59-year-old James Verone had never been in trouble with the law until two weeks ago when he robbed a bank in Gastonia, N.C., for one dollar. Rather than flee, Verone told the teller she should call the police while he waited on the couch in the bank for them to come. Why would anyone do this? Unemployed and in need of medical care, Verone thought he had a better shot at receiving medical attention in prison than out. Verone drew media attention from some who identified his desperation as proof that our health care system is broken, and others who said this must have been orchestrated for someone’s speechwriting purposes. As reporters all over the country write about a little bank in Gastonia, N.C., and Verone sits in prison, the Affordable Care Act continues to be implemented.
AT THE AGENCIES
On Monday (6/20), HHS launched a campaign to encourage Medicare recipients to take advantage of free preventative services in hopes that early treatment and diagnoses will lead to cost savings. CMS said that only 5.5 million of the 33 million eligible beneficiaries have taken advantage of the free services (such as mammograms, bone density tests and screenings for prostate cancer). The Act also entitles beneficiaries to annual wellness visits. CMS is releasing public service announcements to some 1,400 television stations and 4,400 radio stations to increase awareness of the benefits. Also on Monday, CMS sent a letter to doctors nationwide encouraging them to educate their patients about the benefits.
Eleven months ago, HHS issued rules governing patients' rights to appeal if insurers do not cover care the patient deems necessary. This past Wednesday (6/22), HHS altered the rules, providing patients with more clout in disputes with their health insurers. The rule says patients are permitted to appeal if an insurer declines to pay for care on the basis of a medical judgment. Patients cannot appeal, however, when the dispute is based on mistakes involving diagnosis coding or disagreements about whether a patient should see a medical specialist outside the insurer's network of doctors. The new version of the rules give patients only two months, instead of four, to file a complaint and gives reviewers more time to make a decision.
The Medicare Payment Advisory Commission (MedPAC), which issues two reports each year (one in March and one in June) released its June Report to Congress. The report contains suggestions for adjustments and alternatives to the sustainable growth rate system and suggestions for improving payment accuracy for imaging and diagnostic tests. Specifically, MedPAC recommends that Congress require preauthorization for certain imaging services. In response, the Medical Imaging & Technology Alliance is calling on Congress to reject these recommendations.
On Friday (6/17), CMS announced that it was contracting with a global security firm to develop predictive modeling fraud detection technology to help identify suspicious claims before they are paid. The contract will start being implemented on July 1, 2011.
In a letter to CMS last week, the American Hospital Association (AHA) praised CMS' decision to prepay a portion of future shared savings to increase participation in the Medicare Shared Savings Program. Also in the letter, the AHA urged CMS to be flexible in estimating appropriate disbursements and determining how to reconcile the pre-payments and the calculation of shared savings. Finally, the AHA requested that CMS consider offering additional funds, arguing that the costs for implementing an accountable care organization were much higher than CMS estimated.
In the latest issue of Foreign Affairs Magazine, Former Office of Management and Budget Director Peter Orszag explores several of the mistakes in the Affordable Care Act. He identifies the law’s failure to change medical liability laws as the Affordable Care Act’s “biggest substantive shortcoming.”
ON THE HILL AND AT THE ASSOCIATIONS
After receiving numerous requests for more information regarding its survey of employer reactions to the Affordable Care Act, McKinsey & Co. on Monday (6/20) released the questionnaire and survey results that led to its estimate that 30 percent of U.S. companies will “definitely or probably” stop offering employer-sponsored health insurance once the health law goes into effect in 2014. In a statement, McKinsey said that its survey, which has led to strong reactions from Democrats, was not intended to be "a predictive economic analysis of the impact" of the Affordable Care Act, but rather, was intended to capture "the attitudes of employers" and provide "an understanding of the facts that could influence decision-making related to employee health benefits." Senate Finance Chairman Max Baucus (D-Mont.) accused McKinsey of changing its story, cherry picking facts and slanting questions. An article in The Wall Street Journal's Review and Outlook Thursday (6/23), said that it was wrong for Democrats to maim McKinsey's reputation when, in fact, its survey was rigorous. The article indirectly suggests that valuing "CBO's microeconomic models that depend on undisclosed assumptions" over "an analysis of business attitudes in the real world" is absurd.
In a new study, which can be found here: http://thehill.com/images/stories/blogs/healthwatch/avalere.pdf, contrary to McKinsey's findings, Avalere Health LLC predicts that the Affordable Care Act will have a limited impact on employers.
On Monday (6/20), the American Medical Association's House of Delegates voted 326-165 to support the individual mandate. There are other parts of the Affordable Care Act the AMA does not support, however. The AMA has called the ACO rule recently drafted by HHS “overly prescriptive, operationally burdensome,” and claims that the incentives “are too difficult to achieve.” A survey of AMA members showed that 93 percent won’t enroll. Along those lines but seeming to arrive at a different conclusion, a new survey by health care staffing agency AMN Healthcare polled health care facility administrators and physicians about forming ACOs. 58 percent said they were either in the process of forming them or considering it, and 42 percent said they did not see ACO formation in the foreseeable future. The biggest reason for not forming an ACO, according to the survey, is lack of physician alignment.
Additionally, almost a year and a half ago, the American Medical Association wrote a letter to Senator Harry Reid (D-NV) to express the Association’s opposition to the Independent Payment Advisory Board, a United States Government agency created by the Affordable Care Act tasked with reducing the rate of growth in Medicare without affecting coverage or quality. This week, the Coalition to Protect Patients’ Rights applauded this decision by the American Medical Association to call for the repeal of IPAB.
IN THE STATES
In Missouri, President Pro Tem Rob Mayer (R-Dexter) appointed an interim committee to determine whether the state should enact a health insurance exchange.
On Monday (6/20), Planned Parenthood of Indiana said it would have to stop accepting Medicaid patients by the end of the day. Planned Parenthood's announcement was in reaction to a state law that prevents Medicaid payments to groups that provide abortions. Though Planned Parenthood had filed for a preliminary injunction that stopped the Indiana law, because there was no ruling by Monday, Planned Parenthood of Indiana will now only take Medicaid patients who can pay for their own services.
On Thursday (6/16), Wisconsin's state legislature adopted a budget that strips close to $1 million from Planned Parenthood.
In New Jersey, state Assemblywoman Alison McHose (R-Susssex) introduced a bill that would make it a criminal offense in the state to enforce the Affordable Care Act's requirements.
FloridaSenate Minority Leader Nan Rich (D-Weston) sent a letter to HHS Sec. Sebelius raising several objections to the Affordable Care Act, including that the overhaul does not have a medical loss ratio requiring HMOs to spend a percentage of the money they receive on health services and that it requires Medicaid beneficiaries to pay $100 if they show up at emergency rooms for what turn out to be non-emergency issues.
IN THE COURTS
On Wednesday (6/22), a three-judge panel of the U.S. Court of Appeals for the Third Circuit heard arguments from New Jersey Physicians, Inc., a physician advocacy group, and a patient identified as John Doe, challenging the constitutionality of the Affordable Care Act. The judges expressed concern over whether the plaintiffs had standing to sue before harm had been suffered. The suit was dismissed in December by a federal judge who ruled the plaintiff did not have standing.
THIS WEEK
On January 1, 2011, a provision of the health care legislation went into effect under which over-the-counter drugs can no longer be reimbursed from a health flexible spending account, health reimbursement arrangement or a health savings account unless the drug is insulin or the consumer has a prescription. Employers' cafeteria plans, which refer to employee benefit plans offered pursuant to Section 125 of the IRC, need to be amended to conform to this new rule by this coming Thursday (6/30). As this provision officially becomes effective, the Consumer Healthcare Products Association argues vigorously that making over-the-counter drugs more difficult to obtain will only raise health care costs and lead to additional (unnecessary) trips to physicians.
On Monday (6/27) at 4:00 p.m., the Cato Institute will hold a discussion on Medicare vouchers.
On Tuesday (6/28) at 9:30 a.m., the Kaiser Family Foundation will host a briefing with two former Medicare and Medicaid administrators to examine how changes to Medicare, which are now being considered, might work and their implications for beneficiaries and taxpayers.
As always, please feel free to contact us with any questions.
To view our compilation of recent health care reform implementation news, click here.