Spe­cial re­port: 2011 was an­other un­for­get­table year in health­care

Modern Healthcare - - FRONT PAGE -

The first week of 2011 ush­ers in the 112th Congress, with a new Repub­li­can ma­jor­ity in the House led by Speaker John Boehner (R-ohio). House GOP mem­bers vow im­me­di­ately to “re­peal and re­place” the Pa­tient Pro­tec­tion and Af­ford­able Care Act that Pres­i­dent Barack Obama signed into law in 2010. Ex­cite­ment on Capi­tol Hill in the first week of the new year soon turns to tragedy when a shoot­ing spree out­side a gro­cery store in Tuc­son, Ariz., leaves Rep. Gabrielle Gif­fords (D-ariz.) in crit­i­cal con­di­tion and six oth­ers dead. House GOP mem­bers change their tone slightly, re­fer­ring to the Af­ford­able Care Act as a “job-de­stroy­ing” rather than a “job-killing” bill, but they are no less com­mit­ted to their goal of abol­ish­ing the law. And they soon make good on their prom­ise, as the lower cham­ber votes 245-189 to re­peal the re­form act with help from all 242 House Repub­li­cans and three Democrats. With no chance of pass­ing in the Se­nate, the re­peal bill is seen largely as a sym­bolic move. Still, Repub­li­cans con­tinue to chip away at the law through­out all of 2011, even as the Obama ad­min­is­tra­tion and HHS stay the course, re­leas­ing reg­u­la­tions and an­nounc­ing pro­grams that the law es­tab­lished.

Other high­lights:

Long de­layed, the pro­posed rule for ac­count­able care or­ga­ni­za­tions is re­leased on the last day of March and is met with much skep­ti­cism by health­care providers, as the 429-page reg­u­la­tion prom­ises more fed­eral scrutiny, a host of clin­i­cal qual­ity mea­sures to achieve and down­side risk for par­tic­i­pants in the pro­gram.

In April, House GOP mem­bers are suc­cess­ful in over­turn­ing a piece of the Af­ford­able Care Act when Obama signs a law re­peal­ing the con­tentious 1099 pro­vi­sion that would have re­quired busi­nesses start­ing in 2012 to re­port in­for­ma­tion to the In­ter­nal Rev­enue Ser­vice on pay­ments of goods to­tal­ing $600 or more.

In May, HHS an­nounces the “Pioneer

ACO” pro­gram to help ready-made ACOS en­ter the Medi­care pro­gram quickly and have other providers fol­low.

Later in the year, the CMS In­no­va­tion Cen­ter an­nounces two in­no­va­tion-re­lated pro­grams: the “In­no­va­tion Ad­vi­sors” pro­gram, a $6 mil­lion ini­tia­tive in­tended to help lead­ers gain the skills to carry out sys­tem re­forms for Medi­care, Med­i­caid and Chil­dren’s Health In­sur­ance Pro­gram ben­e­fi­cia­ries at their re­spec­tive or­ga­ni­za­tions; and the “In­no­va­tion Chal­lenge,” for which HHS will in­vest up to $1 bil­lion in projects na­tion­wide that test ways to de­liver bet­ter health­care qual­ity and save money—with pref­er­ence go­ing to mod­els that fo­cus on hir­ing and train­ing health­care work­ers quickly.

In early De­cem­ber, HHS re­leases fi­nal reg­u­la­tions on the med­i­cal-loss ra­tio, which re­quires in­di­vid­ual and small group in­sur­ance plans to spend at least 80% of in­sur­ance pre­mi­ums on med­i­cal care and large group plans to spend at least 85%. Through­out 2011, the CMS’ Cen­ter for Consumer In­for­ma­tion and In­sur­ance Over­sight de­nies North Dakota and Delaware’s re­quests for med­i­cal-loss-ra­tio ad­just­ments; grants Maine’s full re­quest; and makes ad­just­ments to the re­quests from New Hamp­shire, Ne­vada, Ken­tucky and Iowa. The states of Florida, In­di­ana, Louisiana and Michi­gan com­plete ap­pli­ca­tions, while ap­pli­ca­tions from Kansas, North Carolina, Ok­la­homa and Texas are un­der­go­ing a “re­view for com­plete­ness.”

Sev­eral states take dra­matic and some­times di­a­met­ri­cally op­posed ap­proaches to health­care re­form, with Ver­mont ap­prov­ing leg­is­la­tion to cre­ate a sin­gle-payer sys­tem and Florida aim­ing to use pri­vate in­sur­ers for Med­i­caid man­aged care.

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