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ASN NEWS

The pace at ASN headquarters hasn’t slowed since last fall’s Renal Week. In addition to gearing up for Renal Week 2003 in San Diego, we’re busy improving membership communications and diversifying our committee leadership.

The ASN is proud to offer its members a quick and efficient way to learn about the Society’s upcoming activities and events. Beginning in January, ASN started offering its members an electronic newsletter, Renal Express, which is automatically e-mailed to ASN members on the first and third Tuesday of every month. The first issue of the month presents an overview of current and upcoming ASN activities and events, and the second issue of the month consists exclusively of ASN’s public policy endeavors. If you are an ASN member and are not receiving Renal Express but would like to, please send a request with your email address to email@asn-online.org. Renal Express replaces our previous quarterly newsletter, Highlights. However, we will continue distributing Onsite Highlights during Renal Week.

Committee Updates

Last spring, ASN’s Council decided to provide ASN members with an opportunity to be heard and involved by inviting all current and active ASN members to indicate personal interest or recommend others to serve on ASN standing committees or advisory groups. By broadening the selection process of new committee members, the Council has indicated a desire to revitalize ASN with new ideas and initiatives. Again in April 2003, the ASN will be releasing a "Committee Call for Nominations," and we encourage all of you with an interest in getting actively involved in ASN business and programs to indicate your willingness to serve on a committee or advisory group. Last year, the response was very strong, with over 200 individuals volunteering their time and talent. Because the number of open positions was much smaller, of course, many of those volunteers could not be appointed to a committee. However, there are new openings this year, so please let us know of your willingness to participate! Watch for the "call" in one more month!

The Council also recently formed a new committee, the Education Committee, led by Past-President Roland Blantz, to perform a variety of functions. This committee is charged with reviewing all the educational activities developed or sponsored by the Society and assessing the quality and effectiveness of the educational programs offered by the Society to its members.

Public Policy News

NIH Funding
There is a growing concern among members of the biomedical research community that future funding increases for the National Institutes of Health (NIH) are likely to be small under the Bush Administration budget being prepared for next year. Despite large increases due to the NIH doubling effort and strong public support for biomedical research, reports indicated that future NIH increases could be 1% or less.

The FY 2004 budget projections for the NIH reflect the growing competition for limited federal funds. Representatives of the biomedical research community are concerned that such a small increase in FY 2004 for NIH would effectively be a cut, because it does not keep up with the biomedical inflation rate. Researchers are concerned that a lack of appropriate NIH funding increases would wipe out the benefit of significant advances in recent years and would force researchers into alternative careers, putting America’s current leadership role in biomedical research in question. Several biomedical coalitions will advocate for future NIH funding increases in the range of 8 to 10%.

The biomedical research community is planning a big effort to prod Congress and the Administration for continued support of NIH. The ASN will work closely with coalitions and representatives of the patient, research, and medical communities to advocate for reasonable NIH funding increases in FY 2004 and beyond. NIH funding is a major policy initiative for the ASN in the coming year.

Indirect Medical Education Payments (IME)
The government commission responsible for studying Medicare payment levels is currently considering reductions to the Medicare indirect medical education (IME) adjustment. If the Medicare Payment Advisory Commission (MedPAC) approves a recommendation for a reduction in the IMEs it will be included in MedPAC’s "Report to Congress," which is due in March 2003.

The Medicare IME adjustment was reduced from 6.5% to 5.5% for FY 2003, which began October 1, 2002. According to the Association of American Medical Colleges (AAMC), this reduction is resulting in an $800 million annual loss for teaching hospitals. MedPAC is considering a recommendation that IME be further reduced to 2.7%, either immediately or over several years. AAMC estimates such a reduction would result in an additional annual loss of $2 billion for teaching hospitals.

This recommendation for reduction comes from MedPAC staff, who calculated that a 2.7% IME adjustment would cover the actual cost of having residents at teaching hospitals. The Alliance for Academic Internal Medicine (AAIM) and other organizations have questioned these calculations. Congress is expected to consider reversing recent cuts to physician payments, and an IME increase could be included alongside other Medicare adjustments.

Physician Fee Schedule
At its February 10^th meeting, the Center for Medicare and Medicaid Services (CMS) Practicing Physician Advisory Board received testimony and public comment on the 2004 Proposed Rule for the Physician Fee Schedule. The information gathered at the meeting will be included in the advisory board’s recommendation to the Secretary of Health and Human Services and CMS Administrator.

Testimony on the 2004 Proposed Rule will be important because the publication of the 2003 Physician Fee Schedule on December 31, 2002, did not dampen the debate over the Medicare physician fee schedule. CMS Administrator Tom Scully states, "CMS has done everything it can to shore up physician payments for 2003, but only Congress has the authority to fix the formula." CMS refined the methodology for calculating the rate of inflation in providing physicians’ services by adjusting the measure of productivity. As a result, physicians will see a reduction of 4.4% rather than the 5.1% reduction that would have occurred without the change. "These methodological adjustments translate into an additional $14.5 billion in Medicare payments to physicians over the next ten years," said Scully.

CMS recognizes that this is the second year in a row in which physician fees will be affected by a negative update for the conversion factor. The reduction in physician fee schedule rates results from a formula specified in the Medicare law, and CMS believes that formula is flawed and must be fixed. Although Congress considered several options for fixing the fee schedule formula for 2003, and the House actually passed a bill to address these issues, no final action was taken before Congress adjourned in December of 2002.

CKD Activity

The ASN has joined with the National Kidney Foundation and the Renal Physicians Association to sponsor focused meetings and conferences associated with chronic kidney disease. Just a couple weeks ago, the first of these activities was held in Washington, DC, and provided an opportunity for a variety of parties with an intersecting interest in CKD to get together and generate a potential set of activities designed to target the CKD problem in the United States. The February meeting focused on the magnitude of the CKD problem, how clinical care models may need to change to appropriately serve the CKD population, and the impact that new or modified care methodologies may have on payment systems, etc. Watch for important news and details on other meetings and activities that will continue to focus on this critical health issue.

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