|
LOBBYING REPORT |
Lobbying Disclosure Act of 1995 (Section 5) - All Filers Are Required to Complete This Page
2. Address
Address1 | 1000 NORTH OAK AVENUE |
Address2 | |
City | MARSHFIELD |
State | WI |
Zip Code | 54449 |
Country | USA |
3. Principal place of business (if different than line 2)
City | |
State | |
Zip Code | |
Country | |
|
5. Senate ID# 57830-12
|
||||||||
|
6. House ID# 352550000
|
TYPE OF REPORT | 8. Year | 2010 |
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 | |||||||||
---|---|---|---|---|---|---|---|---|---|
12. Lobbying | 13. Organizations | ||||||||
INCOME relating to lobbying activities for this reporting period was: | EXPENSE relating to lobbying activities for this reporting period were: | ||||||||
|
|
||||||||
|
|
||||||||
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 | 07/16/2010 |
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
Provisions of the FY 2009 Budget and Budget Resolution (S Con Res 70 and HR 1105) and related Labor/HHS appropriations legislation regarding funding for the Centers for Medicare and Medicaid Services (CMS) for implementation of the Medicare program and Medicare Advantage Programs, the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans,
and comparative effectiveness research at the Agency for Health Research and Quality (AHRQ).
Labor HHS Appropriations, Appropriations for Community Health Centers, and Increased Funding for Tele-health Activities. Funding for Dental programs in underserved areas. Future funding for Hospital Emergency Department infrastructure in Flambeau, Wisconsin.
Provisions of the American Recovery and Reinvestment Act (HR 1) including appropriations for:
HRSA - $500 M for community health centers; $500M for health professions training; and $200 M for primary care and dentistry programs.
Comparative effectiveness research at NIH $400 M, AHRQ $300M, and HHS $400M. The funding in the conference agreement shall be used to conduct or support research to evaluate and compare the clinical outcomes, effectiveness, risk, and benefits of two or more medical treatments and services that address a particular medical condition.
HHS ONCHIT $2 B, $300 M of which is for regional efforts for health information exchange; remaining funds can be used for: development of certified electronic health records software if HHS sees that the private market does not meet certain providers needs; training on best practices to integrate health I.T. systems; infrastructure and tools to provide telemedicine; promotion of technologies and best practices that enhance the protection of health information; promotion of the interoperability of clinical data repositories or registries; and improvement and expansion of the use of health I.T. by public health departments. Much of the funds could be distributed to states as planning and implementation grants.
HHS HIT Grants to facilitate the purchase, train personnel in use, and secure electronic exchange of health information; Medicare HIT incentive payments up to $44,000 for physicians who are meaningful users of certified EHR technology to improve quality, and who submit quality information (under PQRI - Rules for 2010 forthcoming in July) - with 10% additional in Health professional shortage areas; $11 million for hospitals; Penalties for those physician and providers who have not implemented EMRs begin in 2015. Medicaid incentive payments for non-hospital based physicians, nurse practitioners, nurse midwives, and physician assistants who are meaningful users, but not claiming Medicare incentives equal to 85% of net allowable technology costs not exceeding $63,750. Rural Health Clinics and FQHCs with at least 30% patient volume attributable to Medicaid will be eligible for payments not exceeding $63,750 for the cost of adoption and use of certified HER
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), Executive Office of the President (EOP)
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 |
|
|
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
The following bullet points summarize the objectives of the Marshfield Clinic's Health Policy Agenda:
"promoting payment fairness in Medicare physician and practice expense payments;
"new formulas for aligning Medicare reimbursement with value;
"value-based purchasing of health services including bonus payments for high value Medicare Advantage programs;
bonus payments for efficient providers;
bonus payments for primary care providers;
establishment and funding of comparative effectiveness research;
financing for the adoption and utilization of health information technology;
repeal and reform of the Medicare sustainable growth rate mechanism for updating physician payments;
improved reimbursement for the CMS Physician Group Practice (PGP) demonstration;
expansion of the PGP demonstration methodology into a national accountable care organization program to extend the physician group practice demonstration; and
opposition to the establishment of a public option in Health Insurance Exchanges if it were to reimburse providers at Medicare rates.
Value Index
Rewarding Value in the Reimbursement System Congress must introduce a value index into Medicare Parts A and B, to reward physicians and hospitals who provide safe, high quality care with excellent service to Medicare patients at a reasonable cost. The value index can be constructed for many types of payment models, including hospital DRG payments, physician fees, payment updates, and other payment formulas. We recommend that the geographic adjustment of physician work should be eliminated as recommended in legislation introduced by Senator Feingold (S 712) and Senator Grassley (S 318), and replaced with a quality/efficiency based coefficient for physician work as soon as possible. Legislation that we strongly support and would accomplish this objective, has been introduced by Iowa Rep. Bruce Braley and Wisconsin Rep. Ron Kind in the House and by Minnesota Senator Amy Klobuchar and Wisconsin Senators Feingold and Kohl in the Senate. The Medicare Payment Improvement Act (HR 2844, S 1249) seeks to reform the Medicare system to one that rewards the value of care over quantity of procedures, improving quality and lowering the total cost of care over time. The bills outcome-based approach creates the incentive for physicians and hospitals to work together to improve quality and use resources efficiently. These provisions were included in Sections 1159 and 1160 of the House Bill, HR 3962, the Affordable Health Care for America Act, and in section 3007 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act.
Value Based Purchasing
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. According to a recent report by the Congressional Budget Office spending in high-spending regions could be reduced without producing worse outcomes, on average, or reductions in the quality of care. (CBO February 2008) Alternatives:
Medicare 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.
Improve access to care in rural areas.
The Medicare Advantage program provides a capitated reimbursement to health plans for all Medicare benefits provided to enrolled beneficiaries. Corresponding mechanisms for rewarding value in the Medicare Advantage program should offer incentives for those plans that demonstrate superior patient care performance. 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.
These provisions were included in Sections 1161 of the House Bill, HR 3962, the Affordable Health Care for America Act, and in section 3201 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act.
The Patient Protection and Affordable Care Act will reward Medicare Advantage plans that achieve a quality ranking of four stars or above based on a five-star rating system. The current star rating system was initiated in 2007 to allow the Centers for Medicare and Medicaid Services (CMS) and Medicare beneficiaries to assess health plans based on quality. It was not designed to be a payment system, but could be used as a means to apply bonus payments to high-performing Medicare Advantage plans. The current star rating system incorporates some of the longest-standing quality measurements (HEDIS and CAHPS) in the health care system and provides a credible, solid starting point for evaluating health plan quality. Marshfield Clinic believes that the incorporation of the quality incentive provisions into Medicare Advantage is a significant step in the evolution of Medicare payment. The current star rating system is a credible starting point, and we look forward to the opportunity to work to improve the system in ways that will sustain a strong incentive and reward for better health outcomes for Medicare beneficiaries.
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. The federal government developed formulas to evaluate the cost of providing services in different practice settings and in different geographic locations. Those formulas measure resource inputs that have changed over the +40 year life of the program. To ensure affordable access to Medicare services throughout the country Medicare must take steps to refine its measures of the cost of providing services so that Medicares overwhelming financial dominance does not interfere with affordable access in markets that have changed very much since the program began. Congress must ensure that CMS has adequate funding to provide oversight of its many programs, including its measurement of resource and input costs.
Information Technology
Under current law the capital and operating expenses of installing and maintaining electronic medical records (EMRs) are assumed to be part of the overhead expense of a medical practice. Since no more than 5 10% of the physician population has installed EMRs, CMS now obsolete measurement of physician practice expenses reflect minimal average expense associated with IT. Alternatives:
Congress should provide incentives for EMR adoption, and/or utilization, and
Establish standards to facilitate the sharing and exchange of data.
CMS must update its mechanism for evaluating the cost of medical practice.
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. A proposed rule issued by CMS outlines proposed provisions governing the EHR incentive programs, including defining the central concept of meaningful use of EHR technology. An interim final regulation (IFR) issued by ONC sets 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 it HIT Policy and Standards Committees to assure meaningful use of electronic medical records and efficient standards for certification and interoperability of unrelated systems.
Payment Equity for Physician Work
Before MMA 03, Medicares payments were geographically adjusted based upon erroneous assumptions about the cost of hiring and retaining physicians. Congress established a floor payment mechanism for the physician work component of Medicare payment for 04 06 to assure that physicians in low payment localities were compensated for their work at least at the national average payment amount. The payment floor provision expired in 06, but has been extended in federal legislation every year since then.
Alternatives:
The payment floor should be extended indefinitely;
Geographic adjustment of work should be eliminated entirely; and replaced with a coefficient of quality and efficiency.
Support Senator Feingolds bill, the Rural Medicare Equity Act, S 712. These provisions were included in Sections 1157 and 1158 and 1194 of the House Bill, HR 3962, the Affordable Health Care for America Act, and in section 3102 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act.
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. These provisions were included in Sections 1401 of the House Bill, HR 3962, the Affordable Health Care for America Act, and in section 6301 and 6302 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act.
Marshfield Clinic nominated Dr. Douglas Reding for an open position on the Medicare Payment Advisory Commission, and as a candidate for appointment to the Medicaid and CHIP Payment and Access Commission (MACPAC) in 2010.
Marshfield Clinic nominated Marilyn Follen for an open nurse position on the Board of Governors of the Patient-Centered Outcomes Research Institute. Marshfield Clinic also supported the nomination of Dr Jeff Thompson of the Gundersen Lutheran Health System on the same Board of Governors.
On March 20, 2010, HHS Secretary Sebelius wrote a letter to the House of Representatives Quality of Care Coalition stating that HHS would commission two studies by the Institute of Medicine to 1) evaluate hospital and physician geographic payment adjustments, the validity of the adjustment factors, and the sources of data used for such adjustments; and 2) examine the geographic variation in the volume and intensity of health care services ultimately recommending ways to incorporate quality and value metrics into the Medicare reimbursement system. Secretary Sebelius also announced that she plans to convene a National Summit on Geographic Variation, cost, Access, and Value in Health Care later this year.
Practice expense geographic practice cost index (GPCI) adjustment: Retroactively effective from Jan. 1, 2010, HHS is required to revise the calculation method of the practice expense (PE) portion of the GPCI. This revision results in increased PE GPCIs for certain rural areas. Implementation of this provision will likely require CMS to reprocess certain 2010 claims (Sec. 3102 of HR 3590 as modified by Sec. 1108 of HR 4872 Reconciliation).
CMS Physician Group Practice Demonstration On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and was selected by CMS to participate in the demonstration program, effective April 1, 2005. Marshfield Clinic supported CMS determination to extend this program, beyond its initial 3-year term, and transition these organizations into Accountable care Organizations. Section 1301 of the House bill HR 3962, the Affordable Health Care for America Act, and Section 3022 of the Senate bill HR 3590, the Patient Protections and Affordable Care Act. Marshfield Clinic Also supported efforts to eliminate the 2% threshold for payments and the 5% limitation on payments in the PGP demonstration.
The Reconciliation Act of 2010, HR 4872, introduced by Rep. John Spratt included Section 1108 amending Section 3102 of the Patient Protection and Affordable Care Act, which increase the practice expense component of Medicare physician payment in localities that are below the mean of costs nationwide, effective January 1, 2010.
HR 4213: The American Jobs and Closing Tax Loopholes Act introduced by rep. Charles Rangel included a 6-month ARRA FMAP extension that would provide much needed Medicaid relief for states ($305 Million for Wisconsin alone). HR 4213 also included provisions canceling the pending reductions in physician reimbursement under the SGR formula. Marshfield Clinic urged Wisconsin Senators to support the extension of federal funding.
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), Executive Office of the President (EOP), Health & Human Services - Dept of (HHS), Health Resources & Services Administration (HRSA), Council of Economic Advisers (CEA)
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 |
|
|
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
The American Recovery and Reinvestment Act (HR 1) 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 potential 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. A proposed rule issued by CMS outlines proposed provisions governing the EHR incentive programs, including defining the central concept of meaningful use of EHR technology. An interim final regulation (IFR) issued by ONC sets 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 it HIT Policy and Standards Committees to assure meaningful use of electronic medical records and efficient standards for certification and interoperability of unrelated systems.
Marshfield Clinic presented testimony to the Policy Committee of the HHS Office of the National Coordinator discussing concerns about the timing and requirements imposed upon eligible providers to perform physician order entry into an electronic medical record of patients care. In particular Marshfield Clinic expressed concerns that order entry requirements may unnecessarily interfere with team oriented work processes.
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), Council of Economic Advisers (CEA), Executive Office of the President (EOP), 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 |
|
|
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
Address | |
||||||
City | |
State | |
Zip Code | |
Country | |
21. Client new principal place of business (if different than line 20)
City | |
State | |
Zip Code | |
Country | |
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
|
|
||||||||
1 |
|
3 |
|
||||||
2 |
|
4 |
|
ISSUE UPDATE
24. General lobbying issue that no longer pertains
|
|
|
|
|
|
|
|
|
AFFILIATED ORGANIZATIONS
25. Add the following affiliated organization(s)
Internet Address:
Name | Address |
Principal Place of Business (city and state or country) |
||||||||||||
| ||||||||||||||
|
26. Name of each previously reported organization that is no longer affiliated with the registrant or client
1 | 2 | 3 |
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 | ||||||||||
| ||||||||||||||
|
% |
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 | 3 | 5 |
2 | 4 | 6 |