American Academy of American Academy of Pain Medicine Pain Medicine LEGISLATIVE ADVOCACY LEGISLATIVE ADVOCACY May 2, 2006 May 2, 2006 BOB SANER ADAM CHRISNEY BOB SANER ADAM CHRISNEY Powers Pyles Sutter Verville PC Powers Pyles Sutter Verville PC
Establishing AAPM Issue Priorities Establishing AAPM Issue Priorities Overall Goal: Overall Goal: – Promote quality care of patients with pain as a symptom of disease and primary pain disease through research, education, and advocacy. Legislative Goals - - 2007: 2007: Legislative Goals – Increase federal investment in pain research; Increase federal investment in pain research; – – Ensure DEA enforcement of the Controlled Ensure DEA enforcement of the Controlled – Substances Act (CSA) does not also impede Substances Act (CSA) does not also impede pain management. pain management. 2 2
Legislative Objectives for 2007 Legislative Objectives for 2007 AAPM 2007 Legislative Objectives Include: AAPM 2007 Legislative Objectives Include: Passage of the National Pain Care Policy Act of 2007; Passage of the National Pain Care Policy Act of 2007; – The re – The re- -drafted drafted ‘ ‘Rogers Rogers’ ’ Bill Bill – – HR 1020. HR 1020. Increased appropriations for DoD and/or VA pain Increased appropriations for DoD and/or VA pain research funding; research funding; Monitor enforcement of CSA laws and regulations; Monitor enforcement of CSA laws and regulations; – Oppose unnecessary legislative or regulatory restrictions. Oppose unnecessary legislative or regulatory restrictions. – 3 3
ISSUE: : ISSUE Comprehensive Pain Care Legislation Comprehensive Pain Care Legislation ‘Rogers Rogers’ ’ Bill Bill - - National Pain Care Policy Act: ‘ – Institute of Medicine conference on pain care; Institute of Medicine conference on pain care; – – Boosting funding for NIH Pain Consortium; Boosting funding for NIH Pain Consortium; – – Pain care education and training programs; Pain care education and training programs; – – Public awareness campaign on pain management; Public awareness campaign on pain management; – New: Military and Veterans Pain Care Act New: – Pain care coverage initiatives in military health Pain care coverage initiatives in military health – facilities; facilities; – Pain care standards for TRICARE. Pain care standards for TRICARE. – 4 4
ISSUE: : ISSUE Pain Research Pain Research Congress recently doubled NIH funding. Congress recently doubled NIH funding. Recently passed H.R. 6164 would: Recently passed H.R. 6164 would: – – Authorize (not appropriate) increases in 2007- Authorize (not appropriate) increases in 2007 -2009; 2009; The FY 2007 CR provides a $620 million increase – – still needs to be passed as of 1/30. still needs to be passed as of 1/30. The FY 2007 CR provides a $620 million increase – – Establish new, public Establish new, public electronic catalogue and reporting system for all research; electronic catalogue and reporting system for all research; – Limit NIH Institutes and Centers to current 27; – Limit NIH Institutes and Centers to current 27; – Create new public review of NIH structure every 7 years; – Create new public review of NIH structure every 7 years; – – Create new strategic planning Division under the Director for NIH reorganization; Create new strategic planning Division under the Director for NI H reorganization; New Scientific Management Review Board to analyze NIH structural effectiveness; effectiveness; New Scientific Management Review Board to analyze NIH structural – – Create new “ Create new “common fund common fund” ” to identify, support and advance trans to identify, support and advance trans- -NIH research; NIH research; Competed over by Institutes, Centers and Independent investigators; rs; Competed over by Institutes, Centers and Independent investigato New advisory council to review and recommend projects to be funded. New advisory council to review and recommend projects to be fund ed. Only pain Only pain- -specific provision specific provision: : ‘ ‘pain pain’ ’ to be one of 12 specific categories of to be one of 12 specific categories of research highlighted in a new biennial NIH report to Congress. research highlighted in a new biennial NIH report to Congress. For 2007: For 2007 : Support National Pain Care Policy Act (sec. 3 and 4), Support House or Senate to revisit NIH Reform or other NIH Research issues? es? House or Senate to revisit NIH Reform or other NIH Research issu 5 5
ISSUE: : ISSUE DEA & The Controlled Substances Act DEA & The Controlled Substances Act DEA enforcement of CSA is having “ “chilling chilling DEA enforcement of CSA is having effect” ” on pain treatment. DEA on pain treatment. DEA “ “issues issues” ” include: include: effect – Oregon Oregon’ ’s physician s physician- -assisted suicide law; assisted suicide law; – – DOJ interpreting Oregon law & DOJ interpreting Oregon law & Gonzales v. Oregon; Gonzales v. Oregon; – – Joint DEA/state/professional Joint DEA/state/professional “ “balance balance” ” statement; statement; – – Development & disavowal of Development & disavowal of DEA DEA’ ’s s FAQ document; FAQ document; – – High visibility prosecutions High visibility prosecutions – – Dr. Hurwitz; Dr. Hurwitz; – – Prescription monitoring laws pass; Prescription monitoring laws pass; – – Recent DEA rule on multiple prescriptions. Recent DEA rule on multiple prescriptions. – : progress is unlikely, PRO or CON. 2007 : progress is unlikely, PRO or CON. 2007 – Though Brownback bill reintroduction expected. Though Brownback bill reintroduction expected. – 6 6
Issues Members/Staff Might Raise: Issues Members/Staff Might Raise: Pharmaceutical Issues: : Pharmaceutical Issues Internet Pharmacies. Internet Pharmacies. Physician Specific Issues: : Physician Specific Issues Medicare Payment Issues. Medicare Payment Issues. – SGR Fix SGR Fix – – Long Long- -term; Short term; Short- -term, term, – – Quality Measures (P4P, PQRI), Quality Measures (P4P, PQRI), – – Medical Malpractice. Medical Malpractice. – 7 7
HILL ISSUE: : HILL ISSUE Internet Pharmacies Internet Pharmacies Prescription drug abuse, especially pain- -killers, is an killers, is an Prescription drug abuse, especially pain increasing focus for legislators. increasing focus for legislators. Options (threats) under consideration include: Options (threats) under consideration include: – Prohibit sales w/o prescription or examination + higher penaltie Prohibit sales w/o prescription or examination + higher penalties; s; – Curb focus on on- -line questionnaires. line questionnaires. Curb focus on on – Increase Schedule III drug penalties for sales; – Increase Schedule III drug penalties for sales; – Increase Customs forfeiture laws to include Schedule III drugs; – Increase Customs forfeiture laws to include Schedule III drugs; – Increase use of electronic ID tech for Rx Drugs; – Increase use of electronic ID tech for Rx Drugs; – Reduce individual – Reduce individual’ ’s international transporting of s international transporting of Sched Sched. III drugs; . III drugs; Leading Bills from Last Congress: Leading Bills from Last Congress: – H.R. 840 H.R. 840 - - Davis/Waxman Davis/Waxman – – Govt. Reform Cmte. Govt. Reform Cmte. – – H.R. 4769 H.R. 4769 – – Norwood/Strickland Norwood/Strickland – – Energy & Commerce Cmte. Energy & Commerce Cmte. – : Oppose or alter such proposals. Oppose or alter such proposals. For 2007: For 2007 8 8
HILL ISSUE: : HILL ISSUE Medicare Payments Medicare Payments Medicare policy drives that for Medicaid and commercial Medicare policy drives that for Medicaid and commercial insurance. Examples include: insurance. Examples include: – Rogers pain care bill – Rogers pain care bill - - mandate for pain treatment in Medicare mandate for pain treatment in Medicare managed care plans; managed care plans; – In – In- -/outpatient payments & new tech /outpatient payments & new tech - - implantable devices; implantable devices; – Proposed payment changes for Medicare ASC pain Proposed payment changes for Medicare ASC pain – management; management; – Recent IPPS DRG change reduces payment for complex Recent IPPS DRG change reduces payment for complex – inpatient headache cases; inpatient headache cases; – Declining conversion factor in time will curtail physician acces Declining conversion factor in time will curtail physician access; s; – – SGR SGR- -fix fix: Fix for 2007 (freeze at 2005 level instead of a cut) that : Fix for 2007 (freeze at 2005 level instead of a cut) that – passed at end of 2006 added quality measure reporting bonus – – passed at end of 2006 added quality measure reporting bonus nearly doubling the cost for a 1- nearly doubling the cost for a 1 -year SGR fix this year. year SGR fix this year. : SGR fix & ASC payment reform most likely. For 2007 : SGR fix & ASC payment reform most likely. For 2007 9 9
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