Health­care pol­icy keeps nation’s cap­i­tal busy

Modern Healthcare - - Special Report -

While the first part of the year in Washington fo­cuses al­most ex­clu­sively on pass­ing a health re­form bill, the rest of 2010 sees some of those re­forms tak­ing shape in the on­go­ing im­ple­men­ta­tion phase. The year also brings with it a new CMS ad­min­is­tra­tor in Don­ald Ber­wick. And in the last month of year, Congress passes—and the pres­i­dent signs—the Physi­cian Pay­ment and Ther­apy Re­lief Act of 2010, which de­layed for one month a 23% cut to Medi­care pay­ments to physi­cians that was sched­uled to take ef­fect the same day Pres­i­dent Barack Obama signed the leg­is­la­tion.

Other high­lights:

In July, dur­ing a con­gres­sional re­cess, Obama names physi­cian Ber­wick, a Har­vard-trained pe­di­a­tri­cian and pa­tient-safety ex­pert, to lead the CMS. The re­cess ap­point­ment angers some con­gres­sional Repub­li­cans, who con­tended Ber­wick fa­vors health­care ra­tioning and were un­able to ques­tion Ber­wick dur­ing hear­ings and vote on his con­fir­ma­tion. Some of those GOP lead­ers re­mind Ber­wick of this when he ap­pears for the first time be­fore the pow­er­ful Se­nate Fi­nance Com­mit­tee on Nov. 17.

In Oc­to­ber, HHS an­nounces it will al­lo­cate $30 mil­lion in fed­eral fund­ing from the Af­ford­able Care Act to 35 states, four territories and Washington, D.C., to ei­ther es­tab­lish or strengthen pro­grams that pro­vide di­rect ser­vices de­signed to help pa­tients with their health in­surance. These ser­vices in­clude help­ing con­sumers en­roll in health cov­er­age, file com­plaints and ap­peals against health plans, and ed­u­cate them about their rights.

Repub­li­cans win back con­trol of the U.S. House of Rep­re­sen­ta­tives on Nov. 2, vow­ing to “re­peal and re­form” the Af­ford­able Care Act. Health­care ex­perts and po­lit­i­cal pun­dits say that while a re­peal is un­likely—given that Democrats still con­trol the Se­nate and the White House—House lead­ers could use meth­ods to de­fund parts of the mas­sive leg­is­la­tion.

The CMS launches its In­no­va­tion Cen­ter in mid-Novem­ber. Led by physi­cian and for­mer Geisinger Health Plan CEO Richard “Rick” Gil­fil­lan, the cen­ter was es­tab­lished in the Af­ford­able Care Act to study new ways of de­liv­er­ing care and pay­ing providers that im­prove qual­ity and save money.

At a news con­fer­ence Nov. 22, HHS Sec­re­tary Kath­leen Se­be­lius an­nounces the muchan­tic­i­pated med­i­cal loss ra­tio reg­u­la­tions, which re­quire in­sur­ers to spend at least 80% of con­sumers’ pre­mium costs on pa­tient care. An­tic­i­pat­ing dis­rup­tions and mar­ket desta­bi­liza­tion, some states request ad­just­ments to this pro­vi­sion, which takes ef­fect Jan. 1.

In early De­cem­ber, the Se­nate Demo­cratic and Repub­li­can lead­ers and the Se­nate Fi­nance Com­mit­tee chiefs in­tro­duce leg­is­la­tion that would ex­tend a fix to the Medi­care physi­cian pay­ment for­mula through 2011.

Se­nate Ma­jor­ity Leader Harry Reid, Se­nate Mi­nor­ity Leader Mitch McCon­nell and Fi­nance Com­mit­tee lead­ers Max Bau­cus (D-Mont.) and Chuck Grass­ley (R-Iowa) in­tro­duce the Medi­care and Med­i­caid Ex­ten­ders Act of 2010, which would avert the 25% Medi­care pay­ment cut to physi­cians sched­uled for Jan. 1, 2011. One pro­vi­sion would re­verse that re­duc­tion and ex­tend the cur­rent Medi­care pay­ment rates through Dec. 31, 2011. The es­ti­mated cost of the pro­vi­sion is $14.9 bil­lion over 10 years. It is passed and signed into law in mid-De­cem­ber.

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