American Recovery & Reinvestment Act

1. American Recovery & Reinvestment Act "You never want a serious crisis to go to waste" ~ Rahm Emanuel

2. Authors: • Grace Anglin • Ben Evans • Evelyn Lucas-Perry • Andy Pritchard • Henry Stabler

3. Health Spending in the ARRA Health Spending in the ARRA "create jobs, support the states, and invest in our country’s future"

4. Health Spending in the ARRA "create jobs, support the states, and invest in our country’s future“

5. Do we have a new health system post-ARRA?

6. Recovery and Reinvestment

7. COBRA

8. Medicare at a Glance • Eliminate proposed reductions in Medicare reimbursements --Cost $191 million • Eliminate proposed reductions in wage-index payments –Cost $134 million • Adjustments to Medicare reimbursements for long-term care hospitals--Cost $13 million

9. Medicaid at a Glance • Temporary increase in Medicaid payments to hospitals -- Cost $460 million • Acceleration of Medicaid reimbursements--Cost $680 million • Extension for low-income Medicare beneficiaries –Cost $550 million • Eliminate out-of-pocket costs for enrolled American Indians and Alaska Natives --Cost of $134 million • Disproportionate Share Hospitals (DSH) –Cost of $268 million

10. COBRA Intentions • “A valuable first step towards helping people maintain coverage.” • Yet an area of concern…cost

11. COBRA at a Glance • Federal subsidy for 65% of the premium for nine months for qualified workers. • Subsidy applies to workers who lose their jobs between Sept. 1, 2008, and Dec. 31, 2009. • Subsidy available for up to 9 months. • Workers who may have pre-existing conditions must maintain coverage to protect insurability.

12. COBRA

13. COBRA Beneficiary Example COBRA Beneficiary Example

14. NIH Appropriations • $10 billion • $1.8 billion for constuction and renovation of NIH facilities, extramural facilities, and research equipment • $8.2 billion for new grants • $7.2 billion for the Common Fund (CF) • $800 million overseen by the Office of the Director

15. NIH Appropriations • Poor support from Bush Administration • Will substantially increase grant funding for clinical, biomedical, and health systems research

16. NIH Appropriations: Challange Grants • Challenge Topics • Behavior, Behavior Change, & Prevention • Bioethics • Biomarker Discovery & Validation • Clinical Research • CER • Enabling Technologies • Enhancing Clinical Trials • Genomics • Health Disparities • IT for Processing Health Care Data • Regenerative Medicine • STEM • Theranostics • Stem Cells • Translational Science

17. NIH Appropriations: Why Research Funding? • Economic Benefit: Families USA study • 7 jobs per grant • $2.21 return for every $1 investment • Social Benefit

18. HRSA Allocation • $500 million to HRSA • $300 million to NHSC • Will substantially increase medical school scholarships, salary support, and student loans to public health practitioners willing to work in under-served rural areas 

19. Broadband Allocation • $2.5 billion for broadband expansion into remote areas to improve and promote: • Distance Learning • Telemedicine • Have been found to be effective method of removing barriers to access while delivering specialty care to remote, under-served areas

20. HITECH • Provision A, Title 13 and Provision B, Title 4 make up the "HITECH Act"  • Under HITECH: • Development of a national HIT system • HIT incentives through Medicare/Medicaid • Increased privacy/security regulations • $21 billion allocated to development and promotion of HIT

21. HITECH Development of a national HIT system: •  Expanded role of ONCHIT • Promote use of HIT • Identify measurable outcome goals • Evaluate and report on progress • Matching funds for state investments • beginning in 2011 - 10:1, 7:1, 3:1 • NIST charged with testing, R, & D • Researching technology improvements • Improve inter-hospital connectivity • Develop new security software • Use HIT to reduce error

22. HITECH HIT incentives through Medicare: • "eligible professionals" can receive incentive payments for implimenting HIT/EHR systems • $18,000 in 2011, decreasing to $2,000 in 2013 • Hospitals using HIT are eligible for incentive payments • $2,000,000 base grant; • $0 for the first through 1,149th discharge; • $200 for the 1,150th through the 23,000th discharge; • $0 for any discharges after the 23,000th

23. HITECH HIT incentives through Medicaid: • Providers that implement HIT/EHR will be eligible for up to 100% of the amount of Medicaid payments.  • Miscellaneous items are also included • Hospice • SCHIP • long-term care providers

24. HITECH Increased privacy & security: •  Increased enforcement under HIPAA •  Required notification in case of security breach • If breach involves the records of 10 or more individuals, they must be notified • If breach involves 500 or more people, the individuals, ONCHIT, and a media outlet must be notified •  Specifies penalties for security breaches

25. HITECH Impact of HIT changes: • CBO estimates that over the next 10 years: • HIT investment will cost $32.7 billion • will save $12.5 billion • 70% of hospitals will adopt HIT • Obama admin. cites a RAND study reporting that savings from large-scale use of HIT could reach $77 billion • HIT can reduce admin. costs: • as low as 2-5% in some countries • 25% of health spending in the US

26. HITECH Impact of HIPAA changes: • HIPAA changes may have unforeseen consequences • HIPAA will apply to many more workers • Changes add to an already complex set of regulations • No funding to meet these new requirements • AAFP reports changes will, "increase the uncertainty, complexity, cost and risk for anyone or any organization who collects, stores, manages or transmits personal health information."

27. HITECH Tie-ins with other ARRA and Obama Admin. priorities: • Research: • Data from HIT will facilitate research into quality, comparative effectiveness, small area variation, medical error, etc. • NIH challenge grants will exploit this new source of data • HITECH dovetails with broader health reform goals: • campaign promise to invest $10 billion a year in HIT • Admin. states that, "strengthening privacy and security in the digital age" is a top priority

28. Comparative Effectiveness Research $1.1 billion total appropriations $700 million to the Agency for Healthcare Research and Quality  - $400 million transfered to the National Institute of Health $400 million to the Secretary of Health and Human Services - $1.5 million to IOM study

29. Comparative EffectivenessResearch NIH Challenge Grants • 69 separate headings • Common themes:  Substance Abuse Treatment, Diagnostic Biomarkers, Aging Related Illness, Cancer Treatment, Cardiovascular Treatment, Diagnostic Testing IOM Study • Form to hospitals

30. What Will This DO? • Improve health delivery in rural areas by increasing personnel and communication abilities of rural clinics • Reduce barriers between remote populations and clinicians, researchers, etc.

31. Comparative Effectiveness Sec 804:  Establishes the Federal Coordinating Council for Comparative Effectivness Research Purpose:  "The council shall foster optimum coordination of comparative effectiveness and related health services research conducted or supported by relevant Federal deparments and agencies, with the goal of reducing duplicative efforts and encouraging coordinated and complementary use of resources"

32. Comparative Effectiveness Council - 15 members including senior officials from: •  Agency of Healthcare Research and Quality •  Centers for Medicare and Medicaid •  National Institute of Health • Office of the National Coordinator for Health Information Technology •  The Food and Drug Administration •  The Veterans Health Administration •  Department of Defense Military Health Care System • At least 8 member have to be physicians or have significant clinical experience Chaired by the Secretary of HHS

33. Comparative Effectiveness Research Rules of Construction Sect 804 (g)(1&2) "Nothing in this section shall be construed to permit the Council to mandate coverage, reimbursement or other policies for any public or private payer" "None of the reports submitted under the section or recommendations made by the Council shall be construed  as mandates or clinical guidelines for payment, coverage or treatment"

36. Do we have a new health system? No, but we do have a base for health reform • Framing the problem • Framing the soultion • Media attention   Is the window open?

37. Where should you work? • NIH  • Federally qualified health centers

38. Questions and Comments

39. Credits: • Grace Anglin • Ben Evans • Evelyn Lucas-Perry • Andy Pritchard • Henry Stabler