In France, Insurers Have to Pay Claims in 3 Days? (From MGMA Meeting)

Today at the Medical Group Management Association (MGMA) national meeting, author T.R. Reid drew laughs from a crowd of over 10,000 practice administrators when he said that, in France, Insurers must pay claims to providers within 3 days. What a perfect example of some of the costly administrative gaps that exist in the US Health care system. In light of the economic crisis this past year and challenges in access to capital, the current US health care system and its complex and inconsistent claims payment systems take on even more significance.

Also at today's conference was bioethicist Ezekial Emanuel, MD who had several key quotes that were then shared via Twitter real time to MGMA members:

• "The problem in the system is not that we don't have the right technologies... it's how we connect with patients."
• "There needs to be a shift from volume-driven care to coordinated care."
• "The holy grail is High Touch Medicine: access, quality and controlled cost growth."

MGMA urged its members to stay involved and also provided an update on health reform efforts since it is likely that grassroots type input will be important once we move to potential floor amendments on a wide range of key issues impacting physician practices in particular that are not addressed in the current Senate health reform proposal.

Senate Finance Committee Votes Tomorrow on Health Reform

On Tuesday, Oct. 13, the Senate Finance Committee will vote to approve its version of healthcare reform, which includes Chairman Max Baucus' redrafted legislation as amended during committee deliberations.

The Congressional Budget Office (CBO), the official scorekeeper of legislation, has tallied the cost of the bill at $829 billion. This is less than the $900 billion that the president and Baucus, D-Mont., were seeking. The bill also reduces the budget deficit by $81 billion over 10 years. Senate Majority Leader Harry Reid, D-Nev., will meld this legislation with the bill approved in July by the Health, Education, Labor and Pensions Committee. The combined version will then be sent to the CBO for an official cost estimate necessary prior to consideration by the full Senate.

Since the Constitution mandates that legislation with tax revenues originate in the House, Sen. Reid is expected to "call up" for consideration a House-passed bill related to the AIG bailout and substitute the healthcare reform language for that currently contained in the bailout measure. Republicans are expected to object to consideration of the bill, forcing Reid to file a cloture motion to cut off the filibuster and move to consideration of healthcare reform by the full Senate. This will require 60 votes. If Sen. Reid succeeds, anywhere from hundreds to more than 1,000 amendments could be offered for consideration.

Since most analysts believe that the majority of the re-crafted Senate bill will be derived from the Finance bill, there is an opportunity to reach out to Senators related to specific concerns such as the cuts in Medicare physician reimbursement and to postpone CME proposed cuts that are to be implemented on January 1st since some of those changes in RVUs include dramatic cuts in reimbursement that could impact patient access to care.

The Finance bill only provides a 0.5 percent Medicare payment increase in 2010 and then reverts to massive cuts of approximately 25 percent in 2011 and beyond. There is hope that amendments will be offered during the Senate Floor Debate to address some of these key issues.

Groups such as the Medical Group Management Association (MCMA) and the Community Oncology Alliance (COA) have tools on their websites to facilitate access to members of Congress on these issues.

From AMCP Today: Howard Dean and Bill Frist both predict health reform legislation to pass

At the Academy of Managed Care Pharmacy (AMCP) meeting in San Antonio, TX, both former Gov. Howard Dean and former Senator Bill Frist predicted health care reform would pass this fall. Frist predicted that key votes would occur next week.

Despite their very different political background the two physicians and former politicians agreed on many of the key items of health reform. The biggest difference was whether health reform needs a public option.

• Dean advocated for a public option to be included so that there is a "real choice". He believes that having a modest sized but true public option is important to create change in the market and he felt that health insurance companies would rise to that challenge. He feared that without a real public option of some form that in order to have change in the cost model and incentives we would need a system like Switzerland where private insurers were like a publicly held, highly regulated utility.
• Frist presented a case that a public option would be modeled from Medicare payment system which is flawed and would leave a significant gap for physicians, hospitals and other providers. He also presented concerns that more people would opt into the public plan and a public plan that is too large "is not real choice". Frist predicted that we would probably not see a public plan included in health reform since it is not included in the Senate Finance health reform package.

Both agreed that this really is just the beginning of health reform changes -- not the end and both acknowledged that many of the key issues to truly change the incentives of the systems and the "cost curve" that further change and innovation would be needed.

Senate Finance to Vote on Health Reform on Tuesday (Oct 13th)

The Senate Finance Committee will vote next Tuesday, Oct. 13, on the pending health reform bill based on announcements today from Senate Finance Committee Chairman Max Baucus (D-MT). The announcement came one day after a Congressional Budget Office (CBO) analysis projected that the bill would cost $829 billion and reduce federal deficits by a total of $81 billion over 10 years which is one of President Obama’s main requirements for health reform. The bill would also expand coverage from 83 percent to 94 percent of non elderly Americans over 10 years.

Republicans including Senator Charles Grassely (R-IA) have cautioned that the celebration of reducing the deficit "masks who pays the bills" and that the package includes hundreds of billions of dollars in new taxes and fees. Expect to see a long day Tuesday as Senate Finance members will likely have many questions regarding the CBO analysis and projections released yesterday.

While the Senate Finance Health Reform was developed by a bipartisan team, many project that the final votes for health reform within the Senate Finance Committee may end up appearing largely partisan.

CBO Releases cost estimate for Senate Finance Reform

Breaking news. This afternoon, the Congressional Budget Office (CBO) issued a letter to Senate Finance Chairman Baucus (D-MT) regarding the cost of his health reform proposal (or Chairman's Mark). The CBO concluded that the bill would increase federal spending by $829 billion over 10 years but would be offset by enough spending cuts and tax increases to reduce the budget deficit by $81 billion over 10 years.

The fact that the plan does reduce the deficit over the next 10 years means that it meets a key objective for health reform and the Finance Committee will now move to consideration of their final bill perhaps this week but more likely next week.

Senate Finance Health Reform Bill Continues to Move forward – CBO to estimate the cost

The Senate Finance Committee moved health reform to the next level Friday by completing the mark-up process and sending it to the Congressional Budget Office (CBO) for a revised score. The CBO score with its vast array of assumptions will play a key role in determining the next steps for health reform. Once a preliminary CBO score is released the Senate Finance could move forward as early as next week depending on what adjustments must be made.

Why do many feel the Senate Finance proposed reforms have the best chance to pass?

• Plan does not include a public option. Senate Finance voted down two separately proposed amendments to add a public plan option this week. Given the public concerns related to a public option, the Senate Finance reforms now appear the most moderate and have some bipartisan support.
• The plan does include a popular incentive to all health plans to vary premiums and reward consumers who participate in wellness programs.
• The plan does address the looming 2010 Medicare Physician Fee Schedule issue (which would reduce Medicare physician reimbursement by over 20% starting Jan 1st) which has bipartisan support and must be addressed this year.
• Includes bipartisan key health insurance reform changes such as prohibiting exclusions for pre-existing conditions.

However, the bill does include controversial issues such as the new Medicare Commission (known as the “Super MedPAC”). Many key issues are not addressed as part of the plan so we would expect to see a significant range of floor amendments offered.

Senator Baucus’s proposed plan appears to balance many of the most controversial issues and it looks well positioned to move forward in the coming weeks in some form. As the work of the Senate Finance Committee is merged with the efforts of the Senate HELP committee we do expect that biosimilars will be added to the Senate version of reform.

Key Questions For Next Week:

• Will the Senate Finance bill meet the President's budget related requirements?
• Will it have any bipartisan support such as Sen. Olympia Snowe (R-ME)?
  

Breaking News: Congress expected to delay new requirements for DME Suppliers

Perhaps as early as tonight, Congress will likely finalize legislation to delay implementation of new requirements for Durable Medical Equipment (DME) suppliers until January 1, 2010. This is an important change, particularly for local medical suppliers and community pharmacies, since many local providers would not be able to continue to provide Medicare beneficiaries with access to DME and related medical supplies based on the new requirements.

CMS issued a release today that new requirements for suppliers of medical equipment and supplies starting today unless there was legislative action. The House passed a bill last night (H.R. 3663) to delay the DME accreditation requirement for pharmacies until January 1, 2010.
Reports now anticipate that the Senate will pass legislation as early as this evening to delay the accreditation requirement for pharmacies.

Why is this delay important for patients? This would be good news for Medicare patients that access any type of DME or related supplies as they can continue to use their existing providers. Lets hope Congress takes temporary action today and then permanently excludes pharmacies and other community providers as part of health reform.