Weekend Update / Miscellany

• Congress passed an FY 2010 budget resolution that applies the budget reconciliation process to health care reform, according to this New York Times report. The budget reconciliation process would allow the Senate to avoid a filibuster over health care reform. Now the Sen. Arlen Spector has switched parties from Republican to Democrat, the Senate majority has inched closer (59 votes) to the magic 60 votes required for cloture, and the Minnesota election dispute to date favors the Democrat Al Franken who would provide the 60th vote. But of course Senators pride themselves on independence so no one should count their chickens before they hatch.

• Speaking of such independence, Sen. Max Baucus, the powerful Senate Finance Committee chairman made some interesting comments at a hearing last week according to the Kaiser Foundation daly health policy report for April 30:

  During a confirmation hearing for William Corr, President Obama's choice for deputy secretary of HHS, Baucus said, "There are some very, very thoughtful people in health care who really, seriously, wonder if CMS is up to the job," adding that "there's some question whether they are able to develop the designs and putting new programs together as opposed to just implementing old programs." He raised the prospect of creating a separate entity to work alongside CMS that would be tasked with designing possible changes such as bundling payments for services, or developing accountable care organizations and the medical home concept. Corr said, "It begins also with leadership and I think Secretary Sebelius intends to bring in outstanding leaders to the department, to CMS," continuing, "I hope within several months that when you make that assessment again, you will be able to say different things about the direction CMS is moving in" (Norman, CQ HealthBeat,
  4/30).

  I suggest that the problem is not CMS but rather the hideously complicated Medicare program.

• Modern Healthcare reports that "U.S. health officials are cautiously optimistic that the new swine flu isn't as dangerous as first feared, but urged people on Sunday to keep taking commonsense precautions — and they can't predict if it will roar back in the fall." Modern Healthleaders offered a report on how "the onset of swine flu has reignited the debate about whether retail-based, walk-in healthcare clinics are an appropriate venue for treating people with highly communicable diseases." Aren't these people going the pharmacy anyway?

• On May 1, CMS released a proposed rule setting Medicare's inpatient acute and long term care hospital payments for discharges occuring on or after October 1, 2010, the next federal fiscal year. "CMS is proposing to update acute care hospital rates by 2.1 percent for inflation less an adjustment of 1.9 percentage points to remove the effect of increases in aggregate payments due to changes in hospital coding practices that do not reflect increases in patient’s severity of illness." CMS also announced new quality measures.

• Also on May 1, OPM announced the award of a seven year long term care insurance contract to John Hancock as insurer and Long Term Care partners as administrator. "Premium rates for current enrollees with automatic compound inflation (ACI) protection will increase between 5 percent and 25 percent. The program has not had an increase in the last seven years and another increase is not expected until 2016. There is no premium increase for enrollees with Future Purchase Option."

• AHIP released a report on private sector health plan strategies to control expenses and improve quality, such as pay for performance.

• The new health information technology czar David Blumenthal announced according to Government HIT News that "he expects to start meeting shortly with members of health IT advisory panels set up under the economic stimulus law and take first steps on how to use some of the $2 billion health IT war chest it funded. HHS also rolled out a new HIT website.

• In the April 28 Federal Register, HHS, the Labor Department, and the IRS sought public comment on issues affecting the implementation of the new federal mental health parity law which takes effect next year. The comment deadline is May 28, 2009.

• The Federal Trade Commission announced a three month delay in implementaion of new identity theft prevention requirements imposed on creditors and financial institutions. Doctors have been screaming bloody murder about these rules. You can therefore imagine my consternation when I discovered that lawyers also are subject to these Red Flag rules. The new implementation date is August 1, 2009.