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April 27, 2015

Washington Health Policy Week in Review Archive ce724262-8696-4fc0-852d-4211154bce74

Newsletter Article


Half of Eligible Docs Were in 'Meaningful Use' Program, CMS Says

By Rebecca Adams, CQ Roll Call

April 23, 2015 -- About half of the physicians and other eligible professionals who could participate in the federal electronic medical records incentive program did so in 2013, according to a report that the Obama administration planned to release last week. The number of providers participating rose by 47 percent from 2012 to 2013.

The Centers for Medicare and Medicaid Services (CMS) released statistics showing that 641,654 eligible medical professionals participated in the so-called meaningful use program in 2013, up from 435,931 professionals who participated in 2012. Incentive payments to physicians and other eligible professionals who met CMS standards totaled almost $215 million that year.

Some 469,755 medical professionals face penalties of 1.5 percent in Medicare payments for not adopting an electronic medical records system that met CMS guidelines. The meaningful use program prods physician practices to use electronic records to track patient histories, paying incentives in early years. 

Another program that incentivized physicians to electronically transmit prescriptions paid out more than $168 million in 2013. That year, 377,004 eligible professionals participated, which was an increase of 9 percent from the previous year.

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Newsletter Article


HHS Chief Says She'll Work with Senate on E-Health Problems

By Melissa Attias, CQ Roll Call

April 23, 2015 -- The chairman of the Senate Health, Education, Labor, and Pensions (HELP) Committee has secured a commitment from Health and Human Services (HHS) Secretary Sylvia Mathews Burwell to work to address problems with electronic health records.

At a Senate Labor-HHS-Education Appropriations Subcommittee hearing, Lamar Alexander, R-Tenn., expressed concern about the amount of federal funding spent subsidizing the shift from paper to electronic records while doctors continue to resist, even in the face of penalties for non-participation, and express dissatisfaction with the systems. Alexander and Patty Murray of Washington, the top Democrat on the HELP panel, have formed a bipartisan working group to identify five or six problems with electronic health records that can be addressed administratively or legislatively.

"What I'd like to do is to move up toward the top of our—your list and our list—doing something about electronic health records," Alexander told Burwell.

Asked if she would work with senators to identify those issues, Burwell agreed and said she has a staff working group ready. Electronic health records touch everything from opioid abuse to precision medicine to delivery system changes, she noted.

Electronic records make it easier for medical providers to track whether they are providing the services patients need and meeting guidelines put forward by federal health officials.

"Where everything is going in terms of our ability to serve the consumer, the patient, in the way we need to, this is a core part," she said, adding that she looks forward to putting the list together and getting it accomplished.

Alexander said there's great interest in the issue within his committee, naming Louisiana Republican Bill Cassidy in particular. The chairman said he's already met with Andy Slavitt, acting administrator for the Centers for Medicare and Medicaid Services, and plans to meet with Karen DeSalvo, national coordinator for health information technology.

Senators quizzed Burwell about a variety of issues at a recent hearing on the Health and Human Services Department's fiscal 2016 budget request, including pending regulations to extend the Food and Drug Administration's (FDA) authority to electronic cigarettes and other unregulated tobacco products.

Oregon Democrat Jeff Merkley asked if the rule proposed last April has moved from FDA to the Office of Management and Budget for review. Burwell said HHS is still going through comments and it hasn't moved to the Office of Management and Budget.

"It's our hope that over the summer, that at some point this summer, we will get to a final stage," she said.

On the issue of opioid abuse, Burwell suggested that the department may request legislation related to training guidelines on prescribing opioids.

"Even if we put the guidelines out, the questions of whether or not those existing physicians and even those coming through will be trained in these mechanisms and trained in these guidelines is a question that I think is an extremely important one," she said. "How that and where that occurs may be a conversation that we need to continue."

Subcommittee Chairman Roy Blunt, R-Mo., asked if the department needs more authorizing language or funding.

"It's not just money," Burwell responded. "It is other questions about how people are willing to implement the guidelines and make sure that people are trained."

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Newsletter Article


Pew Study: Before Health Care Law, Recession Pushed Up Medicaid Spending

By Marissa Evans

April 22, 2015 -- States spent a larger portion of their own money on Medicaid in 2013 than they did in 2000, as participation in the joint federal–state health insurance program for low-income and disabled Americans grew because of the Great Recession of 2007–09, according to a study by the Pew Trusts.

Maine, California, Minnesota, Montana, and Arizona saw the biggest gains in Medicaid spending during the period. Only one state, North Dakota, which experienced an energy employment boom during the recession, saw its Medicaid spending fall, the report found.

The Pew study, released last week, looked at Medicaid spending in the 50 states from 2000 through 2013; states were able to expand their Medicaid programs under the health care law starting in January 2014, with 100 percent of the additional cost borne by the federal government through 2016, when the federal contribution starts to decline to 90 percent by 2020 and thereafter.

Medicaid spending accounted for 16.9 percent of all state-generated funds in 2013, according to the report. The findings are available via PDF and interactive graphic.

Andrea Maresca, director of federal policy and strategy for the National Association of Medicaid Directors, said the report's findings were not surprising but they emphasize how big of a player Medicaid is in the health care world. She said, considering the $200 billion that states are spending on their Medicaid programs, people need to remember the stakes they also have in the program's success.

"There's a false impression states are trying to game the system and not mind the store, and I think with the amount of money they're spending that's an erroneous assumption," Maresca said.

Under the 2010 health care law, state Medicaid programs can be expanded to enrollees with incomes up to 138 percent of the federal poverty line. Twenty-eight states and the District of Columbia are participating in the expansion. States that did not expand their Medicaid program receive an average reimbursement of just 57 percent of their costs.

"The states that have expanded [Medicaid] have outpaced other states that haven't expanded in insurance coverage," said Jesse Cross-Call, health policy analyst for the Center on Budget and Policy Priorities. "Spending isn't just happening; there's also good coming along with it, and that good is people are gaining coverage."

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Congressional Conference Wrestles with Use of Reconciliation

By Paul M. Krawzak, CQ Roll Call

April 22, 2015 -- The major difference between the House and Senate budget plans that needs to be ironed out in conference committee concerns what to use the powerful reconciliation procedure for—the expedited method of bringing revenue and spending into conformity with the policies in the congressional budget resolution.

Senate leaders want to employ reconciliation to repeal and replace the 2010 health care law. The Senate's fiscal 2016 budget resolution (S Con Res 11) reflects this, issuing reconciliation instructions to just two committees, Finance and Health, Education, Labor and Pensions, or HELP. Finance and HELP share jurisdiction over health care programs. Finance has jurisdiction over taxes.

The House Budget Committee wrote instructions in its plan (H Con Res 27) to 13 committees, including Ways and Means and Energy and Commerce, the committees with jurisdiction over health care programs, providing them with a broad directive to find deficit reduction in many different federal programs.

Several people with knowledge of the negotiations say the budget conferees are moving in the direction of limiting reconciliation to the health care law, as Senate leaders prefer. But that could change as House and Senate conferees seek to reach agreement before the end of the month. The House and Senate Budget Committee chairmen, Rep. Tom Price of Georgia and Sen. Michael B. Enzi of Wyoming, have said little about reconciliation recently. Both chairmen stressed the need to repeal "Obamacare" during the first conference meeting. But neither they nor any of the other Republican members of the conference committee even brought up reconciliation.

The two reconciliation approaches boil down to a choice between using the procedure for deficit reduction in general, or using it to produce the more limited savings that would be realized from repealing much of the health care law. Reconciliation is particularly potent in the Senate, where it allows budget-related legislation to be considered and approved with a simple majority of 51 votes instead of the usual supermajority of 60.

A third but related potential use of reconciliation that both committees have contemplated is to employ it to pass a GOP legislative response to a Supreme Court ruling on health care subsidies that is expected in June. Republicans hope the court will rule in King vs. Burwell that the federal government can't offer subsidies on a federal exchange, opening the door for the GOP to offer its own transition plan that could eventually replace the health care law.

Sen. Ron Johnson, R-Wis., said he would like to see reconciliation used for a response to the court decision "if it's possible." Johnson is urging the GOP to come up with a response plan sooner rather than later. He introduced legislation April 20 that would allow individuals to keep any health care plan they have until August 2017 if the federal subsidies are struck down. The bill also would repeal requirements for individuals to buy insurance and allow them to purchase any new insurance plan on the market even if it did not meet federal requirements.

Those who want to limit reconciliation to repealing and replacing the health care law argue that approach would allow Republicans to make clear to the public what they are trying to accomplish, even though it is certain that President Barack Obama would veto the measure. Combining repeal with other spending cuts would muddy the issue and give Democrats the opportunity to switch the focus away from the health care law to other elements of the reconciliation legislation, they say.

Georgia Republican David Perdue, a freshman member of the Senate Budget Committee, favors using reconciliation for the health care law. "I am very nervous about broadening the use of that at all," he said.

Broader reconciliation instructions, such as those envisioned in the House plan, would widen the field of mandatory spending programs that could be cut and make greater deficit reduction possible.

"Given the need to slow the growth of entitlement spending, the budget conference should adopt the House's approach to reconciliation -- instructing every committee dealing with mandatory programs to find at least some savings," the non-partisan Committee for a Responsible Federal Budget advocated in a report last week. "This way, Congress has maximum flexibility to enact deficit reduction from across the budget, allowing it to act on the mandatory savings assumed in the budget resolution, or a smaller set of savings with broader bipartisan support."

The reconciliation instructions in both budgets were written to provide a high degree of flexibility enabling the procedure to be used for a bill to respond to the Supreme Court decision. That is particularly the case in the House budget, which includes a special rule allowing any potential subsidy replacement plan to have its cost estimated relative to the January 2015 Congressional Budget Office baseline. If a plan were scored against an updated baseline after the court ruled against subsidies, the legislation would potentially constitute a spending increase. But scored against the January baseline, it would appear as a spending cut.

Sen. Rob Portman, R-Ohio, said he wants to retain flexibility to respond to a court decision in the final budget resolution. "I think in terms of the health care side of it, keeping it broad makes sense because we don't know what's going to happen with the court case," he said.

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Newsletter Article


Hospitals Protest Modest Increases in Medicare Payment Rule

By Kerry Young, CQ Roll Call

April 20, 2015 -- The American Hospital Association (AHA) is upset that a Medicare payment proposal would give its members only a small bump in funds at a time when the group says they are being asked to make many changes in their approach to the delivery of care.

In a statement about the fiscal 2016 payment rule for many services delivered in hospitals, Rick Pollack, executive vice president of the AHA, noted the proposal carries forward many congressionally mandated policies. The Centers for Medicare and Medicaid Services (CMS) has estimated the planned changes would raise operating payments by 0.3 percent through the inpatient prospective payment system.

"These very modest increases will make it even more challenging for hospitals to deliver care patients and communities expect," Pollack said.

In the rule, CMS estimates that the proposed rule would result in a net increase of about $121 million for hospitals for inpatient services.

Medicare, which covers about 54 million elderly and disabled, is one of the largest sources of revenue for hospitals, accounting for about a fifth of hospitals' overall revenues in 2012, according to the Medicare Payment Advisory Commission. Medicare that year spent about $120 billion through its acute inpatient prospective payment system, making up about a quarter percent of the program's expenses.

The fiscal 2016 inpatient prospective rule runs to more than 1,500 pages, covering hundreds of tweaks to current policies and new proposals. Among them are changes to extraordinary circumstances policies, meant to apply to reduced payments for excess rates of readmission and for patient acquiring infections in hospitals. Extraordinary circumstances policies allow a waiver on use of data in cases where disasters such as hurricanes and flood affect a hospital.

The AHA said it is concerned about a CMS policy that was not address in the proposal. The group and the agency have been at odds for several years about when patients' short visits to hospitals should merit the more generous reimbursement made through Medicare Part A claims, and when they should be billed for observation services. Hospitals have been able to hold somewhat at bay the use of recovery audit contractors, whose work could put them at risk of missing out on any payment for a blown call on how to bill Medicare for services delivered.

In a statement about the proposal payment rule, CMS explained that it had set a benchmark of expecting stays lasting at least two nights to qualify as inpatient care, while shorter ones could be covered as outpatient services. CMS said that it expects to include "a further discussion of the broader set of issues related to short inpatient hospital stays, long outpatient stays with observation services" in another of the payment proposals, the one for calendar 2016 for outpatient services.

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