The Obama administration has pulled a
highly controversial final regulation undergoing White House clearance that
would have allowed hospitals and other providers to determine if there was
"harm" when patient health information was breached, a situation that privacy
advocates criticized as "the fox watching the hen house." Key lawmakers had
complained in recent months that the breach standard violated congressional
intent. The rule pulled from clearance would have finalized an interim final
rule that includes the breach standard.
Richard
Gilfillan, the former president and CEO of Geisinger Health Plans, has accepted
a job directing CMS' performance-based payment policy staff, according to an
internal agency e-mail. In this position, Gilfillan will play a key role in the
agency's implementation of the new health reform law's delivery system and
value-based purchasing reforms.
In a win for
drug makers, CMS is waiting three years to bundle reimbursement of oral
treatments for end stage renal disease that have have no injectible
equivalents. Biopharmaceutical companies Amgen and Genzyme had lobbied for a
delay, using a health reform law provision to bolster their argument. Big
dialysis companies did not fair as well in the rule unveiled by the agency July
26, receiving a 3-percent cut in Medicare payments during the four-year
transition, which is on top of the 2-percent statutory cut. Dialysis companies
had lobbied against the 3-percent reduction.
CMS for the
first time will link providers' payment rates to the quality of care as part of
a proposed rule on the Quality Improvement Program (QIP) for end-stage renal
disease. The payment system was dictated to CMS by the Medicare Improvement for
Patients and Providers Act in 2008, but the ESRD proposal is similar to the
value-based purchasing systems envisioned for hospitals in the new health
overhaul law.
Hospital groups blasted CMS July 30 for
moving forward on a final inpatient prospective payment system final rule and
interim final rule that offsets payments to hospitals due to "coding creep"
that occurred as a result of the Medicare Severity Diagnosis Related Group
policy in 2007. This provision cancels out the 2.6 percent market basket update
called for in the rule and will result in payments next year that are about $440
million less for the approximately 3,500 hospitals paid under the IPPS.
Assisted
living advocates were on Capitol Hill in mid July urging lawmakers to exert
pressure on HHS to implement a provision of health care reform that calls for
the elimination of Medicare Part D co-payments for dual eligibles in assisted
living, sources say. The health reform law calls for HHS to implement the
provision no earlier than Jan. 1, 2012 but doesn't provide a deadline, so the
department would not be violating the law if the provision never kicked in,
Karl Polzer, the senior policy director for the National Center for Assisted
Living, told Inside Health Policy.
A bipartisan
plan to extend medical liability coverage to physicians volunteering at free
clinics passed the full House Energy and Commerce Committee by voice vote on
July 28. The legislation failed twice over the past two years to move through
Congress, but staffers are optimistic that the measure will succeed this time.
CMS will
require drug makers to pay disputed discounts for doughnut hole drugs up front,
but extended the time period in which the manufacturers must reimburse
quarterly invoices to 38 days, more than double the 15 days originally
envisioned by agency officials, according to documents released by the agency.
A bipartisan
coalition of lawmakers is looking to build on a trend of linking medical
providers with attorneys as a way to help patients through the health care
process, avoid preventable medical conditions and reduce health care costs.
Senate health committee Chair Tom Harkin (D-IA) along with other senators last
month introduced legislation that would set aside $10 million for a federal
demonstration and evaluation program to bring attorneys into health care
settings and integrate preventive law and medicine, and provide legal
assistance to providers and patients.
The author of
the Health Information Technology for Economic and Clinical Health Act (HITECH)
grilled HHS officials about the law's implementation at a lengthy July 27
hearing on Capitol Hill, focusing on the aggressive timeline set out in the
rule to certify electronic health records systems (EHR) and urging HHS to set
up the accreditation process as quickly as possible. Implementation of EHR
requirements is viewed as a foundation for health reform.
As new
provisions in the health reform law strive to lower readmission rates to
hospitals, Medicare managed care plans are highlighting techniques they use --
including transitional care models -- to keep patients home after a discharge
and point to data suggesting MA readmission rates are up to 29 percent lower
than those in fee-for-service Medicare. Members of America's Health Insurance
Plans (AHIP) touted the MA data at a Capitol Hill briefing last week.
A
Republican House member introduced a resolution last week seeking documents,
records and communications from HHS related to any analysis conducted by the
CMS chief actuary pertaining to the health reform bill, and specifically a
report issued weeks after the March 23 passage of the bill in an effort to
determine whether the Obama administration withheld releasing data on the bill
days before a final vote.
Five Republican senators have called for HHS to pull an
advertisement featuring Andy Griffith that touts the new health care reform law
and makes the allegation that "this year, like always, we'll have our
guaranteed benefits."
As home health agencies face scrutiny
from the Securities and Exchange Commission, cuts in Medicare reimbursement and
enjoy double-digit Medicare margins, a bill introduced July 28 by a Ways and
Means Democrat with strong labor support would require them to pay their
workers overtime and minimum wages. The bill also charges CMS with crunching
the numbers on a plethora of workforce data about the industry.
The Senate voted 61-38 on Wednesday to end debate on a bill that includes a six-month extension of enhanced federal Medicaid payments. The measure had been attached to an array of other bills over the past few months, and the cloture vote follows intense lobbying by governors, hospitals and other stakeholders. On news of an impending Senate vote on FMAP, House Speaker Nancy Pelosi (D-CA) tweeted that she will call members back from recess to vote on the measure.
Weeks after
HHS made it clear that multi-campus hospital systems would only receive one
electronic health record meaningful use payment, a bipartisan bill group of
House lawmakers has drafted legislation that would circumvent the agency's
rule. The bill's sponsors say the measure has the support of more than 30
members of the Ways and Means and Energy and Commerce committees, including the
chairs.
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