Washington Report –March, 2009
An HBMA Government Relations Publication
Healthcare Reform Moves to Top of the Congressional Agenda
Congressional Healthcare Reform Hearings – Voices for Change
2009 Physician Quality Reporting Initiative
COBRA Subsidy Information Now Available
Senate Begins Debate on Sebelius Nomination
CBO Paints Gloomy Picture But Sees Light at End of Tunnel
Deceptive Health Insurance Industry Practices
You’ve Got Mail
CMS Transmittals
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Healthcare Reform Moves to Top of the Congressional Agenda
During the 2008 Presidential campaign, candidate Obama argued that fundamental changes were necessary in the way healthcare is delivered and financed. The object of those changes: ensure that all individuals have access to quality, affordable healthcare. Now President Obama seeks to enact the changes he believes are necessary to achieve those goals.
As reported in the February Washington Report, President Obama identified a very ambitious healthcare reform agenda during a nationally televised address to a joint session of Congress in late February. That speech was soon followed by the release of the President’s budget summary where he again identified healthcare reform as a major policy goal in the first year of the first term of the new President.
Reforming our nation’s healthcare delivery system takes more than just speeches and outlines. At some point, numerous policy options and ideas must be considered, debated and voted upon if reform is to become a reality.
During the month of March numerous Committee hearings considering various aspects of Healthcare Reform were held and both the House and Senate Budget Committees began the process of fleshing out the President’s budget and developing a very detailed and specific budget. Part of that process includes putting money into the federal budget for the type of healthcare reform the President might seek.
It should be noted that as of early April, the President had not sent a specific healthcare reform proposal. Indications are that the President may not send Congress anything more than a set of broad principles and allow Congress to work out the details.Both the House and Senate Budget resolutions include a deficit-neutral reserve fund “to facilitate legislation that transforms and modernizes our health care system”. The goal of this initiative, according to Budget Committee documents is to achieve the “common goals of constraining costs, expanding access, and improving quality.”
The “reserve fund” authorized by the Budget merely provides the financial resources to pay for healthcare reform, the actual work and legislative changes necessary to accomplish that objective will fall to other Committees of Congress, most notably the Senate Finance Committee, Senate Health Education, Labor and Pensions (HELP) Committee, the House Ways & Means Committee and the House Energy and Commerce Committee.
The President has identified 8 principles that he believes must serve as the foundation for any healthcare reform initiative. These are:
1. Protect families’ financial health
2. Make health coverage affordable
3. Aim for universality
4. Provide portability of coverage
5. Guarantee choice
6. Invest in prevention and wellness
7. Improve patient safety and quality care
8. Maintain long-term fiscal sustainability
The reserve fund included in the budget, attempts to provide maximum flexibility to the Committees mentioned above, to determine the appropriate level of spending and the offsets required to pay for these investments. The purpose of the reserve fund is the implicit acknowledgement that there will be a need for “upfront investments” and that delivery system reforms may not reap immediate savings.
Although previous Presidents have called for major reforms of our nation’s healthcare delivery system, those efforts have always crashed. This initiative appears different if only because we are going down the path towards healthcare reform with little specific direction. The principles outlined above appear to be so broad that the most ardent liberal and ardent conservative could likely agree on most if not all the principles. One suspects, however, that when the details of just how the principles will be met, the divisions between liberals and conservatives, Republicans and Democrats will surface.
In the end, it appears that the legislation could be the “sum of its parts” as determined by Congress rather a substantially “whole cloth” policy presented to Congress by the President.
The Committee Report released by the Senate Budget Committee identifies the challenge facing Congress as follows:
“… efforts to provide near universal coverage without initiatives to control costs will make coverage expansion financially unsustainable to households, employers, and federal and state governments in the long run.”The President has said that he wants to work with Congress in a bipartisan way to meet the eight principles for health reform that he identified in his budget. Similar statements were made with respect to the economic stimulus legislation. Unfortunately, it should be noted that the only “bi-partisan” votes on the budget were actually the votes against the House Budget. All GOP Members in the House voted against the Budget Resolution and they were joined by 20 Democrats. In the Senate, the vote on final passage of the Budget Resolution was largely along party lines; however, one Democrat did join all Republicans in voting against it.
When Congress adjourned for the Easter/Passover/Spring Break recess, the House and Senate had not reconciled differences between their respective versions of the 2010 budget. Although the Budget Resolution does not go to the President for signature, it is necessary for the House and Senate to pass a single resolution.
A final budget resolution is expected to pass both houses of Congress shortly after they return to work in Washington in mid-April.
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Congressional Healthcare Reform Hearings – Voices for Change
Over the past month, several House and Senate Committees have conducted hearings examining various aspects of the problems facing our nation’s healthcare delivery system. Academics, uninsured individuals, families suffocating under huge healthcare indebtedness, health insurance company executives and healthcare economists have all gone before Congress with their anecdotes, experiences, and prescriptions for curing what ails the healthcare delivery system.
Out of all of this, Congress will have to design and deliver a legislative package that simultaneously improves the quality of healthcare, improves access to healthcare and reduces the cost of healthcare. That, if the polls are accurate, is what the American people are expecting. Whether Congress and the President can deliver, is another matter.
Advocates for a government run, single payer system look at the President’s principles and conclude that their vision of how our nation’s healthcare delivery system should operate fits in nicely with the President’s vision. Similarly, advocates for some type of insurance mandate (either an employer or individual insurance mandate) also look at the President’s principles and see compatibility with their vision.
Typical of the various hearings was one held on March 10 by the House Energy and Commerce Subcommittee on Health held a hearing entitled, “Making Health Care Work for American Families: Designing a High Performing Health Care System.” In his opening remarks, the Chairman of the Subcommittee had this to say about the goal of the healthcare reform process:
“issues such as quality, cost, coverage and prevention are an important part of to health care reform debate.The President’s budget proposals would change the way Medicare pays for and delivers health care through reducing readmission rates at hospitals, providing performance based payments for physicians, and promoting coordinated care between acute and post-acute care settings through bundled payments. He (the President) believes that by “focusing more on primary care, coordinated care models, and prevention, we can achieve greater savings and efficiencies within our health care system.”Frank Pallone (D-NJ)
One of the witnesses testifying before the Subcommittee was Glen Hackbarth, Chairman of the Medicare Payment Advisory Committee (MedPAC) who, in his opening remarks, cautioned against moving too quickly to reform our system, noting that the present health care system evolved over decades and that reforming the system will also take many years to complete.
He did recommend that the process of reforming our system begin as soon as possible because Medicare’s financial sustainability is deteriorating due to the dysfunctional delivery system that the current payment systems have helped to create. Hackbarth went on to note that “new technology should be a principle focus of efforts and that Congress should incorporate large-scale comparative effectiveness research.” Mr. Hackbarth also suggested bundling payments in order to force engagement and collaboration between physicians rather than competing against one another and that the health care system should include both public and private plans that are both distinctive and complementary.
Congressional Budget Office (CBO), Director David Elmendorf emphasized to the Committee that more spending on healthcare does not mean better care and explained that controlling costs and improving efficiency present many challenges. He suggested that Congress consider moving away from the fee-for-services payment model and instead, provide stronger incentives to control costs and reward value.
Elmendorf also argued that the current tax exclusion for employment-based health insurance—which exempts most payments for such insurance from both income and payroll taxes—reduces incentives to control cost (and utilization) because it is unlimited. He suggested restructuring (i.e. limit) the tax exclusion to encourage workers to join health plans with lower premiums that would reflect some combination of higher cost-sharing requirements and tighter management of benefits.
Dr. Todd Williamson, representing providers, explained that medical care in America became the best in the world because of the patient-physician relationship and the right of a patient to select his or her own physician. Williamson attributed the decline in the number of new private practices to the large educational debt and high practice start-up costs. He also expressed concern that many potential medical school candidates might defer enrollment in medical schools and discourage the pursuit of a health care career if they believe that larger government involvement in health care is on the horizon.
Williamson explained that health insurance was created as a mechanism for distributing risk, not a means of paying for all health care services. Once third party payers (whether government or commercial) began to pay for medical care, they began controlling the delivery of medical care. Dr. Williamson believes that in order to heal the medical care system, we must restore the patient-physician relationship by ensuring that patients have the right to privately contract with the physician of their choice.
To date, nearly a dozen hearings looking at various aspects of healthcare reform have been held by different Congressional Committees.
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2009 Physician Quality Reporting Initiative
The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host the fourth in a series of national provider conference calls on the 2009 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 2:30 p.m. – 4:30 p.m., EDT, on Wednesday, April 22, 2009.
Although the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) made the PQRI program permanent, incentive payments are only authorized through 2010. Eligible professionals who meet the criteria for satisfactory submission of quality measures data for services furnished during the reporting period, January 1, 2009 - December 31, 2009, will earn an incentive payment of 2.0 percent of their total allowed charges for Physician Fee Schedule (PFS) covered professional services furnished during that same period. The 2009 PQRI consists of 153 quality measures and 7 measures groups.
The topics covered on this national provider call will include:
An update on the prostate cancer measures
Tips for satisfactorily participating in the 2009 PQRI
Planning for the 2010 PQRI reporting options
Following the formal presentation, the lines will be opened to allow participants to ask questions of CMS PQRI subject matter experts.
Conference call details:
Date: April 22, 2009
Conference Title: 2009 Physician Quality Reporting Initiative - National Provider Call
Time: 2:30 p.m. EDT
In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to listen in as part of a group (i.e. a single phone line), only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. If you cannot attend the call, replay information is available below.
Registration will close at 2:30 p.m. EDT on April 21, 2009, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
To register for the call participants need to go to:
http://www2.eventsvc.com/palmettogba/042209
Fill in all required data. Verify your time zone is displayed correctly in the drop down box and then click "Register".
You will receive a confirmation email shortly thereafter indicating that your registration has been accepted.CMS recommends that you print and save the confirmation page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.
For those unable to attend, a replay option will be available shortly following the end of the call. The replay will be accessible from 3:30 p.m. EDT 4/22/2009 until 11:59 p.m. EDT 4/29/2009. The call in data for the replay is (800) 642-1687 and the passcode is 90578004.
If you require services for the hearing impaired please send an email to:
.
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COBRA Subsidy Information Now Available
The Department of Labor has released guidelines to employers on how to implement federal subsidies to help newly unemployed workers cover the cost of health insurance premiums under COBRA. According to a press release issued by the Department, the American Reinvestment and Recovery Act (ARRA) provides a 65 percent tax subsidy for the cost of health benefits, making them more affordable for the unemployed and their families. Millions of individuals, including those who previously declined employer-provided coverage under COBRA, will be eligible to receive a subsidy on their premiums for up to nine months.
"Today the Labor Department is publishing more information to help the public understand how the program works and how they can qualify for the premium subsidy for continuation of health coverage under private, state and federal programs. The model notices we are releasing enable employers to quickly spell out for former employees and their families how to take advantage of COBRA coverage and the subsidy.