Monday, February 21, 2011

Happy Presidents' Day

It's Presidents' Day, and Congress is on recess until next week. Before leaving on recess, the Senate passed an Federal Aviation Administration reauthorization bill (S. 223) which according to Business Insurance includes a repeal of the expanded IRS Form 1099 reporting requirements created by the Affordable Care Act. The House of Representatives passed on a party line vote a new full year continuing resolution (H.R. 1) that would cut current appropriations by $61 billion. reports on the House bill's potential impact. The Senate majority leadership is opposed to the House measure, and the President has formally threatened to veto it.

The current continuing resolution funding the federal government expires on March 4. There's still time to reach a compromise. However, if no compromise is reached, then a government shutdown will occur by operation of the Anti-Deficiency Act. The Washington Post reports today on that prospect. Here's the key consideration from the FEHBlog's perspective -- which is drawn from a 1998 Congressional Research Service report following the government shutdowns that occurred in 1995 and 1996:
Effects on Federal Staffing. An immediate and critical shutdown effect is the furloughing (placing in a temporary, non-duty, non-pay status) of federal employees. Exempted from furloughs are 
presidential appointees, Members of Congress, uniformed military personnel, and federal employees rated "essential." "Essential" employees, required to work during a shutdown, are those performing duties vital to national defense, public health and safety, or other crucial operations. Shutdown furloughs are not considered a break in service and are generally creditable for retaining benefits and seniority.
Federal Employee Health Benefit Program (FEHBP) benefits continue for a year in a non-pay status, and the government continues to be obligated for its share of their health plan premium. Employees may continue to pay their share while on furlough, or they may elect to have their premium costs accumulate and have them deducted from their pay in a lump-sum when they return to work.
The AMA News reports that at a recent AMA meeting, the CMS Administrator Donald Berwick MD urged doctors to embrace the Administration's health care quality and electronic medical record initiatives in order to avoid being left in the competitive dust. Here's an interesting excerpt from the Q&A session at that meeting:
Payment methods should reward physicians and hospitals for keeping patients healthy, said Harold Miller, executive director at the nonprofit Center for Healthcare Quality and Payment Reform. "Nobody gets paid at all when patients stay well."
Such payments could be possible under accountable care organizations, as mandated by the health reform law. At this article's deadline, CMS was preparing to unveil a proposed rule on ACOs, which will allow physicians and hospitals to work together on coordinating care and sharing some of the savings that they generate for federal health programs.
But Miller said the public could turn against ACOs if people feel they are another way to ration care. [Federation of American Hospitals President Chip] Kahn questioned how ACOs will effectively coordinate care for patients who don't stay in the care network.
Welcome, Mr. Kahn to the wonderful world of health insurers.

The Wall Street Journal reported at length on the problem that erroneous medical bills create for patients. According to the article,
There are no comprehensive statistics on medical-billing mistakes, but Stephen Parente, a professor of health finance at the University of Minnesota who has studied medical billing extensively, estimates that 30% to 40% of bills contain errors. The Access Project, a Boston-based health-care advocacy group, says it's closer to 80%. 
I have a daughter who attends college out of state. I have had problems with her health care bills which are sent to the wrong health insurer. (These types of errors are included in the error percentage according to the article.) When I get the bills, I call the provider's billing office which is quite willing to re-bill the correct insurer. Hopefully some of the CORE Operating Rules will help eliminate these types of mistakes over time. e.g., with improved real time eligibility records.

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