Senate Confirms CMS Administrator

Although later than expected due to a hold placed by Senator Tom Harkin (D-IA), the Senate voted yesterday to confirm Marilyn Tavenner as Administrator for the Centers for Medicare and Medicaid Services. The roll call vote, which passed 91-7, places Tavenner as the first confirmed administrator since 2005, when Mark McClellan left the agency. She has been Acting Administrator since December of 2011.

HHS Releases Enhanced Culturally and Linguistically Appropriate Service Guidelines

Last month, the Department of Health and Human Services released enhanced National Care Standards for Culturally and Linguistically Appropriate Services (CLAS) in health care.  The enhanced standards, developed by the HHS Office of Minority Health, are a comprehensive update of the 2000 National CLAS Standards, and include the expertise of federal and non-federal partners nationwide.

These standards, according to the Office of Minority Health, are intended to advance health equity, improve quality, and help eliminate health care disparities by providing a blueprint for individuals and health care organizations to implement culturally and linguistically appropriate services.

The burden of insufficient and inequitable care related to racial and ethnic health disparities has been estimated to top $1 trillion, according to a study cited by HHS. These losses are due to the provision of care to a sicker and more disadvantaged population, as well as the indirect costs of health inequities such as lost productivity, lost wages, absenteeism, family leave, and premature death.  Specifically, the study found that More than 30 percent of direct medical costs faced by African Americans, Hispanics, and Asian Americans were excess costs due to health inequities – more than $230 billion over a four year period.

The new standards, released at a joint press event with the Kaiser Family Foundation, are part of an effort to emphasize the importance of integrating standards into practice in order to improve quality of care and services for everyone.

HHS officials were joined in the announcement by representatives from the American Hospital Association, Texas Health Institute, and National Center for Cultural Competence at Georgetown University. 

Outdated Technology Costs Hospital Money

A new study conducted by the Ponemon Institute and reported by USA Today’s “CyberTruth”, finds that hospitals are absorbing an estimated $8.3 billion annually due to outdated technology. The losses are due to lost productivity and increased patient discharge times caused by the old technology.

According to the study, clinicians waste an average of 46 minutes per day waiting for patient information. Specifically, 37 minutes of the average discharge time of 102 minutes is due to waiting for hospital staff to respond with information necessary for the patient's release. Other lost time is due to inefficient pager systems, no Wi-Fi access, and bans on the use of personally owned devices.

As NAHAM News has previously reported, the Obama administration authorized $19 billion in 2009 to promote the use of electronic medical records. The program reimburses doctors and medical facilities for expenses that can provide “meaningful use” in advancing medical technology at their facility.

Some facilities are adopting technologies like secure text messaging systems that staff can download to their personal phones. One program in particular encrypts text messages that it sends, and stores the messages so that they can be audited. Other technologies include the implementation of a virtual desktop system so staff only has to remember one password to log onto terminals anywhere in the hospital.

Unique challenges within the healthcare industry may prevent rapid implementation of new technology and cause the lag in technology. Security and privacy policies mandated by law, for example, must be taken into account for any upgrades. Competing electronic health record vendors and the lack of a national EHR infrastructure further complicate matters.

The GAO Says the Medicaid Matching Rate is Unfair

The Government Accountability Office (GAO), a nonpartisan congressional watchdog group, released a report this month arguing for a new Medicaid matching rate. The GAO says this rate, currently calculated using the Federal Medical Assistance Percentage (FMAP), is unfair because it doesn’t take into account factors other than per capita income.

According to a CQ article, the FAMP is based on each state’s per capita income in comparison to the national per capita income. Currently, states on average get a federal matching rate of 57 percent, but the share varies widely among states. The report says that a funding allocation mechanism should take into account the demand for services in each state, geographic cost differences among states, and individual state resources,  in order to be equitable from the perspective of beneficiaries and allow states to provide a comparable level of services to each person in need.

Specifically, the GAO suggests creating new measures based on those three criteria. To assess the demand for Medicaid services, the government could use federal surveys such as the American Community Survey and the Current Population Survey to target the population in need of services. The program could account for geographic health care cost differences by looking at the provider costs from the Occupational Employment Statistics survey. Finally, state resources can be taken into account by using data in the Total Taxable Resources measure.

The report is non-binding, and any changes to the program would have to come via congressional legislation. That could pose issues with lawmakers from states that would lose matching funds with the new criteria.

Insurance Marketplace “Navigators” Spark Debate

As specifics about the health insurance exchanges continue to come out, opponents continue to scrutinize and criticize regulations. The most recent concerns, according to CQ, come from Republicans who are worried about the role that “navigators” will play in the marketplace.

NAHAM has previously written about the idea of navigators; people that will help customers choose which insurance plan to pick, and will help determine whether they are eligible for Medicaid or tax credits. The navigators are needed because “many people who would buy insurance through the marketplace have never had insurance before, and will need help in choosing the right plan” says Gary Cohen, director of the HHS Center for Consumer Information and Insurance Oversight.

Congressman Tim Murphy (R-PA), a member of the House committee on Energy and Commerce, agrees that there needs to be a helper, but disagrees with HHS’s idea. Currently, HHS plans to fund the navigators with $54 million in grants that will be spread across the 33 states that have a federally run exchanges or a state-federal partnership. Murphy announced a hearing that the role can be filled by insurance brokers, paid by private sector companies instead of the federal government.  

HHS disagrees with Murphy, stressing the need for the navigators to be independent. Otherwise, they fear, brokers will be more focused on selling their company’s plan to the customer, even when it may not be the right plan for them. Regulations set down by HHS bar licensed brokers and insurance agents from acting as navigators, but allows them to assist people in signing up for coverage. This approach worries some Republicans who fear that those experienced in the insurance industry will not be able to help, leaving the navigator roles to be filled by inexperience newcomers.

These navigators will finish their training in August before the public starts seeing eligible plans in September. The open enrollment period begins in October, and all marketplace plans will cover individuals beginning January 2014. 

HHS Offers Unprecedented Look at Hospital Charges

For the first time, the Centers for Medicare and Medicaid Services released standardized data about healthcare costs at different hospitals around the country. According to a CMS press release Wednesday, the data that they collected included hospital-specific charges for the “more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments,” and compared the “top 100 most frequently billed discharges”. The data showed “significant variation across the country, and within communities, in what hospitals charge for common inpatient services.”

Some variation across the country is expected, due to different costs of living and different state insurance structures.  Due to insurance structure in Maryland, for example, the highest rate charge for a lower joint replacement was $36,000. This is compared to $160,832 for the same procedure at a medical center just outside Dallas.

The variation is not only across the county; an article by the Washington Post highlights the massive variation that can occur within the same city. In Washington, DC, for example, the Post found that “George Washington University’s average bill for a patient on a ventilator was $115,000, while Providence Hospital’s average charge for the same service was just under $53,000. For a lower joint replacement, George Washington University charged almost $69,000 compared with Sibley Memorial Hospital’s average of just under $30,000.”

Of course, these charges are an average of all billing amounts per procedure. Further, it is common for hospitals and insurers, including Medicare, to negotiate rates below the full charge.

The release of this data was part of a transparency push from CMS and the Obama administration. According to CMS, the Robert Wood Johnson Foundation (RWJF) is planning a data visualization challenge which will further the dissemination of these data. You can download the raw data here. 

CMS Administrator Confirmation Back On Track

Following a rocky start, the confirmation of Acting CMS Administrator Marilyn Tavenner seems to be back on track this week. As NAHAM reported last month, Tavenner’s confirmation was stalled when Senator Tom Harkin (D-IA) placed a hold on it. A hold is a parliamentary procedure in the Senate that can prevent a measure from coming to the floor for a vote.

Harkin did this over a directive that Tavenner signed in March, channeling funds away from the healthcare reform’s Prevention and Public Health Trust fund, and instead spending it on Outreach efforts.

ModernHealthcare.com reports that Harkin is still upset, but that he has no objections to Tavenner leading the CMS. Senate Majority Leader Harry Reid (D-NV) announced that he will bring the nomination up for a vote when the “Republicans back off.” Sen. John Thune (R-SD) responded by saying that he wasn’t aware of any massive opposition.

CMS has not had a Senate confirmed administrator in seven years.