Sunday, April 15, 2012

Weekend Update

The House and Senate return from their Easter recess this week. Modern Healthcare reports that "members of Congress are already discussing the likelihood that they will return soon after the polls close [in November] for an extensive lame duck session to resolve numerous high-profile issues, such as (yet another) looming Medicare physician reimbursement cut."

Following up on Thursday's post about anti-trust issues, the AMA News confirms that
Hospitals are merging or being bought and sold at an increasing rate, according to recent reports. Data released Feb. 28 by Irving Levin Associates indicated that 86 hospital merger or acquisition deals were done in 2011, the highest number in the past decade. Seventy-five happened in 2010 and 51 occurred in 2009. A report issued March 8 by Moody’s Investors Service said these trends will continue but did not predict how many mergers would take place.
Last week, the Internal Revenue Service announced on its ACA website
The Affordable Care Act establishes the Patient-Centered Outcomes Research Institute ["PCORI"]. Funded by the Patient-Centered Outcomes Research Trust Fund, the institute will assist patients, clinicians, purchasers and policy-makers in making informed health decisions by advancing clinical effectiveness research. The trust fund will be funded in part by fees paid by issuers of health insurance policies and sponsors of self-insured health plans [beginning later this year. The fee will be $1 per covered life for the first year and $2 per covered life in subsequent years ending in 2019.

On April 12, 2012, the IRS and the Treasury Department issued proposed regulations on this fee. The IRS and Treasury request comment on the proposed regulations by July 16, 2012. Comments may be submitted electronically, by mail or hand delivered to the IRS. Additionally, a public hearing is scheduled for August 8, 2012. The preamble to the proposed regulations provides instructions on how to submit comments and participate in the public hearing.
The fee is expected to generate $2.6 billion in revenues through 2019.  Here's the rub reported by LifeHealth Pro

To dispel fears that the "comparative effectiveness research" (CER) institute will be a care rationing "death panel," PCORI is supposed to influence health care solely by publishing its findings and letting physicians and hospitals decide for themselves how to use the information. Insurers are not supposed to use PCORI's work as the basis for making specific coverage decisions.
 The PCORI Executive Director quoted a Board of Governors member as follows:

“Ultimately, we’re going to be listening to a lot of stakeholders but our true North is going to be … patients and their caregivers … for whom the consequences of a [health care] decision is the greatest,” he said. “Help us frame a new way of thinking about how the health care system ought to operate.”
 Time will tell the PCORI's value.

Privacy officials for HIPAA covered entities and health plans must read this AIS interview with the HHS Office for Civil Rights Director Leon Rodriguez. OCR is responsible for enforcing the HIPAA Privacy and Security Rules. The article begins with the chilling sentence --  "The $1.5 million settlement that the Office for Civil Rights recently reached with BlueCross BlueShield of Tennessee heralds a new era of “monetary enforcement” by the agency, in contrast to its long-standing approach of what OCR Director Leon Rodriguez termed 'hand-holding.'” Bear in mind here that BCBST was a crime victim in this situation but that did not stop the government from imposing the sanctions for inadequate security. The times they are a changin.

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