TeleHealth need to be removed. At a minimum, the geographic requirement that the patient be located outside of a metropolitan statistical area must be removed.
1.Ammend the Medicare requirement for non-MSA geographic location of the patient to allow all Medicare certified organizations as originating sites regardless of rural or metropolitan statistical area designation.
2.Alternative amend the Medicare requirement for non-MSA geographic location of the patient to allow accountable care organizations to be exempt from the MSA requirement.
Telemedicine in ACOUNTABLE CARE ORGANIZATIONS
Marshfield Clinic is Medicares premier Physician Group Practice (PGP) demonstration site, achieving quality and cost savings greater than all nine other programs combined, saving Medicare $118 million dollars over five years. The Accountable Care model (accountable care organization ACO) was designed from Marshfield Clinics experience with PGP. Scientific evidence exists regarding clinical outcomes for patients when access is improved, when patients receive care from the right provider at the right time, and when evidence-based practice is used in a clinically integrated model. Evidence-based practice and clinical integration are the hallmarks of accountable care. Yet, again, the inequitable carve out that Medicare has for payment for services delivered via TeleHealth does not support the constructs of accountable care. In addition, the use of remote monitoring in the Medicare population who experience chronic conditions has shown significant cost savings with avoidable hospitalizations and complications. Yet, no payment policies exist for the use of remote monitoring as a component of a comprehensive strategy to engage patients and support the goals of meaningful use, care coordination, and accountable care.
1.Exempt accountable care organizations from any restrictions on the use of Telehealth and allow ACOs to bill and be compensated for care delivered to patients via TeleHealth equal to in-person care including the facility fee.
2.Legislative mandate that CMS develop a payment structure for remote monitoring used as a strategy to improve quality and reduce costs (admissions, re-admissions, days of stay, Emergency Department visits) for ACOs for FY 2014.
HEALTH RESOURCE SERVICE ADMINISTRATION (HRSA) HEALTH INSURANCE MARKETPLACE
The federally mandated health insurance exchange managed by HRSA, the Health Insurance Marketplace, will go into effect on October 1, 2013, offering insurance coverage to millions of Americans currently without insurance or with high cost plans. There is currently no information available as to whether the plans included in the marketplace are required to pay for services delivered via TeleHealth. The lack of clarity will create significant barriers to care for enrollees in the marketplace plan.
1.Legislative mandate that all participating insurance carriers and health plans in HRSAs Health Insurance Marketplace, have comprehensive coverage for services delivered via Telehealth, including facility fees, equal to payment for in-person care.
Community Health Centers Under Health Reform
The Affordable Care Act contained a number of key provisions relating to community health centers, including $11 billion of new funding for the community health center program over five years and $1.5 billion over five years to expand the National Health Service Corp. While these are mandatory funding levels, the Congress did cut the base funding levels for community health centers and it is possible that they may do so again effectively further diminishing the impact of the reform legislation. As reform is rolled out there are key payment protections and improvements for community health centers. For example, the Act requires that health centers receive no less than their Medicaid rate from private insurers offering plans through the new health insurance exchanges and it requires that these plans must, under network adequacy rules, contract with a sufficient number of essential community providers, the definition of which includes health centers. Other provisions add preventive services to the federally qualified health center Medicare payment rate and eliminate the outdated Medicare payment cap on FQHC payments. The ACA recognizes the growing role of health centers in teaching the next generation of primary care providers by authorizing and funding new programs for health center-based residencies. A new Title VII grant program for the development of residency programs at health centers is established along with a new Title III program that would provide payments to community-based entities that operate teaching programs. It directly appropriates $230 million over five years for the new Title III payment program. Marshfield Clinic supports the continuation of this funding.
Dental Access and Integration with Traditional Medicine
The Institute of Medicine (IOM) released a report, Dental Education at the Crossroads: Challenges and Change in January 1995 which called for a strong cohesion between medicine and dentistry. The IOM report states that "Dentistry will and should become more closely integrated with medicine and the health care system on all levels: research, education, and patient care. The National Institutes of Health has supported research documenting the importance of oral health in the context of general health and well being. Studies have demonstrated numerous oral-systemic interactions that underscore the need for more integrated care delivery. As our nation embraces EHR technologies, science underscores the need to fully incorporate oral health within an integrated EHR. Marshfield Clinic has developed a comprehensive medical-dental integrated electronic health record (iEHR) environment. CattailsMD, the internally developed electronic health record at Marshfield Clinic in Wisconsin, is one of the oldest electronic medical records systems in the country, with coded diagnoses back to 1960. More recently a dental module, CattailsDental has been integrated and successfully rolled out in all of the seven dental centers across Central and Northern Wisconsin.
GME Residency Expansion -- Marshfield Clinic is concerned about having a sufficient supply of primary care physicians in order to meet the demands of an expanding and aging population. This is doubly true for patients and health systems in a rural setting. Currently only about 10% of physicians practice in rural areas while 25% of the population resides there. While 36% allopathic residents and 50% osteopathic residents who are trained in a rural residency end up practicing in a rural area, only 4% of the residency training actually occurs in rural areas. As of 2012, there are more US medical students graduating from medical school than there are GME slots. An increase in GME primary care training positions is essential to maintaining high-quality, accessible, and cost efficient care.
GME Funding Models Should Include Non-Hospital Sites and Interprofessionalism --As a rural community based GME partner, Marshfield Clinic would welcome an opportunity to collaborate with Health and Human Services and other external GME partners in developing and implementing strategies for effective use of CMS and HRSA funding for expanding graduate medical education programs. This could include a shift from hospital based payment mechanisms for GME to ambulatory and community health center training locations. This would particularly help rural and underserved areas establish GME training programs. Additionally, given that teaming in healthcare is an essential element of achieving cost and quality opportunities, incentives should be developed for programs that incorporate inter-professional, team based training programs, and iEHR training.
Oral Health Coverage for the Medically Compromised and at Risk Populations --There is sufficient data that demonstrates oral health impacts the systemic health of the patient and in doing can reduce the cost of care. Linkages that encourage patient compliance, patient education, provider education, and bi-directional referral and surveillance should be incented and compensated. Shared savings demonstrations should be developed for health systems and co-pay incentives developed for patients engaging in and complying with such inter-disciplinary care.
Simulation Program Development --The Accreditation Council on Graduate Medical Education (ACGME) Program Requirements for Resident Education in Internal Medicine has recommended that residency programs need to Provide residents with access to training using simulation. Marshfield Clinic will support legislation to initiate, maintain and grow medical simulation programs through the identification of simulation centers of excellence, advancement of simulation technologies, allocation of grant funds for institutions who train healthcare providers and call together key leaders to discuss the direction of medical simulation.
Loan Forgiveness -- Congress must continue to fund loan forgiveness for health profession shortage areas. The program funding should be regardless of HPSA ranking to ensure rural areas as well as urban areas can attract and staff an adequate workforce.
S.T.E.M. Programming in High Schools and Colleges -- As workforce demands increase for professionally trained healthcare workers and as professional training programs continue to escalate in costs, creating under-graduate student Science, Technology, Engineering, and Mathematics (STEM) pipelines from rural and underserved areas using focused educational undergraduate programming will be essential to aid timely graduation and to ensure a robust pool of applicants into professional programs while limiting cost escalation through extraneous credits. The Department of Education should work in partnership with HRSA to promote change within accrediting bodies and states to create such programming. Distance learning technology should be seen as an alternative to cost prohibitive face to face curriculum. Incentives should for incorporating such technology should be considered.
Meaningful Use of Health Information Technology -- As information technology has sparked this explosive growth in knowledge, only information technology can provide an adequate response. By using evidence-based knowledge embedded in clinical decision support deployed within a well-designed workflow, physicians can manage the ever changing and growing knowledge base critical to the delivery of effective and efficient healthcare. Health IT on a broad basis is still in its infancy. Looking to what can be achieved in the future due to implementation of these systems should be our focus, and an ongoing oversight function of the Office of the National Coordinator for HIT which must be closely integrated with Medicare reimbursement.
Personalized Medicine Personalized medicine, the tailoring of medical treatments to patient characteristics, relies upon the ability to classify individuals into subpopulations that differ in disease susceptibility and treatment responses. It allows clinicians to target preventive or therapeutic interventions on those who will benefit, and thereby to spare the expense and side effects of treatment for those who will not, thus making medicine more efficient. If the multiple population groups in the United States and elsewhere in the world are to benefit fully and fairly from such research, a national resource operated as a trust for the public good must be established to conduct a large populationbased cohort study that includes full representation of minority populations. The Federal government should make critical investments in the enabling tools and resources essential to moving beyond genomic discoveries to personalized medicine services of patient and public benefit.
17. House(s) of Congress and Federal agencies Check if None
U.S. HOUSE OF REPRESENTATIVES, U.S. SENATE, Centers For Medicare and Medicaid Services (CMS), Health & Human Services - Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), White House Office
18. Name of each individual who acted as a lobbyist in this issue area
First Name | Last Name | Suffix | Covered Official Position (if applicable) | New |
Brent |
Miller |
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19. Interest of each foreign entity in the specific issues listed on line 16 above Check if None
LOBBYING ACTIVITY. Select as many codes as necessary to reflect the general issue areas in which the registrant engaged in lobbying on behalf of the client during the reporting period. Using a separate page for each code, provide information as requested. Add additional page(s) as needed.
15. General issue area code HCR
16. Specific lobbying issues
Federally Facilitated Exchange Policy Issues
Federally Facilitated Exchanges should take into account quality when serving up consumer plan results beginning with the first open enrollment period in 2013.
Rather than waiting until 2016 to show quality ratings, the Federally Facilitated Exchange should display quality data for plans as soon as it is available to assist consumers in making a high quality plan choice. This aligns with the Triple Aim of improving the quality of care, reducing the cost of care and improving the experience.
Federally Facilitated Exchanges should recognize the marketplace contributions of community-based insurers and should work to ensure regulations do not unduly favor national carriers. Community based carriers ensure a vibrant and competitive marketplace and often have more member-centric service philosophies.
Community Engagement for Healthy Lifestyles Coalitions, Afterschool, AmeriCorps and Community Organizations
Improving the health of an entire community goes beyond doctor-patient visits, to population health efforts directed at vulnerable populations. Marshfield clinic believes that high quality afterschool programs are a credible venue to improve the health and education of children and communities. Afterschool programs are poised to assist children to develop and reinforce lifelong healthy habits to stem the tide of chronic disease and to reduce the incidence of lifestyle related disease related to alcohol, tobacco and other substance abuse; high risk sexual behavior; intentional and unintentional injuries and violence; overweight, obesity and lack of physical activity; and, tobacco use and exposure. There is a critical need for strategic action at the federal level to counter the obesity epidemic in our nation. Chronic diseases related to obesity such as diabetes, heart disease, high blood pressure and certain cancers are the leading causes of premature death and disability. Unless the obesity epidemic can be curbed, the life expectancy of future generations will be compromised. Programs, practices and policy approaches that have been effective in the adult population such as employee wellness and policies promoting physical activity must be implemented early in life to redirect obesity inducing habits and behaviors in children. Evidence shows that physical activity and nutrition policies and programs can decrease obesity levels and promote life-long healthy habits in children. Marshfield Clinic will support legislation to implement policies that take a comprehensive approach to obesity prevention, addressing nutrition and physical activity in a broad variety of environments including communities, businesses, schools and afterschool programs. Marshfield Clinic supports federal funding designed to improve the health and education outcomes of youth, children and families. Examples of funding streams that are of particular importance include: Corp for National Service AmeriCorps Program; Department of Education 21st Century funding; and, the Department of Health and Human Services Child Care Development Block Grant; Center for Disease Control Childhood Obesity Prevention and Community Transformation grants; etc.
Privacy and Security provisions of ARRA -- The American Recovery and Reinvestment Act expands current Federal privacy and security protections for health information. Marshfield clinic has specific concerns about:
Providing transparency to patients by allowing them to request an audit trail showing all disclosures of their health information- including treatment, payment and operations- made through an electronic record. Electronic health record (EHR) users or maintainers must provide requesting individuals with an accounting of protected health information disclosures made during the three years prior to the request (but only for as much of that three year period during which the EHR was in use). Marshfield Clinic is concerned about the costs and administrative burdens of this provision.
Covered entities must comply with requests to restrict the disclosure of an individuals protected health information if the disclosure is to a health plan for purposes of carrying out payment or health care operations and the information pertains solely to a health care item or service paid for out-of-pocket by the individual. Marshfield Clinic is concerned about the potential costs and administrative burdens of this provision.
In using, disclosing or requesting protected health information, covered entities must limit themselves, to the extent practicable, to limited data sets or the minimum necessary information. Marshfield Clinic is concerned about the potential costs and administrative burdens of this provision.
Marshfield Clinic supports provisions strengthening enforcement of Federal privacy and security laws by increasing penalties for violations and providing greater resources for enforcement and oversight activities.
Meaningful Use of health information technology -- On December 30, 2009, the Centers for Medicare & Medicare Services (CMS) and the ONC released two regulations required by the American Recovery and Reinvestment Act that lay the foundation for "meaningful use" of certified electronic health record (EHR) technology. Proposed rules issued by CMS outline provisions governing the EHR incentive programs, including defining the central concept of "meaningful use" of EHR technology. Final regulations issued by ONC set initial standards, implementation specifications, and certification criteria for EHR technology. Marshfield Clinic is vendor of a proprietary electronic medical record, and closely follows federal developments of the HHS office of the national coordinator and the HIT Policy and Standards Committees to assure meaningful use of electronic medical records and efficient standards for certification and interoperability of unrelated systems
17. House(s) of Congress and Federal agencies Check if None
U.S. HOUSE OF REPRESENTATIVES, U.S. SENATE, Centers For Medicare and Medicaid Services (CMS), Health & Human Services - Dept of (HHS)
18. Name of each individual who acted as a lobbyist in this issue area
First Name | Last Name | Suffix | Covered Official Position (if applicable) | New |
Brent |
Miller |
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19. Interest of each foreign entity in the specific issues listed on line 16 above Check if None
Information Update Page - Complete ONLY where registration information has changed.
20. Client new address
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21. Client new principal place of business (if different than line 20)
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22. New General description of client’s business or activities
LOBBYIST UPDATE
23. Name of each previously reported individual who is no longer expected to act as a lobbyist for the client
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ISSUE UPDATE
24. General lobbying issue that no longer pertains
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AFFILIATED ORGANIZATIONS
25. Add the following affiliated organization(s)
Internet Address:
Name | Address |
Principal Place of Business (city and state or country) |
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26. Name of each previously reported organization that is no longer affiliated with the registrant or client
1 | 3 | 5 |
2 | 4 | 6 |
FOREIGN ENTITIES
27. Add the following foreign entities:
Name | Address |
Principal place of business (city and state or country) |
Amount of contribution for lobbying activities | Ownership percentage in client | ||||||||||
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28. Name of each previously reported foreign entity that no longer owns, or controls, or is affiliated with the registrant, client or affiliated organization
1 | 5 | 9 |
2 | 6 | 10 |
3 | 7 | 11 |
4 | 8 | 12 |