Here’s the good news for health plans: In just over a year, as many as 40 million new customers will enter the insurance market.
And the bad news: They’re primarily individuals and small groups.
Yep, the very business that insurers have more or less been giving the back of their hand to for years is going to be front and center. And guess what: these new customers are not going to hit the dance floor with just any health insurer. Nope, these folks are going to need to be wooed to be won because there will be a lot of options out there—including health insurance exchanges—to compete for the affections of this new market force.
A study from Accenture, a global management consulting firm, suggests that appealing to this new market will require a shift in marketing strategy from a wholesale to retail mindset. According to the study, customer service will be at the forefront of this change and health plans need to take advantage of new opportunities.
In December and January, Accenture conducted an online survey of 1,000 health insurance customers to try to get a handle on their attitudes toward the customer service practices of health insurers. The results indicate that customer service isn’t meeting customer expectations in terms of personal service, convenience, and technology. And, 64% of the respondents said they left one insurer and moved to another because of poor customer service.
So what’s a health plan to do?
Doug VanWingerden, who authored the report, suggests there are a couple of things payers can do to refocus customer service to serve as a selling point for attracting new customers as well as keeping existing customers. He says the first step is to stop thinking of customer service as only a cost center. Remember, these are the folks who get face time, or at least phone time, with your current and potential members. Treat them right. Invest in training and incentive programs for this important and influential team.
VanWingerden said health plans should also look for ways to use customer service to differentiate their products and services, especially in terms of meeting individual needs. Only 10% of survey respondents said that their health insurers tailor services to match their individual needs or preferences.
One suggestion: Reorganize your customer service call centers to reflect the specific needs of your clientele. Creating a call center for new customers or one for members with a chronic disease will enable customer service reps to provide the information that really helps members develop a closer relationship with the health plan.
Oh and be sure to staff your specialized customer service centers with people who know what they are talking about. Some 85% of the respondents listed knowledge and well-informed employees among the top considerations for a successful customer service center. Not receiving knowledgeable answers from customer service is a common complaint and it is among the leading reasons that members will change health plans.
It’s good to remember that thanks to technology we live in a 24/7 world. Make sure your customer service centers operate that way. Only 48% of the survey respondents said their health plan provides customer service at a convenient time.
Finally, use customer service to enhance your social media strategy. Although more and more folks use the Internet to look for information about their health plan, only 6% of respondents said they use social media to help them understand or become more aware of the products and services offered by their own health insurance companies. And only 5% said social media sites have helped increase contact with their current insurance company and its brands.
VanWingerden says that probably means that your message is getting fragmented or is lost among all of the other social media noise. He suggests using customer service to reinforce social media messages. “Maybe a health plan is promoting women’s health through its social media sites, customer service could plug into that message by reminding callers to schedule a mammogram.” Even better, he says, is for customer service to have the capacity to go ahead and schedule the appointment.
The bottom line is that every health plan will be looking for ways to differentiate itself in the new normal of healthcare reform. Customer service could become that niche for your company. But VanWingerden warns that the time to act is now before the change becomes a competitive necessity.
NYU Langone Medical Center in New York City has received an $84 million grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health to research the comparative effectiveness of medical and invasive approaches to ischemia treatment..
The international study of 8,000 participants will evaluate treatment options for patients with stable ischemic heart disease and moderate to severe ischemia. More than 150 medical centers around the U.S. and hundreds of sites in 33 countries are collaborating.
The trial will be clinically coordinated from the Cardiovascular Clinical Research Center at Langone. Other trial functions will take place at different U.S. sites. Duke Clinical Research Institute will be the statistical and data coordinating center and serve as the coordinating center for the cost economics and quality of life. Emory School of Medicine will be the ischemia imaging coordinating center.
The study will determine which ischemia treatment is superior:
A routine early invasive strategy with cardiac catheterization followed by revascularization plus optimal medical therapy and lifestyle changes, or
A conservative strategy of optimal medical therapy, reserving invasive procedures for failure of this strategy in patients with moderate to severe ischemia.
The study will also assess whether invasive procedures improve angina-related quality of life.
“This multicenter, international study provides a unique research opportunity that could yield vital information to guide clinical practice and improve quality of life and overall medical care for large, diverse populations," said Susan B. Shurin, MD, acting director of the NHLBI.
NYU Langone Medical Center is composed of Tisch Hospital, Rusk Institute of Rehabilitation Medicine and the Hospital for Joint Diseases. It received more than $259 million in research grants in fiscal year 2010.
The Department of Health & Human Services has accepted guidelines developed by the Institute of Medicine that require new health insurance plans to cover women's preventive services such as well-woman visits, breastfeeding support, domestic violence screening, and contraception without charging a co-payment, co-insurance, or a deductible, HHS said Monday.
Two weeks ago, the IOM, which was commissioned by HHS, proposed a list of preventive health services for women that health plans should cover without charging a copayment. The recommendations included contraceptive services and made no exception for religious organizations that might object to those services.
Although the recommendation was lauded by groups like the American Medical Association and Planned Parenthood, Catholic bishops and the Catholic Medical Association publically opposed the measure.
HHS has proposed an amendment that would permit religious institutions that offer insurance to their employees to choose whether or not to cover contraception services.
This regulation is modeled on the most common accommodation for churches available in the majority of the 28 states that already require insurance companies to cover contraception.
Public comments on the proposed amendment will be accepted for 60 days, HHS said.
The remaining recommendations were accepted by HHS without change. Effective August 2012 health plans will be required to cover, without charging a copayment, co-insurance or deductible, the following women's preventive health services:
Well-woman visits;
Screening for gestational diabetes;
Human papillomavirus (HPV) DNA testing for women 30 years and older;
Sexually-transmitted infection counseling;
HIVscreening and counseling;
FDA-approved contraception methods and contraceptive counseling;
Breastfeeding support, supplies, and counseling;
Domestic violence screening and counseling.
IOM made the recommendations based on a review of quality evidence, peer-reviewed studies and professional guidelines. The panel chose services that could improve health or decrease the likelihood of a disease in a broad population of women.
"The Affordable Care Act helps stop health problems before they start," said HHS Secretary Kathleen Sebelius. "These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need."
A report by the Commonwealth Fund found that in 2009 more than half of women delayed or avoided preventive care because of its cost.
A proposed HIPAA privacy disclosures rule would be an administrative and financial burden for providers. Furthermore, the rules go beyond the scope of HIPAA, and they could intrude on the privacy of healthcare providers.
Those were the predominant themes among more than 140 public comments received as the comment period drew to a close Monday.
The usual suspects of tech interest groups such as CHIME and AHIMA filed comments as did a mix of hospitals, government offices, individual physicians, and vendors. Although many comments are generally supportive of the concept of transparency in regard to personal health records, implementation is another matter.
In one of the few complete endorsements of the proposed rule, Sheryl Nicklaus offered her comments from a consumer's perspective. "I want to know who is accessing my electronic health record...I want to know if my EHR record needs to be accessed for legal purposes, or for audit purposes, that facts in the record are NOT changed by medical staff in any way in the days before I receive the document (which is possible with the paper charts now.) This assures accountability and ethical truthfulness of the medical staff."
But the prevailing tone of the comments was negative.
Dr. Glen LaBine, a dentist, said simply, "due to the economy, this would put a hardship on my business. The burden of financial costs would cause me to close my practice."
Dr. Christina Morris, commenting as a family physician, said "I am strongly opposed to this rule…as it will serve only to increase tedious workloads by requiring redundant documentation of the need to view critical patient information to perform clinical duties" She expressed concern that the "issue of necessary practitioner access to medical records will only serve as fodder for the already encumbered medical liability system until appropriate tort reform measures are addressed."
Here is a sampling of the other comments posted on regulations.gov:
American Health Information Management Association represents 61,000 health information management professionals. Dan Rode, vice president of policy and government relations, wrote "Although we strongly support the right of individuals to ask questions regarding access to their PHI, we are troubled because such rules go outside of the current scope of HIPAA, even with the HITECH amendments… the transition to electronic health record systems did not contemplate the necessity of tracking this level of access or take into consideration the potential administrative costs, and thus, will cause significant burden for covered entities and their EHR vendors."
"AHIMA queried our HIM professionals on how they currently handle individuals' concerns about who has accessed their electronic health records. The HIM professionals indicated that they have been able to respond to the queries and satisfy the individuals without providing the details proposed in the access report...AHIMA suggests it would make more sense to require covered entities and business associates to respond to these requests on an ad hoc basis rather than require significant systems and process changes that will raise the cost of healthcare for what appears to be a very limited number of requests."
Medical Group Management Association's more than 21,000 members are professional administrators and leaders of medical group practices. Like AHIMA, the MGMA provided information gleaned from a survey of its membership that included a very low demand for the access records. MGMA reported that 65% of the respondents reported they had received less than 1 patient request per FTE physician for disclosure reports in the past 12 months.
"Considering how infrequently physician practices receive these requests from patients, the proposed rule fails to meet the statutory requirement to balance the needs of patients with the burden on providers," wrote William F. Jessee, MGMA president and CEO. "These reports, which would be required to show all electronic access to a patient's health information for up to three years, could be hundreds or even thousands of pages long, making them extremely challenging for physician practices to produce and of little practical value to the patient receiving them."
College of Healthcare Information Management Executives (CHIME) represents more than 1,400 CIO members, healthcare IT vendors and professional services firms. In its comments CHIME notes that the access reports would not differentiate between uses of the information for care delivery and disclosures of the information. "Many legitimate access events could occur across clinical systems that fall outside certified EHRs, complicating any requirement to deliver a consolidated report or allowing for customized views."
The comment letter takes issue with the release of the names of staff members who have accessed a patient's information saying the disclosures has the potential to "expose employees to unnecessary scrutiny or other negative consequences. This could be viewed as a violation of employee rights."
The University of California has five medical centers that receive more than 3.9 million patient visits annually. The university echoed other comments that challenged the expansion of the right conferred under HITECH to an access report from the electronic designated record set. John Stobo, senior vice president for health sciences and services at UC, said in a letter that "Covered entities should not be required to provide an access report for anything other than access that would constitute a disclosure of PHI for treatment, payment and operations. If the right to an access report is retained in the regulation then such a right should be limited to the EHR and not expanded to the much broader electronic designated record set. The expansion of the requirement to provide access logs from the electronic designated record set is a much broader requirement than is mandated under the HITECH Act, will impose a significant administrative burden on health care facilities and providers at a time when they are focused on implementation of EHRs to promote the nation's health, and provides little patient benefit."
Stobo also cited some special circumstances in recommending that employee names not be included in access reports. He noted that with UC's public mission its hospitals serve a variety of patient, including prisoners and other criminals. "With these unique patient populations in mind, the disclosure of employee names in an access report presents a significant and real employee safety concern."
The New York Department of Health made a plea to exclude computer programmers from the access rules. Jason Helgerson, the Medicaid director wrote "…the department's Medicaid data warehouse will be accessed by scores of individuals on an hourly basis as they write computer programs. All of these queries will be accessing thousands and in many cases millions of claims records. While keeping track of these inquiries can be done technologically, we question whether an access report listing the names of anyone who wrote a program that used claims data to create a report will provide any useful information."
Page, Wolfberg & Wirth is a law firm that represents more than 1,000 ambulance services and emergency medical services agencies. "HHS believes that covered entities are already tracking every instance when electronic PHI is accessed under the HIPAA security rule. The rule does not mandate constant access tracking not does it provide specific details on the technology or methods that must be used to monitor access to ePHIs. Current systems are geared to track only a limited number of disclosures to comply with the current accounting standard. The proposed rule would require upgrading and/or reconfiguration of most current software systems."
IMS Health provides information services for the healthcare industry. In its comment letter IMS expressed concerns about the access report concept. "While the access report may satisfy patient curiosity regarding who might have touched his or her medical records, it's certainly not the best means for a patient to determine ifsomeone inappropriately accessed his or her records. Many covered entities put alerts on patient files when there is some suspicion of inappropriate access, and this would seem to satisfy any requisite investigational needs and remediation efforts. Further, regulations that specifically address the particular issue of suspected inappropriate access would be more appropriate than what is proposed."
Brigham and Women's Hospital in Boston is a major medical research facility. In its comment letter the hospital voiced support for excluding research from the required access disclosures citing the difficulty of collecting that information because "unlike other types of institutional records, research records often are not maintained in a central, electronic system. Typically they are maintained by individual investigators in a manner specific to the nature and requirements of the protocol."
In response to a report highly critical of its 510(k) clearance process for certain medical devices, the Food and Drug Administration has announced plans to open a public docket to begin receiving comments on program. The FDA said it will also schedule a public hearing.
In a scorching report released Friday, the Institute of Medicine said the 510 (k) program is an ineffective tool for establishing the safety and effectiveness of moderate risk Class II medical devices such as artificial hips.
Instead of attempting to modify the program, the IOM wants the FDA to scrap it and develop a new framework for review that "integrates pre-market clearance and post-market performance to assure the safety and effectiveness of a medical device through its life cycle."
The FDA, which commissioned the IOM report in September 2009, noted in a statement that the IOM's recommendations are nonbinding. "FDA believes that the 510(k) process should not be eliminated, but we are open to additional proposals and approaches for continued improvement of our device review programs," said Jeffrey Shuren, director of the FDA's Center for Devices and Radiological Health.
Critics have long called for changes in the 510(k) program, which reviews about 4,000 applications each year, to bring medical device review in line with the strict standards applied to new drug releases. The FDA proposed in January its own plan to change 510 (k) but was criticized then for deferring any consideration of creating a subset of Class II medical devices that would require a more rigorous review than other devices in the class.
In assessing the 510 (k) program the IOM took particular issue with the "substantial equivalence" standard, which by law permits the FDA to clear for marketing a medical device that is similar to any previously cleared 510 (k) device. According to the report, the FDA doesn't require evidence that the new device is safe and effective and instead assumes that it meets that standard based on its similarity to another approved device.
"The 501 (k) program can't be transformed as long as that standard is used," said David Challoner at the press conference announcing the release of the report. Challoner, who chaired the IOM report committee, challenged the FDA to be forward-thinking. "A system was put in place 35 years ago that does not really assess safety and effectiveness. We need something different for the next 35 years. We're dealing with a whole new world: new technology, new materials and new data."
The committee recommended that any new medical device review framework considered by the FDA should:
Be based on sound science;
Be clear, predictable, straightforward, and fair;
Be self-sustaining and self-improving;
Facilitate innovation that improves public health by making medical devices available in a timely manner and ensuring their safety and effectiveness throughout their lifecycle;
Use relevant and appropriate regulatory authorities and standards throughout the life cycle of devices to ensure safety and effectiveness;
Be risk-based.
Interest groups were quick to side with the FDA. Among the criticism: changes in the 510 (k) program would require Congress to act and that would slow the introduction of new medical devices to the market.
Stephen J. Ubl, president and CEO of the Advanced Medical Technology Association, which represents medical device companies, said "The report's conclusions do not deserve serious consideration from the Congress or the administration. It proposes abandoning efforts to address the serious problems with the administration of the current program by replacing it at some unknown date with an untried, unproven, and unspecified new legal structure. This would be a disservice to patients and the public health."
The Medical Device Manufacturers Association released a statement saying "MDMA will continue to closely examine this report, though we completely disagree that the 510(k) pathway is flawed and that the FDA needs to eliminate it…it is also important to remember that studies prove the 510(k) process has a strong track record on patient safety, and a complete overhaul of the system is simply not warranted."
The consumer advocacy group Public Citizen applauded the IOM findings. "The FDA should accept the IOM's recommendations, abandon efforts to salvage the 510(k) process that are doomed to fail, and quickly move forward with developing and implementing a new, more robust regulatory framework for clearing medical devices that will protect the public health.
Public Citizen's health research group for years has asserted that the FDA's procedures for clearing medical devices under the 510(k) process are flawed and fail to adequately protect public health."
Challoner rebuffed suggestions that existing regulations already thwart medical device innovation and that the IOM recommendations will only make the situation more difficult. "There is no way of assessing, based on a review of available evidence, whether current regulations are having either a positive or a negative effect on innovation. He suggested that the FDA commission to review the issue.
For its part, the FDA said it already has underway efforts to incorporate some of the IOM findings to strengthen the 510 (k) process, including clarifying when manufacturer changes to a 510(k)-cleared device already on the market warrant a new 510(k) submission.
Since January health insurers have been required to meet certain medical loss ratio targets.
The MLR, mandated by the Affordable Care Act, requires insurance companies to spend no more than 15% to 20% on administrative expenses such as executive salaries, overhead, and marketing, and the rest must be spent on patient care and/or quality improvement.
That means payers must spend 80% to 85% of premiums collected in the individual and small group markets on direct patient care and efforts to improve care quality.
And here's the kicker: Health plans that don't meet the MLR must provide a rebate to their customers. We're talking some big collective bucks. The Department of Health and Human Services estimates that 9 million members could be eligible to share rebates worth up to $1.4 billion. That's money health plans aren't anxious to part with so they have appealed to their state departments of insurance to request state waivers to delay implementation of the MLR requirement.
So far 12 states – Kentucky, Maine, Nevada, New Hampshire, Delaware, Florida, Georgia, Indiana, Iowa, Kansas, Louisiana and North Dakota – have filed waiver requests with HHS. Politico, which has been tracking the waiver process, lists another four states – Alaska, Oklahoma, South Carolina and Texas – as likely applicants. And it identifies 23 states as unlikely to enter the waiver process, including Alabama, Maryland, Utah and West Virginia.
The plans of 11 states are unknown, including North Carolina, South Dakota, and Nebraska.
Although there's no firm deadline for submitting a waiver applications Tim Jost, who has studied the waiver applications, says time is running out for states to complete the process before the first round of rebate calculations begin. Jost, a consumer representative on the National Association of Insurance Commissioners and a law professor at Washington & Lee University, explained that "HHS puts the waiver applicants through their paces.
The process takes months to complete and often involves requests for additional information." The rebate requirement goes into effect on Jan. 1, 2012 for any state that hasn't already been granted a waiver.
For the most part, the basis for requesting a MLR waiver – at least for the states that have applied so far – falls into a single category: fear that meeting the standard will destabilize the individual market and result in fewer choices for consumers.
That's an ongoing concern for HHS, as it develops rules and regs to implement the ACA and the department has let it be known that it is open to granting waivers to states that can make that case.
But as North Dakota has learned, making that case is easier said than done.
In its waiver application, the state contended that an increase from the 55% MLR required by state law to the 80% required by the ACA would pressure insurers to reduce or eliminate broker's commissions. That could lead to a reduction in services by brokers and "cause poor purchasing decisions" which could "cause financial harm to our marketplace."
HHS didn't buy it. Last week it notified the state's insurance commissioner that its waiver request had been turned down flat.
Although market destabilization is an overarching concern, in making its MLR waiver decisions HHS looks at five factors:
Whether insurers will leave the market or stop offering insurance
How many enrollees will be affected by the departures
Will access to brokers/agents be limited
What alternative coverage is available
How will premiums and benefits be affected
In its 10-page reply to North Dakota's insurance commissioner, HHS noted that the two insurers that suggested they would leave the state unless they received a reprieve from the MLR requirement already met the 80% threshold and wouldn't be subject to issuing rebates.
HHS also quoted a letter from the state's dominant insurer, Blue Cross Blue Shield of North Dakota, asking the insurance department to withdraw its waiver request. "We see no evidence that insurers are in risk of leaving the North Dakota market," HHS concluded in denying the waiver request.
In addition to North Dakota, HHS has completed its review of waiver applications from Iowa, Kentucky, Maine, Nevada, and New Hampshire. HHS agreed to those requests, with some modifications:
Iowa. Insurance companies will have an additional two years – until 2013 – to hit the 80% MLR standard. Incremental targets are 67% for 2011 and 75% for 2012. HHS was worried that three small issuers could owe rebates in 2011 and would leave the Iowa market. Golden Rule, Coventry and American Republic have MLRs of between 48% and 68%, pay high broker commissions and need more time to adjust their business models.
Kentucky. Insurers received a one-year reprieve. They must achieve a 75% MLR standard for 2011 and meet the required 80% level in 2012. Anthem, the dominant insurer, said it would adjust its business model to meet the 80% standard. Humana and Golden Rule have MLRs well below 80% while Time operates at a loss. High agent commissions also played a role in HHS's decision to grant a modified waiver.
Maine. HHS accepted the state's request for an MLR of 65% for 2011 and 2012 with a possible extension to 2013. MEGA Life & Health Insurance Co. covers about one-third of the individual market and threatened to leave the market if required to meet the 80% standard in 2011 and 2012. MEGA offers lower cost policies and HHS was concerned that individuals would not be able to replace the policies if MEGA left the state.
Nevada. The state requested a 72% MLR standard for 2011. HHS agreed to a 75% adjustment. HHS noted that seven of Nevada's top 10 issuers are expected to have 2011 MLRs above the 72% requested by the DOI.
New Hampshire. The state DOI requested a 70% MLR standard for 2011, 2012, and 2013. HHS agreed to 72% for 2011, 75% for 2012 and 80% for 2013. In making the decision HHS recognized potential losses that some insurers might incur if rebates were necessary. It noted that individual policies in the state are medically underwritten and if a firm dropped out of the market members with pre-existing conditions might have a difficult time finding alternate coverage.
Granting the waivers is controversial. Advocacy groups contend that HHS is taking rebate money out of the pockets of consumers and that HHS is granting waivers based on little or no evidence that a given insurer will actually leave a state.
Carmen Balber, the Washington, D.C. director for Consumer Watchdog, points out that many states have a requirement that once an insurer leaves a state it can't return for five years. With billions of dollars in premium tax credits coming online for insurers in 2014 threats to walk away from a book of business could be nothing more than empty threats.
But the NAIC's Jost says reducing the cost of healthcare insurance premiums – not assessing rebate penalties ? is the real goal of the MLR requirement and that's where the focus should be.
The first phase has been completed of a massive genomics project that could help scientists identify why some people get diseases like cancer and others do not.
More than 100,000 Kaiser Permanente members volunteered to contribute their saliva for DNA and chromosome testing for the project that is expected to accelerate research into conditions such as cardiovascular disease, diabetes, cancers, mental health disorders, and age-related diseases such as Alzheimer's disease.
Between 600,000 and 900,000 genomic regions were genotyped for each saliva sample and length of chromosome tips or telomeres were also analyzed. The collected data will eventually be made available to other scientists.
What makes the research unique is that participants have been Kaiser Permanente patients for 15 to 20 years. That means genomic information can be linked to long-term medical records. And since researchers will be able to follow participants as long as they remain with the Kaiser system, so they will be able to assess whether DNA can predict the likelihood of developing certain diseases.
Neil Risch, co-director of Kaiser Permanente's Research Program on Genes, Environment and Health said the information has an almost unlimited potential. "We could learn how the environment affects chronic disease, why people respond to some medicines and not to others, or why diseases progress in different ways indifferent people," he explained in a telephone interview.
Genomics has been touted as a major step toward personalized medicine as an understanding of the effects of genetic factors may enable physicians to provide patients with the best medicines for them, without needing to adjust and change medications.
Kaiser Permanente's RPGEH teamed with the Institute for Human Genetics at the University of California-San Francisco for the study. The National Institutes of Health provided $24.8 million in grant funding.
RPGEH was set up to facilitate epidemiologic studies of genetic and environmental influences on common health conditions, such as asthma cancer, diabetes, heart disease, and mental health disorders.
Researchers hope to build the data base to 500,000 participants. Risch said Kaiser has invested millions of dollars to generate and store the information, and to maintain the privacy and confidentiality of participants' personal information.
Risch explained that information collected from participants, including saliva samples, self-reported health surveys, and clinical data will be combined in environmental databases that will allow researchers to study the health effects of environmental factors such as air pollution and water quality as well as neighborhood characteristics, such as proximity to parks, grocery stores, and healthy foods.
Proposed federal rules requiring providers and payers to let patients know when anyone accesses their electronic medical records would be difficult to meet and should be scaled back, says a comment letter filed by the College of Healthcare Information Management Executives.
Ann Arbor-based CHIME contends that the federal government's rules rely too much on technical capabilities that aren't widely available and fail to acknowledge the amount of human intervention necessary to achieve compliance.
The group's primary concern is a requirement that would extend responsibility for protected health information contained within a designated record set to include a new right to a consolidated access report. CHIME contends that DRSs are "too broadly defined and too variable in today's health IT environment," and that the ability to aggregate hundreds or thousands of access events in any automated fashion "is not realistic for most covered entities."
The reports would identify who has accessed a patient's protected health information so a patient would know if a specific person had looked at it.
CHIME, which represents more than 1,400 CIO members as well as healthcare IT vendors and professional services firms, wants the access report requirement dropped. But if the requirement remains in the rule, then CHIME suggests that only data gathered through certified electronic health records, not the full array of designated record sets, should populate the access reports.
In its comments CHIME notes that the access reports would not differentiate between uses of the information for care delivery and disclosures of the information. "Many legitimate access events could occur across clinical systems that fall outside certified EHRs, complicating any requirement to deliver a consolidated report or allowing for customized views."
In a press statement Pam McNutt, senior vice president and chief information officer at Dallas-based Methodist Health System and chair of CHIME's policy steering committee, expressed concern that "the access logs, report filters, and other technical specifications needed to generate an access report would be inconsistent or nonexistent across many clinical data sources that might be considered part of a DRS."
CHIME is also concerned that developing the reports would require the purchase of new software and additional data storage space and mean that several employees would need to be dedicated to pulling and consolidating the access logs from a variety of systems.
The comment letter takes issue with the release of the names of staff members who have accessed a patient's information saying the disclosures has the potential to "expose employees to unnecessary scrutiny or other negative consequences. This could be viewed as a violation of employee rights."
As an alternative, CHIME recommends that patients provide the hospitals, physicians, or payers with the names of anyone they suspect may have inappropriately accessed their information.
CHIME also suggests that the current 60-day timeline for responding to accounting of disclosure requests be retained, not shortened to 30 days as suggested by the proposed rule.
The rule is a statutory requirement under the Health Information Technology for Economic and Clinical Health Act (HITECH). Comments may be filed here until Aug. 1. If approved, the rule would go into effect in January 2013.
Ten states have been notified that the Center for Medicaid & Medicare Services will be taking over responsibility for reviewing certain health insurance premiums increases proposed by insurers in their states.
The move, effective Sept. 1, 2011, is part of Affordable Care Act regulations that require significant rate increases in all states to be reviewed by independent experts and disclosed to the public. CMS had hoped that all states would have their own review programs up and running by September and even earmarked $250 million in grants to get the process underway. But some states don’t have the legal authority or resources to effectively review health insurance rates. In those cases the federal government is stepping in.
In Montana and Idaho politics played a role in limiting the review process preparation. The Montana legislature defeated a bill that would have given its state auditor the authority to review rates and negotiate with insurers. According to the Billings Gazette, the Republican-controlled Legislature “wanted nothing to do with implementing the new federal health reform law.”
In Idaho, Gov. C.L. "Butch" Otter's signed an executive order that prohibits the state from carrying out any component of the ACA, according to reports in the Idaho Statesman.
In addition to Idaho and Montana, CMS will handle reviews in the individual and small group market for Alabama, Arizona, Louisiana, Missouri and Wyoming. It will also handle reviews in the small group market for Iowa, Pennsylvania and Virginia; those states will handle their own rate reviews for the individual market.
A CMS spokesperson said the agency will continue to work with the 10 states to align their rate review efforts with ACA regulations, which call for rate increases of 10% or more to be reviewed. Insurers must publically disclose the increases and justify the request to raise premiums.
If you've never attended a Congressional hearing count yourself as lucky.
I spent about six hours last week watching two Congressional committees discuss the pros and cons of the Independent Payment Advisory Board. That's the controversial board created as part of the Affordable care Act and charged with recommending ways to control Medicare costs.
Congressional hearings are really just theater with committee members jawboning with selected "witnesses" who seem to espouse a preset notion of what should or should not be done on a particular issue.
And that's pretty much the way it went during two days of testimony before the Republican-led House Budget Committee and the Health Subcommittee of the House Energy and Commerce Committee. More than 15 witnesses, including HHS Secretary Kathleen Sebelius, testified ? meaning they read well-vetted statements – and answered well-planned and leading questions about the IPAB.
IPAB is the latest whipping boy for those who object to the implementation of healthcare reform. At the hearings the lines were clearly drawn primarily along partisan lines. In broad strokes, Republicans believe the board will ration healthcare, leave seniors out in the cold, and needs to be repealed. Democrats see the IPAB as a backstop or fail safe for controlling Medicare costs and preserving the program for generations to come.
Here's my take on what's happening with the battle over IPAB:
It's politics. In Washington, D.C.? What a surprise. Much of the heavy lifting on the IPAB controversy is taking place in the House where Republicans dominate. The Senate, where Democrats rule, is unlikely to take up the fight either for or against IPAB. HR 452 has been introduced to repeal the board. At last count it had 165 co-sponsors, including eight Democrats. It's a simple, one-line bill: "A bill to repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board."
It's about power. In both committees certain members hammered away at the thought of an un-elected board of 15 people making decision about healthcare costs. If IPAB is implemented, Congress, which has always relished its power of the purse, will find itself without a purse when it comes to Medicare. And that makes for some unhappy members of Congress.
And it's not just Congress that stands to lose power. The "I" in IPAB is for "independent." That means some health industry stakeholders, such as health plans, hospitals, and physicians could find themselves on the outside looking in.
It's about rationing care. No it isn't. But it certainly makes a good sound bite. Sebelius has stressed again and again that ACA prohibits IPAB from rationing health care. It also can't raise Medicare revenues or premiums, increase Medicare beneficiary cost-sharing (including deductibles, coinsurance and copayments), or restrict or reduce benefits. So what can it do?
Critics have a point when they look at this list and worry that IPAB will resort to cutting provider payments, which could mean that fewer providers will be willing to take on Medicare patients and that could limit access to care, which some members of Congress liken to rationing. Sebelius is quick to point out that while reductions in provider payments might mean that some Medicare providers would decide to no longer deliver a service "that is just like the way it works in private health insurance."
Who are these people? The president will appoint individual IPAB members who must be confirmed by the Senate and will serve six-year terms. The Affordable Care Act mentions expertise in things like health finance and economics, actuarial science, and health facility management. Among the membership requirements: employers, physicians, consumers and experts in prescription drug benefits. The president hasn't made the appointments a top priority even though the initial board funding is scheduled to kick in October 2011.
It's unnecessary. Secretary Sebelius has said that according to the CBO, the Affordable Care Act is doing such a great job reducing costs that the board probably wouldn't need to take any action for at least 10 years. She made that comment to ease the minds of opponents, but think about this: there will be 15 members making about $165,000 per year. That's $2.4 million in salaries for the board members only.
Add to that staff, rent and travel and the annual budget could easily reach $3.4 million. In 10 years that's $34 million. Actually, Sebelius is simplifying the job of the IPAB, which will need to keep up with healthcare costs, utilization numbers, patient access to care and quality issues, so it can step in when needed to make proposals to keep Medicare costs from growing out of control.
What's going to happen? HR 452 has been going nowhere fast, even with more than one-third of the House signed on as co-sponsors. It was introduced in January 2011 and referred to the House Subcommittee on Health in February where it still sits. Despite the recent hearing, the subcommittee hasn't scheduled a vote on the bill.
At one time there was a push to attach the bill to legislation raising the debt-ceiling but that seems unlikely given the way debt ceiling debate has been going. But there's still a chance that an amendment to repeal of IPAB could be attached to any number of bills. There has been some talk of reviving a version of HR 452 for the Fall when debt ceiling crisis is resolved (hopefully) and more attention can be focused on IPAB.