Heart on the Hill - August 2016

Heart on the Hill 

FDA Announces New Requirements for Nutrition Facts Label

A nutrition fact label

On May 20, the Food and Drug Administration (FDA) announced several changes to the Nutrition Facts label that appears on most packaged foods. The newly redesigned label will more prominently display the number of calories, the serving size, and the number of servings per container. Food packages will also be required to declare the amount of potassium and vitamin D, as well as the amount of added sugars. As part of the redesign, the FDA also created a Daily Value for added sugars (less than 10 percent of total calories) and lowered the Daily Value for sodium from 2,400mg to 2,300mg.

At the same time, the FDA also released a new rule that alters the serving size for many common foods to better reflect how much people typically eat at one time. For example, the serving size for ice cream is increasing from a half cup to two-thirds of a cup. By law, serving sizes must reflect the amount people actually eat, but they should not be considered as the recommended amount.

In a statement, AHA CEO Nancy Brown praised the release of the new rules for empowering consumers “with the guidance they need to make healthier, more informed food choices that can reduce their risk for heart disease and stroke.” The association was especially pleased that the final rules included many of the recommendations we had made to the FDA since 2007 when the agency first considered updating the nutrition label.

The new labels are scheduled to appear on food products by July 26, 2018; however, small food manufacturers will have one additional year to comply.

Contact: Susan K. Bishop

FAST Act Support Grows

Since June 1, more than 50 members of Congress have been added as cosponsors on the Furthering Access to Stroke Telemedicine Act (FAST Act) – the association’s top stroke legislative priority this year. The total number of House cosponsors is now up to 145, including nearly 50 cosponsors who serve on the health committees with jurisdiction over the bill.

The legislation would require Medicare to cover telestroke consultations for stroke patients located in urban or suburban areas.

In addition, Sen. Ron Wyden (D-OR), the top Democrat on the Senate Finance Committee – which has jurisdiction over Medicare legislation – recently highlighted Medicare’s current policy of limiting telestroke use only to rural areas as an example of an outdated policy that needs to be changed.

Speaking on June 15 at the Brookings Institution, Sen. Wyden said: “(S)ome hospitals may not have immediate access to a neurologist, and against all logic, Medicare rules today sometimes block the use of telemedicine when it could be life-saving. Those rules ought to be thrown in the dustbin. An outdated Medicare policy cannot be the reason a stroke victim is left unable to speak with loved ones or live a productive life.”

Finally, the Medicare Payment Advisory Commission (MedPAC) in its June 2016 Report to Congress specifically singled out telestroke as the one area of telehealth where it makes sense for policymakers to expand Medicare coverage to urban and suburban areas, as the FAST Act would do.

Sue Nelson

Senate and House Labor-HHS Appropriations Bills a Mixed Bag

The Senate and House Appropriations Labor, HHS and Education subcommittees wrapped up work on the FY 2017 funding bills that contained many of our health priorities. The results were mostly positive.

For the second year in a row, the Senate bill added a full $2 billion for the National Institutes of Health (NIH). While heart disease and stroke were not singled out as priorities, report language emphasized the growing burden both heart disease and stroke inflict upon our nation. The association strongly encouraged the NIH to increase its heart and stroke research investment commensurate with the impact on public health and scientific opportunities.

Meanwhile, the House budget included $1.25 billion in funding for the Institutes. As a result, the budget for the National Heart, Lung, and Blood Institute grew by 2.2 percent, in contrast to the Senate bill, which included a 4.1 percent bump. The National Institute of Neurological Disorders and Stroke received a 3 percent increase – far less than the 6.3 percent boost from the Senate.

In a press statement, American Heart Association President Steven Houser stated, "We were hoping House members would follow their Senate colleagues and provide a bigger and much-needed boost. Instead, they recommended fewer federal dollars for the agency, which could mean even less support for research into cardiovascular disease – our nation's no. 1 and most costly killer.

The Senate funded the Centers for Disease Control and Prevention (CDC) at $30 million below last year’s funding level, while the House included the $30 million and added $15 million more. WISEWOMAN and the Million Hearts program were flat funded at $21 million and $4 million, respectively. Report language also urged the CDC to make burden of disease a more significant factor for CDC funding allocations and awards.

Unfortunately, the Senate shortchanged the Student Support and Academic Enrichment block grant that schools can use to fund physical education, among other priorities. The grant was funded at $300 million – far less than the $1.65 billion authorization level included in last year’s bipartisan Every Student Succeeds Act. The House bill, on the other hand, provided $1 billion for the block grants, which was even higher than President Obama’s budget request.

Finally the CDC’s tobacco prevention and control program was flat funded at $210 million in the Senate Appropriations Committee’s bill and slashed to $100 million (a $110 million decrease) in the House Appropriations Committee’s version of the legislation.

Congress is on recess until September. When members return, they will likely pass a continuing resolution for a yet undetermined period of time.

Contact: Claudia Louis


FDA Proposes Voluntary Sodium Reduction Targets

A teaspoon of salt

In June, the Food and Drug Administration (FDA) released voluntary draft sodium reduction targets for the food industry. The targets are intended to encourage, but not require, food manufacturers, restaurants, and food service operators to lower the sodium content of their foods.

In the draft guidance document, the FDA presents targets for 150 food categories (cheese, soup, bakery products, meat and poultry, etc.) and provides both short-term and long-term goals. The initial set of short-term (two-year) targets would reduce sodium consumption from the current average of 3,400 mg to about 3,000 mg per day. The long-term (10-year) targets provide a more substantial reduction to 2,300 mg per day.

The targets are currently in draft form and may be revised based on feedback the FDA receives from stakeholders, including members of the public, public health organizations, and the food industry. The FDA is accepting comments on the short-term targets until October 17 and on the long-term targets until December 2.

In a press statement, AHA CEO Nancy Brown expressed our strong support for the targets, saying that they will “spark a vital, healthy change in our food supply.” The association will also offer detailed feedback in our comment letters to the FDA.

Susan K. Bishop 

New Bundled Payment Model Includes Cardiac Rehabilitation Demo

A man participates in caridiac rehab -- his doctor by his side

Late last month, the Centers for Medicare and Medicaid Services (CMS) proposed a new bundled payment model for cardiac care which included a new demo to increase cardiac rehabilitation (CR) utilization. Currently, just 20 percent of Medicare beneficiaries participate in these services.

The CR demo would test the impact of providing an incentive payment to hospitals where beneficiaries are hospitalized for a heart attack or bypass surgery – in addition to the standard Medicare payment for CR services. Hospitals may use these additional resources to remove barriers to access that beneficiaries currently face, and support adherence to the full cardiac rehabilitation treatment plan.

The incentive payment would be two-part. The initial payment would be $25 per cardiac rehabilitation service for the first 11 services paid for by Medicare. It would increase to $175 per service for the remaining 36 sessions of traditional cardiac rehabilitation, or 72 sessions for intensive cardiac rehabilitation. In addition, the direct supervision provision, which has impeded program expansion, would be waived for patients in these demo programs for supervision, prescribing exercise, and establishing, reviewing, and signing an individualized treatment plan for a provider or supplier of CR and ICR services furnished to a beneficiary.

Clinical studies have found that completing a rehabilitation program can lower a patient’s risk of heart attack or death, improve patient outcomes, and help keep patients healthy and out of the hospital.

The association will submit comments on the demo – which are due by October 3.

Contact: Sue Nelson 

Nutrition Science Under Attack in House Labor-HHS Bill 

Language offered by Rep. Andy Harris, (R-MD), a medical doctor, that was put forth in the House Labor-HHS bill would prohibit the Centers for Disease Control and Prevention (CDC) from moving forward on population-wide sodium reduction activities until after the National Academy of Medicine updates the Dietary Reference Intake (DRI) Report for sodium.

This language could put an end to current grants the CDC is administering on community-based sodium reduction efforts. While the association welcomes a DRI update, we do not agree with Congress that the science behind the need for sodium reduction is weak. Nor does the association agree that current initiatives to lower sodium in the food supply, such as the voluntary sodium targets or the CDC grants, should come to a halt as we wait what some speculate could be 18 months to two years for a DRI update. There is no reason why these initiatives cannot move concurrently with an update, given that 90 percent of Americans currently eat too much sodium, consuming, on average, about 1,000 mgs more than the maximum amount recommended. Tying any sodium reduction initiatives to the DRI update is simply a delay tactic.

The House Labor-HHS language comes on the heels of now-moot language in the agriculture spending bills that would delay the voluntary sodium targets until a DRI sodium update is released. Since neither the LHHS nor agriculture spending bills will be moving in either chamber, the association will be working hard to mitigate any damage done to these important sodium reduction initiatives in an omnibus spending bill at the end of the year.

Contact: Kristy Anderson 


Sens. Whitehouse, Warren Introduce Advanced Care Legislation

In June, Sens. Sheldon Whitehouse (D-RI) and Elizabeth Warren (D-MA) introduced the Removing Barriers to Person-Centered Care Act of 2016, aimed at ensuring that patients with advanced illnesses receive high-quality, coordinated care. Among its provisions, the legislation would establish a pilot program administered by the Centers for Medicare and Medicaid Services (CMS) to support “advanced care collaboratives” that would provide coordinated, high-quality care for their target patient populations.

These collaboratives would receive assistance to determine the needs of their patient populations, update health information technology to facilitate better care coordination, and educate and train health care professionals, beneficiaries, family caregivers, and community-based social service organizations on how to document and communicate beneficiary treatment preference and goals. CMS would also waive certain regulations for the collaboratives to promote innovative care for patients with advanced illnesses, as well as create two new coverage options for the collaboratives under Medicare’s hospice benefit. The collaboratives would also be used to test advanced care quality measures.

Patients with advanced cardiovascular disease and stroke often face prolonged and unpredictable treatment scenarios. The association believes legislative efforts such as this bill could be particularly helpful to these patients.

Contact: Sue Nelson

Statement Issued To Guide Policy Decisions for Palliative Care

The association earlier this month released a new policy statement asserting that palliative care is “central” and should be integrated into the treatment of patients with heart disease and stroke.

Among the nearly 30 recommendations was a call for care teams to work with patients and families at the onset of disease to determine a patient’s needs for palliative care and to coordinate with palliative care specialists.

Other priorities outlined in the statement include setting hospital policies for palliative care during hospitalization, palliative care training for healthcare providers, and greater incentives for federal and state agencies to reimburse for comprehensive palliative care, greater data sharing between payers and providers to identify patients in need of palliative care, and better outcome measures.

“This approach to care can help patients better understand the disease they are fighting, their treatment options and their prognosis,” said Lynne Braun, Ph.D., chair of the committee that wrote the new statement.

Palliative care can also “ease the burden of care” for families and caregivers, said Braun.

AHA CEO Nancy Brown said in a statement, “We hope these policy recommendations are adopted as soon as possible so more heart disease and stroke patients and their families can receive the palliative care they want and deserve.”

Contact: Madeleine Konig 

Association Participates at CMS Meeting on Lower Extremity Chronic Venous Disease

AHA Council on Peripheral Vascular Disease Chair Dr. Joshua Beckman represented the association last month at a meeting of the Centers for Medicare and Medicaid Services (CMS) Medicare Evidence Development and Coverage Advisory Committee (MEDCAC). The committee met to examine the scientific evidence underpinning the benefit and risk of existing lower extremity chronic venous disease interventions that aim to improve health outcomes in the Medicare population.

Dr. Beckman, director of the Section of Vascular Medicine at Vanderbilt University Medical Center, discussed evidence gaps in venous disease and how they impact prevention, diagnosis, and treatment of the disease. He also highlighted the need to standardize endpoints to permit assessment across studies, and suggested that CMS may be able to help collect data to address evidence gaps.

 Susan K. Bishop


Obama Touts ACA Progress To Date

In a July 11 article in the Journal of the American Medical Association, President Barack Obama (D) laid out the progress to date in increasing access to care via the Affordable Care Act (ACA), and recommended steps that policymakers could take to improve the law.

In the article, Obama reported on the great strides the ACA has made since its implementation, such as:

  • Sharply increasing insurance coverage: Since the ACA became law, the uninsured rate in the United States has declined by 43 percent, from 16.0 percent in 2010 to 9.1 percent in 2015, with most of that decline occurring after the law’s main coverage provisions took effect in 2014.
  • Encouraging promising trends in health care costs and quality: From 2010 through 2014, mean annual growth in real per-enrollee Medicare spending has actually been negative. Similarly, mean real per-enrollee growth in private insurance spending has been 1.1 percent per year since 2010, compared with a mean 3.4 percent from 2005 to 2010.
  • Fostering important improvements in the quality of care: The rate of hospital-acquired conditions (such as adverse drug events, infections, and pressure ulcers) has declined by 17 percent. The Department of Health and Human Services (HHS) has estimated 565,000 fewer total readmissions from April 2010 through May 2015.

In other ACA news, the Department of Health and Human Services (HHS) issued a Marketplace “Enrollment Snapshot” which found that as of March 31, 11.1 million consumers who signed up for coverage during open enrollment had paid their premiums and had an active policy. Of those consumers, about 85 percent were receiving a premium tax credit to help make their coverage affordable. The average tax credit for those enrollees who qualified for financial assistance was $291 per month.

On May 13, HHS issued a final rule to implement Section 1557 of the ACA, which broadly prohibits discrimination in federally funded health care programs. Under the rule, individuals are protected from discrimination in health care on the basis of race, color, national origin, age, disability and sex, including discrimination based on pregnancy, gender identity and sex stereotyping. The association issued comments on the proposed rule.

Sue Nelson  

MACRA Update

This summer, the association submitted comments to a proposed rule that would implement key parts of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA replaced the Sustainable Growth Rate (SGR) formula, which was previously used to determine Medicare payments for health care providers’ services. Unlike SGR, under MACRA health care providers are rewarded for the quality of the care they provide rather than the quantity, and existing quality reporting programs have been merged into one new system.

In comments to the Centers for Medicare and Medicaid Services (CMS), the association commended the agency for utilizing existing, successful initiatives to help execute the new law and support many of the proposed clinical practice improvements that focus on chronic conditions. The association also encouraged CMS to consider additional clinical practice improvement activities that would incentivize providers to achieve health equity and ensure access to quality health care, including palliative care services, for all. Among its other recommendations, the association urged CMS to directly consider the patient and caregiver perspectives when measuring and rewarding the quality of care delivery and the resulting outcomes of that care.

Contact: Sue Nelson


12 Texas Cities Go Smoke-free in 12 Months 

The 2015-2016 fiscal year was one for the record books. Under the Southwest Affiliate local policy team’s leadership, 12 Texas cities passed local smoke-free ordinances. The cities are: Sherman, Waco, DeSoto, Port Lavaca, Edinburg, Red Oak, Duncanville, Seagoville, Universal City, Pharr, Mesquite, and Mission. As a result of this critical work, more than 705,000 additional Texans are now protected from toxic exposure to secondhand smoke and no longer have to put their health at risk to earn a paycheck. These local smoke-free ordinances will directly contribute to a decline in the number of heart attacks, asthma attacks, strokes, and hospitalizations in these cities, and will ultimately save the lives of many Texans.

Contact: Chris Sherwin


More Communities Raise Tobacco Sales Age to 21

Kansas – From the first victory in Kansas City, Kansas on November 19, 2015, to the most recent in Leawood, Kansas on June 20, ten cities in the state have now passed Tobacco 21 ordinances – covering more than 630,000 residents. Estimates from the Greater Kansas City Health Care Foundation project that each year the combined impact of these policies in the Greater Kansas City area will prevent approximately 1,000 adults from becoming smokers. This translates to 333 saved lives and $5.8 million saved by private employers.

New York – Two additional counties in New York State recently passed Tobacco 21 policies. The County Executive in Chautauqua County signed its new law into effect on May 19, while Albany County’s County Executive approved its policy on June 8. Tobacco 21 laws now cover more than 10 million people throughout the state.

Massachusetts – Since July 2015, the association has engaged in Tobacco 21 campaigns across the state, sending letters of support and reaching out to Board of Health Members in numerous communities. Overall, a total of 121 (out of 351) communities in Massachusetts now have a Tobacco 21 policy in place, covering more than 56 percent of the state’s population. This represents a total of more than 6.5 million people living in a city or town that has raised the tobacco sale age to 21.


West Virginia Approves Tobacco Tax Increase  

The 65-cent cigarette tax increase approved by the West Virginia Legislature is a modest step forward in reducing tobacco use in a state with some of the highest smoking rates in the country. The tobacco tax bill, which was a key part of Gov. Earl Ray Tomblin’s (D) budget compromise legislation, increases the tax on cigarettes by 65 cents per pack, raises the tax on other tobacco products from 7 percent to 12 percent of wholesale price, and places a new tax on e-cigarette liquids.

The association and our key partners that make up the Coalition for a Tobacco Free West Virginia, including the American Cancer Society-Cancer Action Network and the American Lung Association of West Virginia, have consistently supported at least a $1 per pack increase in order to have a significant public health impact. Although the 65-cent increase is lower than what we’ve advocated, this is a positive outcome overall, considering the original 45-cent increase introduced by the governor and all the threats put forward by the tobacco industry.

Contact: Chris Sherwin 

States and Communities Continue to Pass CPR in Schools Policies

In the past few months, Arizona, Ohio, and Missouri have joined a growing number of states in passing a CPR in Schools policy. A total of 34 states now require CPR training for students prior to high school graduation.

In addition to these states, two school districts in Florida (Miami-Dade County and Hillsborough County) and three in Massachusetts (Worcester, Springfield, and Southwick-Tolland-Granville) have also passed these policies.

As a result of our collective success to date, we now have policies in place across the country that will ensure more than two million students will annually be trained in CPR before graduating high school.

Louisiana Becomes 31st State to Expand Medicaid 

Gov. John Bel Edwards (D) authorized Medicaid expansion on January 12, 2016 via Executive Order, making Louisiana the 31st state to expand its Medicaid program. Enrollment began on June 1, with coverage taking effect on July 1. 
Contact: Lucy Culp

Kansas Now Requires Pulse Oximetry Screening for Newborns

After more than four years, the Kansas Department of Health and Environment (KDHE) has completed its efforts to ensure all Kansas birthing centers are compliant with the current standard of care and CCHD screening.

The association and KDHE staff have worked closely since February 2012 to ensure that all newborns in Kansas are screened for CCHD using pulse oximetry. KDHE staff have also launched a quality improvement project to send trainers into birthing centers in order to train newborn delivery staff on proper testing procedures, data collection, and data reporting a process that has been integrated with the state’s online birth record reporting system. 
Contact: Lucy Culp

Philadelphia Passes Historic Sugary Beverage Tax

In mid-June, the American Heart Association celebrated a huge victory in support of healthy lifestyles in a major city. Philadelphia became the largest, and only the second, U.S. city to pass a sugary drink tax! The 1.5 cents per ounce tax will generate revenue to help fund citywide pre-K and improve parks and community centers.
Contact: Katie Bishop

Media Advocacy Contacts

Retha Sherrod
Director, Media Advocacy
(202) 785-7929

Samantha Carter
Associate Communications Manager, Media Advocacy
(202) 785-7935

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