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Tavenner: 'All the Steps in Place' for 2014 Coverage Expansion

By John Reichard, CQ HealthBeat Editor

March 5, 2013 -- After working for nearly three years behind the scenes overseeing the implementation of the massive health law, Marilyn Tavenner is increasingly stepping out in public to talk about her handiwork.

"I think we are going to have all the steps in place to get it done," Tavenner told a gathering of hospital executives last week regarding the historic 2014 expansion of health coverage under the overhaul law.

Last week, the acting Centers for Medicare and Medicaid Services (CMS) administrator plans to address health information technology executives at a conference sponsored by the Health Information and Management Systems Society.

And not too long from now, Tavenner hopes to be sitting behind a microphone at a planned—but not yet scheduled—hearing by the Senate Finance Committee on her nomination to become permanent head of CMS. Tavenner told reporters that she was very encouraged by a meeting she had last week with the committee's chairman Sen. Max Baucus, D-Mont., concerning her nomination.

Tavenner's remarks at the meeting, sponsored by the Federation of American Hospitals could hint at her testimony before the Finance committee. She cited various "metrics" detailing accomplishments under the health law (PL 111-148, PL 111-152).

But the main event in terms of metrics will come this fall when CMS sees how many people will be covered under expanded state Medicaid programs and how many come to insurance exchanges to obtain health coverage—"part of what we will call our insure America campaign," Tavenner said.

In that area, there is much uncertainty about how many of the uninsured will sign up.

"We are going to need your help," Tavenner told the hospital executives. CMS is holding off until summer in starting its enrollment outreach campaign, she said.

Research shows that if CMS gets too much of a head start in talking to people about tax credits to buy coverage in 2014, and then people are told those credits won't be available for six or seven months, "they start to lose interest," Tavenner said.

Tavenner was asked by a questioner what hospitals – often what he called "the first door" for the uninsured into the health system – could do to ease enrollment in health plans under the health care law. Many hospitals, she said, have someone in their emergency departments who acts as a Medicaid liaison. Those staffers will have enrollment information and will be trained, she said. Hospitals also will be able to help individuals with online enrollment, she added. And they'll be able to direct the uninsured to toll-free telephone lines with counselors available to provide guidance.

In states where the federal government will operate the exchange, federal officials will launch navigator programs to aid enrollment, including by having navigators in some hospital emergency departments. In states that operate their own exchanges, such programs are required. CMS will begin to roll out the navigator program between April and July, she said. In addition, the CMS regional offices will have liaison staff who will send out teams to individual hospitals to help them prepare to enroll the uninsured. She added that "all types" of volunteers will be trained to provide assistance, including those from faith-based organizations.

Health Law Measures

Tavenner reviewed for the hospital executives what CMS counts as the accomplishments so far under the health law: about three million people in their early to mid-twenties with coverage under their parents' health plan; 34.1 million Medicare beneficiaries who got some form of preventive care in 2011; 54 million privately insured Americans with improved preventive benefits; 135,000 Americans with costly pre-existing medical conditions who obtained coverage through the PCIP program; and 6.1 million Medicare enrollees with $5.7 billion in drug discounts under expanded drug coverage.

Another metric she cited relates to cost. "What we've seen is zero percent growth in health spending as a percentage of GDP between 2009 to 2011. This is the lowest sustained growth in 50 years and low growth is continuing into 2012 for Medicare and Medicaid," she said.

Tavenner likely will get an argument on that measure from Finance Committee Republicans. Economists tied much, if not most, of the slowdown in health costs to the downturn in the economy.

Some $2.1 billion has been returned to consumers in rebates under medical loss ratio rules, Tavenner said. The percentage of double digit premium increases by insurers "has gone from a high of 75 percent in 2010 to 14 percent so far in 2013," she said. Average family insurance premiums in 2012 rose four percent. "I think you would all agree that that's a lot lower than our history." Republicans would likely also question the link between the health law and that statistic.

Questions on Health IT

Tavenner also addressed the adoption of health information technology, which has received a big boost under the Obama administration. Recent press coverage has focused on inappropriate billing fueled by the technology and an absence of federal audits to confirm that providers are making "meaningful use" of health IT as they are required to in order to qualify for higher Medicare and Medicaid payments.

Tavenner said it's true that the wider use of electronic health systems has had the ill effect of an increase in inappropriate "upcoding" of bills submitted by facilities for Medicare payment. But the administration is "very much committed" to further IT adoption, she said. "We've seen great success" with health IT.

Some of the upcoding reflects having better tools to document care and so is appropriate, she indicated. But because of the way the records are designed in some cases "it may be a little too easy" for billing staff to upcode inappropriately and there may not be enough of a "firewall" between financial management and clinical management functions associated with the records, she added. Changes perhaps are needed "to make sure that physicians have a chance to review" the work of billing staff, she said.

"Part of what we're going to do this year is spend a lot of time around the education and around the audit process," she said. CMS is talking about having a series of seminars with providers throughout the year to foster appropriate billing, she added. Vendors are also going to need to have safeguards in their records to make sure that it's not too easy to enter the wrong code, she added.

"These are kind of the natural growing pains that we expect," Tavenner said. "What we'll do is spend 2013 pausing and reflecting on these areas to try and increase the education, make sure we have the vendors on board, make sure we do some small targeted audits."

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