New Administration and Congress Struggle to Find Common Ground on Health Reform; Take Action Today
Congress and the Administration continue to struggle with how to proceed with the repeal and replacement of the Affordable Care Act (ACA). Congressional Republicans have yet to agree on a proposal that reduces costs while continuing to provide coverage to those who gained insurance through the ACA. A draft bill was leaked last week that is unlikely to advance because it does not meet either of these goals. While President Trump remains committed to repeal and replacement, some Congressional Republicans have started to consider ways to “repair” the most concerning provisions of the ACA, such as the individual mandate, through passage of separate legislation.
Take Action: The Society developed a list of priorities that must be included in future programs. We encourage you to join us by contacting your members of Congress to urge their support for these priorities. Writing to your Congressional delegation is quick and easy when you use our Health Care Reform campaign link. Click to access the campaign, and a pre-written letter will be provided for you. You will only need to either provide your email and member ID, OR enter your address information so that the system will send your message to the correct recipients.
Trump FY 2018 Budget Threatens Funding for NIH; Join Society Advocacy Campaign to Support Research
On February 27 President Trump released a budget blueprint for Fiscal Year (FY) 2018 that increases defense spending by $59 billion (10% of the federal budget). Because of statutory budget caps, non-defense discretionary (NDD) funding will be cut by the same amount; specific funding levels for each agency are expected to be released in late March. Although the President’s budget is not the rule of law, it does provide an indication of the Administration’s priorities and sets the stage for an aggressive advocacy push by the NDD community.
Take Action: It is more important than ever that your members of Congress hear from you about the need to support biomedical research and public health programs. If you have not done so already, please take a minute to use our online advocacy campaign for NIH funding. Click to access the campaign, and a pre-written letter will be provided for you. You will only need to either provide your email and member ID, OR enter your address information so that the system will send your message to the correct recipients.
Endocrine Society Continues to Influence EU EDC Criteria
On Wednesday, February 8, the European Commission issued further revisions to the criteria for the identification of endocrine-disrupting chemicals. The latest revisions to the criteria do not represent an improvement over previous versions, and would fail to effectively prevent harm to humans and wildlife due to exposures to EDCs. The proposed criteria continue to support an extremely restrictive option, based on the World Health Organization’s definition for EDCs, but with modifications that result in a very narrow definition that will prevent effective regulation of EDCs. Furthermore, a new provision in the revised proposal further complicates regulatory activities by creating broad exemptions for chemicals that disrupt the endocrine systems of pests, such as insects and animals that attack crops. If these chemicals go unregulated, it will create serious gaps in the identification criteria and create a regulatory system that does not reflect the state of the science on EDCs, causing confusion and delays in identifying EDCs that could cause harm.
On February 14, the Endocrine Society issued a press release articulating issues with the proposed criteria that was shared with Members of the European Parliament (MEPs). Based on the information in the Society’s press release, 25 MEPs, led by MEP Nicola Caputo, sent a letter to the EU Commissioner for Health and Food Safety, Vytenis Andriukaitis, MD, opposing the exemptions to the criteria and asking for the creation of multiple categories of evidence for the criteria, consistent with the option supported by the Endocrine Society. A February 28 meeting of the Commission and Member State experts failed to move forward on a vote on the criteria due to lack of support from a qualified majority of EU countries.
We will continue to work with policymakers in the EU to influence the eventual vote on the criteria. On March 8 and 9, an international group of Endocrine Society members will travel to Brussels for a series of bilateral meetings with EU policymakers, including Members of the European Parliament. During the meetings, the Society’s representatives will discuss the latest science on EDCs and why the European Commission should support the Endocrine Society’s recommended option for the criteria that rank EDCs in multiple categories based on available scientific evidence. This option would allow for new data to be incorporated as more studies are published.
We will continue to keep members informed of any future developments regarding the criteria. The Endocrine Society will remain involved in the ongoing debate and subsequent implementation of the criteria as applied relevant EU laws.
Endocrine Society Signs Letter in Support of Federal Public Health Workforce
On February 27, the Endocrine Society joined a community sign-on letter addressed to President Trump in support of “protecting and strengthening the workforce across the public health continuum.” The letter, co-signed by a diverse group of public health stakeholders, describes the important work done by the federal public health workforce and the role of federally-funded biomedical research in improving public health interventions. For more information, and to see the list of signatures, please see the full letter here.
EXTENSION: Harold Vigersky Practicing Physician Travel Award: Applications Due March 16
The Society is now accepting applications for the Harold Vigersky Practicing Physician Travel Award. Two awards are available to US-based clinicians who have completed their endocrinology fellowship in the past 10 years to attend ENDO or CEU. Applications are due March 16, 2017.
Congressman Tom Price Confirmed as New HHS Secretary
On February 10 by a vote of 52 to 47, the Senate confirmed Representative Tom Price to be the next Secretary of the Department of Health and Human Services (HHS). He previously served as chairman of the House Budget Committee and was a member of the House Ways & Means Committee and GOP Doctors’ Caucus.
Dr. Price is an orthopedic surgeon from Georgia and served as a member of the House of Representatives since 2005. His confirmation was contentious because of his strong opposition to the Affordable Care Act (ACA) and the revelation that he had actively traded shares of medical and pharmaceutical companies while in Congress. During his confirmation hearing, Dr. Price maintained that all of his actions were “ethical, aboveboard, legal and transparent.”
Dr. Price will be the first physician to head HHS since 1993. In the House, he proposed an ACA replacement plan that would roll back federal insurance standards, returning authority to the states. The Empowering Patients First Act introduced in the 114th Congress would have increased the amount that people could contribute to their health savings accounts, expanded tax-deductible contributions to these accounts, and allowed the accounts to pay some primary care fees with these funds. His plan also would have required HHS to provide a grant to states for high-risk pools or reinsurance pools to subsidize health insurance for high-risk individuals. Also, the legislation would allow individuals to opt out of Medicare or Medicaid and receive a tax credit instead. Dr. Price has also supported House Speaker Paul Ryan’s (R-WI) A Better Way healthcare plan.
While in Congress, Dr. Price has also been critical of the Center for Medicare and Medicaid Innovation. Health policy consultant Seema Verma of Indiana has been nominated to run the Centers for Medicare and Medicaid Services under Dr. Price, and they will have an opportunity to refocus the work of the Innovation Center.
On February 15, Secretary Price met with Senate Republicans to discuss ACA repeal and replacement. According to attendees, Secretary Price emphasized that there is a path forward despite the amount of work it will take to get there. He also spoke about the need to stabilize the current insurance marketplace and the steps that HHS could take to assist. Despite the meeting, reports suggest that Secretary Price spoke more about the overall picture of repealing and replacing Obamacare rather than any specific policies, leaving the specifics of the legislation to Congress.
The Society recently signed on to a letter to Secretary Price outlining issues with the current valuation of evaluation and management services and its impact on the cognitive specialty workforce. We will keep you apprised of future developments.
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CMS Supports Small Practices Transition to the QPP
The Centers for Medicare and Medicaid Services (CMS) awarded approximately $20 million to 11 organizations to provide on-the-ground training and education for clinicians in individual or small group practices of 15 or fewer clinicians as they transition to the new Medicare Quality Payment Program (QPP). CMS will invest an additional $80 million in this program over the next four years.
These community-based organizations will provide hands-on training to help small practices, especially those in historically under-resourced areas including rural areas, health professional shortage areas, and medically underserved areas. The training and education resources will be available nationwide, and will be provided at no cost to eligible clinicians and practices.
As part of that outreach effort, CMS also launched a new telephone helpline for clinicians seeking assistance with the Quality Payment Program. Clinicians may contact the Quality Payment Program by calling 1-866-288-8292 from 8AM–8PM (EST) or emailing firstname.lastname@example.org.
For more information on the QPP, please visit www.endocrine.org/MACRA for additional resources to support endocrinologists as they transition to the new payment program.
NACHHD Discusses Director’s Vision, Extramural Research Priorities, and All of Us Research Program
On January 31 the Endocrine Society participated in a meeting of the National Advisory Child Health and Human Development Council (NACHHD). Society member Catherine Gordon, MD, MSc, is a pending member of the Council, which advises the Director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) on research, support activities, and functions of the institute.
During the open session of the meeting, the Director of the NICHD, Diana Bianchi, MD, described her vision for the future of NICHD guided by the following core values:
Maintain a High Standard of Excellence
Time to Listen, Learn and Think
"Vision" i.e., Observations and a Suggested Path Forward
Dr. Bianchi stressed the importance of defining the “brand” of NICHD and communicating to stakeholders about the important work that the institute does. Central to the goal of better communication, she provided a preview of the redesign of the NICHD website. She also thanked the Friends of NICHD, a coalition of stakeholders, for their advocacy to Congress in support of NICHD’s work. The Endocrine Society is a member of the Executive Committee of the Friends of NICHD. Other themes that figured prominently in the presentation were listening to the voice of the patient and building bridges both within the research communities supported by NICHD and with other institutes on collaborative activities.
Della Hann, PhD, joined the council to provide an update on the Division of Extramural Research. Dr. Hann gave an overview of training programs and trends in type-1 applications and awards since 2001. NICHD continues to support trainees with approximately 6% of their overall budget, amounting to over 1,200 trainees each year; however, lack of budget increases for NIH in recent years has impacted success rates. The institute’s largest pool of grantees continues to be PhDs, and there is a stable pool of MD-PhD grantees; however, there has been a slow decline in the proportion of MD applicants and awardees. She also discussed strategies to improve the payline for NICHD researchers, including better communication of research priorities and tighter referral guidelines and transfer acceptance. She then described opportunities to increase flexibility for discretionary funding by removing the fixed payline for certain investigator-initiated grant mechanisms (including R-series grants) and allowing decision-making based on branch priorities. Finally, Dr. Hann discussed changes in NIH clinical trial policy and implementation to address previously acknowledged shortcomings in clinical trial design and reporting. New policies and systems will enable NIH to evaluate clinical trials throughout the entire lifecycle and implement reforms, from grant application through data publication.
Stephanie Devaney, PhD, led a discussion with the council on the All of Us Research Program (formerly called the Precision Medicine Initiative). Dr. Devaney’s presentation focused on how the program would encompass a transformational approach to diversity, incorporating communities historically underrepresented in research. All of Us also intends to improve data access and engagement of all stakeholders to accelerate precision medicine research. Council members encouraged the All of Us program to implement methods to be able to engage and retain participants with intellectual disabilities and developmental disorders. In response to a question from a Council member, Dr. Devaney noted that pregnancy would be included in the All of Us survey module, as well as questions regarding disorders of sexual development.
NIDDK Advisory Council Discusses Training Programs, Cancer Moonshot
On February 1, the Endocrine Society participated in a meeting of the National Diabetes and Digestive and Kidney Diseases (NIDDK) Advisory Council. Society members Lee Kaplan, MD, PhD; Alan Saltiel, PhD; and Joel Elmquist, PhD, DVM, are members of the Council, which advises the Director of the NIDDK on research, support activities, and functions of the Institute.
During the open session of the meeting the Director of the NIDDK Griffin Rodgers, MD, discussed the challenges that the institute would face under a full-year Continuing Resolution (CR) for fiscal year (FY) 2017. He also commented on the projects funded by the 21st Century Cures bill such as the Cancer Moonshot, BRAIN Initiative, and Precision Medicine Initiative, and noted that the additional funding for these projects is dependent on the appropriations process.
The Council then discussed training and career programs supported by the institute, and the rates at which individuals supported by training grants go on to compete for independent funding. Dr. Tracy Rankin, PhD, noted that biomedical research cost inflation has created further stresses on funding for trainees; however, the NIDDK has been able to maintain a strong commitment to supporting trainees. She further noted that for NIDDK, nearly 50% of trainees on institutional awards (T32) have MD degrees, while nearly 77% of trainees on F32 awards have PhDs; of these only 19% do human subjects research. The Diabetes, Endocrinology, and Metabolism (DEM) subcouncil, meeting later in the day, noted that their training portfolio tends to support more PhDs relative to the entire NIDDK training portfolio, and that fewer DEM trainees do human subjects research.
Participants acknowledged that there are challenges to tracking measures of the success of training programs, especially for areas outside of typical contributions to the research enterprise. Council members also noted that having training awards to provide protected time for MDs doing research was important, and that length of training supported by training grants might need to be examined in light of the shifting timelines of biomedical research careers. However, training grant support caps are set by law, so significant modifications to support time on training programs would require an act of Congress.”
Douglas Lowy, MD, Acting Director of the National Cancer Institute (NCI) then joined the Council to discuss the Cancer Moonshot Initiative. Dr. Lowy described the recommendations of the Cancer Moonshot Blue Ribbon Panel Report and how funding strategies would align with the recommendations. He also discussed opportunities to participate in co-funded projects through joint Requests for Applications (RFAs) with other institutes, such as NIDDK.