The Infectious Diseases Society of America (IDSA) supports numerous initiatives in the President’s budget proposal for the 2014 fiscal year (FY) that would enhance our nation’s ability to track and respond to serious public health threats such as antimicrobial resistance, influenza and foodborne illnesses. IDSA also is pleased that the budget would cancel the across-the-board funding cuts enacted through sequestration and replace them with a more balanced approach to deficit reduction. However, the Society is disappointed that the budget fails to sufficiently strengthen our nation’s commitment to biomedical research, maintain robust funding for immunizations programs, or preserve access to lifesaving antimicrobial drugs administered in physician offices.
IDSA urges Congress to enact the following administration-proposed investments:
Centers for Disease Control and Prevention (CDC) National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) ($70 million increase): The NCEZID leads federal public health initiatives (such as surveillance, data collection, antimicrobial stewardship efforts) on infectious disease threats, including the deepening crisis of antimicrobial resistance.
New Advanced Molecular Detection (AMD) Initiative ($40 million): This exciting proposal would allow CDC to more quickly determine where emerging diseases come from, whether microbes are resistant to antibiotics, and how microbes are moving through a population. The AMD initiative will strengthen CDC’s epidemiologic and laboratory expertise to effectively guide public health action.
National Healthcare Safety Network (NHSN) ($12.5 million increase): The new funding for NHSN will allow CDC to further invest in the EpiCenters—five academic centers which conduct research projects on health care-associated infections and antibiotic-resistant infections. The EpiCenters have survived on a $2 million budget over the past 15 years with no increase. Examples of areas where the EpiCenters could expand their work include: evaluating interventions to prevent or limit the development of antimicrobial resistance, facilitating public health research on the prevention and control of resistant organisms, and assessing the appropriateness of surveillance and prevention programs in health care and institutional settings.
CDC Influenza Planning and Response ($414 million increase): Last fall IDSA released an updated set of Pandemic and Seasonal Influenza Principles for United States Action which called for increased federal funding to strengthen influenza preparedness and response activities, including immunizations, surveillance and communications. Strong investment in this area can help reduce the incidence and severity of influenza as well as associated hospitalizations and mortality.
CDC Food Safety ($16.5 million increase): The proposed enhanced investment in food safety would improve our nation’s ability to detect foodborne disease case clusters, facilitate real-time communication among health departments, quickly identify outbreaks, and better determine areas where implementation of new measures is likely to increase the safety of our food supply.
Medicare Physician Payment: IDSA continues to call for a repeal of the severely flawed Medicare Sustainable Growth Rate, and we are heartened that the administration shares this goal. The budget proposes a period of payment stability lasting several years to allow time for the continued development of new payment models. IDSA supports the President’s inclusion of physicians in designing these models.
IDSA urges Congress to provide a stronger investment than proposed by the administration for these priorities:
National Institute of Allergy and Infectious Diseases (NIAID) ($92 million increase): While IDSA is pleased by the proposed $92 million increase for NIAID, we believe a larger increase is necessary to sufficiently address research needs. We have proposed $100 million for NIAID’s new Clinical Trials Network on Antibacterial Resistance. Additional funding also is needed for research on diagnostics as well as new influenza antivirals to treat resistant strains of the virus. Also, we remain concerned with the budget’s proposed policy, also adopted for FY2012 and FY2013, to limit the salary of NIH extramural researchers to Executive Level II ($179,700 — a reduction of $20,000 from the Executive Level I cap used for 10 years prior to FY2012). Reducing the salary cap will disproportionately affect physician investigators and serve as a deterrent to recruiting young investigators into research careers at a time when our country is already struggling to remain globally competitive in research and technology.
Biomedical Advanced Research and Development Authority (BARDA) and Strategic Investor (flat funding): IDSA is disappointed that the budget fails to seek increased funding for BARDA, as investment in medical countermeasure development is critical to prepare for both intentional attacks and naturally emerging infections, particularly those resistant to current antimicrobials. IDSA supports the proposed creation of a Strategic Investor, which could fill a significant void by partnering with small “innovator” companies and private investors to address urgent needs, including novel antimicrobials for multidrug-resistant organisms, diagnostics, vaccines and other therapeutics.
Immunizations ($105 million decrease): IDSA continues to oppose the administration’s proposal to decrease funding for CDC immunization programs. The administration’s rationale that recent changes requiring insurance coverage of immunizations lessens the need for these programs is faulty. Insurance coverage alone will not ensure access and utilization. Public health programs are critical to help providers obtain and store vaccines; establish and maintain vaccine registries; educate providers and the public about vaccine recommendations, effectiveness and safety; and promote universal vaccination of health care workers. Of tremendous concern, vaccination rates for adults range from 26 percent to 65 percent, depending on the type of vaccine and population.
Medicare Part B Drugs: IDSA is extremely concerned that the administration’s proposal to decrease Medicare reimbursement for drugs administered in a physicians’ office from 106 percent of the Average Sales Price (ASP) to 103 percent ASP. Unlike other drugs, the vast majority of antimicrobials that are administered in the outpatient setting are low cost drugs that do not have significant profit margins. Medicare’s 2005 transition to the current payment methodology for Part B drugs eliminated what little profit margin had previously been built into antimicrobial reimbursements. Further reducing reimbursement would undermine the ability of most ID practices to offer outpatient antimicrobials, thereby forcing many patients to endure prolonged and costly facility stays which place them at an increased risk of complications.
Note: Increases and decreases are based upon FY2012 funding levels, as exact FY2013 funding levels are still being calculated.
For information on proposed domestic and global HIV/AIDS spending, please see the HIV Medicine Association’s website and Science Speaks, the blog of the Center for the Global Health Policy.
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