Monday, February 27, 2012

WEDI’s Survey on ICD-10 Industry Progress Now Open

The Workgroup for Electronic Data Interchange (WEDI) is conducting its latest Industry Progress Survey on ICD-10. Information from this survey will be used to inform WEDI, CMS, and other organizations on the progress of ICD-10 implementation. This brief survey will also assist in planning necessary programs and actions to assist the industry in transitioning to ICD-10.

To gather the most complete picture of progress within the industry, this survey is open to all organizations affected by ICD-10 such as vendors, health plans, providers, and payers. The survey is open to both WEDI members and non-members.

Responses to this survey will be gathered online. WEDI asks that participants only submit one survey per organization. The survey will close on Wednesday, February 29, 2012. Please direct any questions to Ann Marie Railing at WEDI at 703-391-2718 or

Please visit the ICD-10 website for the latest news and resources.

HHS previously announced a delay in ICD-10 implementation.

Source: HHS News Release

HHS Announces New Assistance to States for Innovation Projects

U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced more assistance to states as it implements three new provisions of the Affordable Care Act. The announcement gives states help by:
-Providing a new round of Affordable Insurance Exchange Establishment Grants, totaling $229 million to 10 states, to help states build new health insurance marketplaces;
- Promoting transparency and meaningful public input into the Medicaid demonstration process, and streamlining the federal-state consideration process as states test new models of care.

“We’re taking important actions that will give states more resources and more flexibility, and ensure transparency thanks to the Affordable Care Act,” said Secretary Sebelius. “All Americans will have access to quality, affordable health care once the Affordable Care Act is fully implemented, and today’s steps are important measures that ensure that States have the help they need to administer their Medicaid programs and oversee their insurance markets while assuring meaningful input for consumers and beneficiaries.”

Thanks to the Affordable Care Act, starting in 2014 Americans will have improved health coverage. Americans who do not have health care through their employer will be able to buy insurance from qualified health plans directly in an Affordable Insurance Exchange and may receive tax credits to help make coverage more affordable. In addition, all individuals under 65 years of age with incomes below 133 percent of the federal poverty level ($14,500 for an individual and $29,700 for a family of four in 2011) will be eligible for Medicaid. Today’s announcements will help States make this transition by giving more assistance to States as they make improvements to their Medicaid programs and insurance markets.

“As a former state health official, I know how important it is to have the right resources to ensure the health and well-being of our residents,” said Marilyn Tavenner, acting administrator of the Centers for Medicare & Medicaid Services (CMS). “These announcements are good news for states and good news for millions of Americans who will enjoy better health care as the Affordable Care Act is fully implemented.”

HHS is providing more resources to States to help them build their open health insurance marketplaces known as Exchanges. HHS announced the award of $229 million in Affordable Insurance Exchange grants to 10 states to help them create Exchanges, giving these states more flexibility and resources to implement the Affordable Care Act. The health care reform law gives states the freedom to design Affordable Insurance Exchanges – one-stop marketplaces where consumers will be able to choose a private qualified health plan that fits their health needs and will have the same kinds of insurance choices as members of Congress. The awards bring to 34 (including the District of Columbia) the number of states that are making significant progress in creating Affordable Insurance Exchanges. States receiving funding today include: Arkansas, Colorado, Kentucky, Massachusetts, Minnesota, Nevada, New Jersey, New York, Pennsylvania, and Tennessee.

More information on the Affordable Insurance Exchanges can be found here:

More Transparency
The Affordable Care Act requires transparency and meaningful public input in the development, review, and approval (or renewal) of Medicaid and CHIP demonstrations. These demonstrations allow States to undertake experimental, pilot, or demonstration projects, to run all or parts of their Medicaid programs in ways that would not otherwise be consistent with federal rules, and can have significant implications for beneficiaries, providers, and states. The final rule ensures transparency at each stage of the demonstration development and review process without impeding the timely submission and review of demonstration applications, ensuring public input while supporting ongoing innovation. Transparency and public input help to ensure that as these changes are being proposed at the state level and reviewed at the federal level, stakeholders have an opportunity to inform the decision-making process.

For more information, please visit:

More Flexibility
HHS along with the Department of Treasury finalized a rule providing more flexibility to States to find the health care solutions that work best for them. The Affordable Care Act gives states the option to receive a State Innovation Waiver so they may pursue their own innovative strategies to ensure their residents have access to high quality, affordable health insurance. Under the law, State Innovation Waivers are available in 2017, and today’s final rules provide detail how States can work with HHS to ensure their residents have the protections provided in the Affordable Care Act and access to innovative State approaches.

In addition, states will have more flexibility to apply for the Exchange Establishment Grants under an amended Funding Opportunity Announcement with additional application opportunities due out later this spring.

More information on the State Innovation Waivers can be found here:

Final rules were placed on display at the Federal Register, and may be found at:

Source: HHS News Release

Friday, February 24, 2012

ONC, CMS Release Meaningful Use Proposed Regulations; Public Comment Requested

The Department of Health and Human Services released two notices of proposed rulemaking (NPRMs) related to Stage 2 Meaningful Use: the Medicare and Medicaid EHR Incentive Programs that detail proposed expectations for providers and the Standards & Certification Criteria (S&CC) that delineate proposed requirements for certified EHR products.

The announcement of the second stage of the three stage process, reflects the desire to create ambitious, but achievable goals that enable eligible professionals and hospitals to make incremental progress in adopting and implementing electronic health records (EHRs). The three stages are:
- Stage 1 (which began in 2011 and remains the starting point for all providers): "meaningful use" consists of transferring data to EHRs and being able to share information, including electronic copies and visit summaries for patients.
- Stage 2 (to be implemented in 2014 under the proposed rule): "meaningful use" includes standards such as online access for patients to their health information and electronic health information exchange between providers.
- Stage 3 (expected to be implemented in 2016): "meaningful use" includes demonstrating that the quality of health care has been improved.

The proposed rules focus on using EHRs to improve health and health care while reducing the burden on physicians and hospitals where possible. CMS' proposed rule would specify the Stage 2 criteria that eligible providers must meet in order to qualify for Medicare and/or Medicaid EHR incentive payments. It also would specify Medicare payment adjustments that, beginning in 2015, providers will face if they fail to demonstrate meaningful use of certified EHR technology and to meet other program participation requirements. In addition, as announced in a November 2011 "We Can't Wait" announcement, Stage 1 has been extended an additional year for providers who attested in 2011 – meaning that these providers will have to attest to Stage 2 in 2014, instead of in 2013.

The proposed rule announced by ONC identifies standards and criteria for the certification of EHR technology, so eligible professionals and hospitals can be sure that the systems they adopt are capable of performing the required functions to demonstrate either stage of meaningful use that would be in effect starting in 2014. Together, these rules will encourage even more providers to participate and support more coordinated, patient-centered care.

The NPRMs represent proposals; public comment is open for 60 days after publication in the Federal Register. Final rules are expected to be released this summer.

For more information on the Stage 2 Meaningful Use NPRM, visit

Source: HHS News Release

Thursday, February 23, 2012

Mobile Devices Security Roundtable Scheduled

Registration is now open for a free Health & Humans Services roundtable on Mobile Security Devices taking place on Friday, March 16, 2012, 8:30 a.m. – 12:30 p.m. EDT at the Hubert H. Humphrey Building, U.S. Department of Health and Human Services – Great Hall,
200 Independence Avenue, S.W., Washington, DC.

The program may also be viewed via webcast.

The Roundtable will include three panels comprised of federal agency representatives, practicing providers, and representatives of research, provider and industry organizations. The event will be an interactive discussion with moderators encouraging interaction between the panelists and the audience. Questions will be accepted in person, through email, and via Twitter.

The Roundtable event is free and open to the public, through in-person or webcast participation, but you need to register online.

For more information or to register, please click here.

Source: HHS News Release

HHS Selects Challenge Winners for Facebook App

Three Facebook applications designed to help people prepare for emergencies and get support from friends and family in an emergency – from personal medical emergencies or car accidents to natural or man-made disasters – are winners of a Facebook application challenge sponsored by the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response (ASPR).

ASPR’s Facebook Lifeline Application Challenge called on software application developers to design new Facebook applications that could enhance individual and community resilience by establishing social connections in advance of an emergency.

Two recent Brown University graduates, Evan Donahue and Erik Stayton, partnered as Team ALP to win first place with their application, named Lifeline. The Las Vegas team JAMAJIC 360 with David Vinson, Erick Rodriguez, Gregg Orr, and Garth Winckler came in second with an app also named JAMAJIC 360. Third place was awarded to AreYouOk? developed by TrueTeamEffort, a team of 11 University of Illinois students led by Alex Kirlik.

Although these top three applications differ in how users interface with the app, all three allow users to designate three lifelines -- Facebook friends the person can count on and who agree to check on them in an emergency, supply them with shelter, food, and other necessities, and provide the person’s social network with an update about their wellbeing. Facebook users could use the lifeline app to create disaster readiness plans and share the plans with their emergency contacts, and provide users with news.

In addition, the first place app allows Facebook friends to collaborate on tracking the user’s status in a disaster-affected area so these friends can easily find the user’s lifelines and contact them to report that the user is safe or if the user appears to be missing. This networked approach increases the efficiency of finding missing users. The app allows users to print cards with a snapshot of their preparedness plan to carry in their wallets.

Team ALP’s app also features a news feed and links to credible information sources which make the app useful for large-scale disasters and individual emergencies, such as car accidents and personal medical emergencies.

The lifeline app is anticipated to be launched in the coming months, prior to the start of hurricane season. The team also receives $10,000 and complimentary passes from Health 2.0 to attend the spring Health 2.0 conference in Boston. JAMAJIC 360 receives $5,000 for second place, and TrueTeamEffort receives $1,000 for third place.

“We’re really excited about the potential of the lifeline app to help people not only to reach out to friends and family for the kinds of assistance they may need in an emergency, but also to help improve their personal health and preparedness,” said Nicole Lurie, M.D., HHS assistant secretary for preparedness and response and a rear admiral in the U.S. Public Health Service. “Having people you can depend on for help is especially important during a disaster, so we want to encourage everyone to identify those people in advance. Since so many people use Facebook to connect with one another, it seemed like a natural way to help people to identify their lifelines.”

Dr. Lurie also noted another possible benefit to the Facebook lifeline apps. “People who have friends or relatives they can rely on for help are healthier and live longer than those who don’t, which means establishing these social connections can enhance individual and community resilience,” she said.

To learn more about application challenges sponsored by federal agencies, including challenges that support emergency preparedness, visit

HHS is the principal federal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves. To learn more about HHS, visit

ASPR leads HHS in preparing the nation to respond to and recover from adverse health effects of emergencies, supporting communities’ ability to withstand adversity, strengthening health and response systems, and enhancing national health security. To learn more about ASPR and preparedness, response and recovery from the health impacts of disasters, visit the HHS public health and medical emergency website,

Source: HHS News Release

Health Reform Law Provides Coverage for Nearly 50,000 Americans With Pre-existing Conditions

U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced that the new health care law’s Pre-Existing Condition Insurance Plan (PCIP) program is providing insurance to nearly 50,000 people with high-risk pre-existing conditions nationwide.

The Department released a new report demonstrating how PCIP is helping to fill a void in the insurance market for consumers with pre-existing conditions who are denied insurance coverage and are ineligible for Medicare or Medicaid coverage.

“For too long, Americans with pre-existing conditions were locked out of the health care system and their health suffered,” said HHS Secretary Kathleen Sebelius. “Thanks to health reform, our most vulnerable Americans across the country have the care they need.”

Under the Affordable Care Act, in 2014, insurers will be prohibited from denying coverage to any American with a pre-existing condition. Until then, the PCIP program will continue to provide enrollees with affordable insurance coverage.

In many cases, PCIP participants have been diagnosed with and need treatment for serious health care conditions such as cancer, ischemic heart disease, degenerative bone diseases and hemophilia. As a result of the new law, PCIP enrollees are receiving health services for their conditions on the first day their insurance coverage begins. Their critical need for treatment, combined with their lack of prior health coverage has led to higher overall per-member claims costs in state-based PCIPs of approximately $29,000 per year, which is more than double the per member cost that traditional State High Risk Pools have experienced in recent years.
Enrollment in PCIP has seen a nearly 400 percent increase from November 2010 to November 2011. PCIP enrollment is anticipated to trend upwards of 50,000 enrollees within the coming month.

People who enroll in the PCIP program are not charged a higher premium because of their medical condition. Program participants pay comparable premium rates to healthy people in the individual insurance market. By law, premiums may vary only on the basis of age, geographic area and tobacco use.

PCIP provides comprehensive health coverage, including primary and specialty care, hospital care, prescription drugs, home health and hospice care, skilled nursing care, preventive health and maternity care. The program is available in 50 states and the District of Columbia and open to U.S. citizens and people who reside in the U.S. legally (regardless of income) who have been without insurance coverage for at least six months, and have a pre-existing condition, or have been denied health insurance coverage because of a health condition.

The Affordable Care Act directed the Secretary of HHS to carry out PCIP either directly or through a contract with a state or nonprofit entity. In 27 states, a state or nonprofit entity elected to administer PCIP, while HHS operates the program in the remaining 23 states and the District of Columbia.

The new report can be found at:

For more information, including eligibility, plan benefits and rates, as well as information on how to apply, visit and click on “Find Your State.” Then select your state from a map of the United States or from the drop-down menu.

The PCIP call center is open from 8 a.m. to 11 p.m. Eastern Time. Call toll-free 1-866-717-5826 (TTY 1-866-561-1604).

Source: HHS News Release

Tuesday, February 21, 2012

HIE Set to Expand

Electronic Health Information Exchanges that allow the secure sharing of patient health information between providers is set to grow considerably in coming years because of new service and payment models that are being adopted said panelists at a recent Brookings Institution presentation.

Policy Megachange and Health Information Exchanges featured panelists Janet Marchibroda, Chair of the Health Information Technology Initiative of The Health Project at the Bipartisan Policy Center; John Piescik of the Strategy and Engagement Center Center for Transforming Health at The MITRE Corporation; P. Jon White, Director Health IT and Acting Director, Center for Primary Care, Prevention and Clinical Partnerships Agency for Healthcare Research Quality (AHRQ); and Claudia Williams, Director of the State Health Information Exchange Office of the National Coordinator (ONC) U.S. Department of Health and Human Services (HHS).

Panelists agreed that HIEs would expand. “[O]ur goal is to get information moving to
support patient care in a secure way," said Claudia Williams of ONC. "Our goal is not necessarily to support a particular model or particular approach, but to see the percentage of transitions that are supported by the information that's needed, of lab results going to doctors electronically and of patients able to get their own information. We need to see these measures really take

"We've got a business case on the horizon with payment reform and delivery system
reform and for the first time talking with a whole host of folks that maybe weren't there 2 years ago," agreed Janet Marchiboda. "...whether it's providers, physician practices, hospitals, labs or vendors, I see an appetite for coming to agreement around a set of policies and standards. We'd have to talk about how far down you go, but principles and policies for getting to exchange even
on a voluntary basis that could be something that could inform what the federal government adopts over the long-term."

The Brookings Institution released a paper called Health Information Exchanges and Megachange in conjuction with the presentation.

Additional information about the presentation, including an audio webcast of the presentation may be accessed here.

Source: CQ HealthBeat (subscription required)

Friday, February 17, 2012

HHS: Progress With HIT

The U.S. Department of Health and Human Services’ (HHS) Secretary Kathleen Sebelius announced the number of hospitals using health information technology (IT) has more than doubled in the last two years. She also announced new data showing nearly 2,000 hospitals and more than 41,000 doctors have received $3.1 billion in incentive payments for ensuring meaningful use of health IT, particularly certified Electronic Health Records (EHR).

Secretary Sebelius is in Kansas City, Missouri visiting Metropolitan Community College-Penn Valley Health Science Institute to make this announcement and discuss the growth of professional jobs in the health information technology field.

“Health IT is the foundation for a truly 21st century health system where we pay for the right care, not just more care,” said Secretary Sebelius. “Health care professionals and hospitals are taking advantage of this unprecedented opportunity to begin using smarter, new technology that improves care and creates the jobs we need for an economy built to last.”

The announcement details information from a new survey conducted by the American Hospital Association and reported by the HHS Office of the National Coordinator for Health IT which found that the percentage of U.S. hospitals that had adopted EHRs has more than doubled from 16 to 35 percent between 2009 and 2011. And, 85 percent of hospitals now report that by 2015 they intend to take advantage of the incentive payments made available through the Medicare and Medicaid EHR Incentive Programs.

The announcement also highlights new data from the Centers for Medicare & Medicaid Services (CMS) detailing $3.12 billion in incentive payments the agency has made to physicians, hospitals, and other health care providers who have started to meaningfully use EHRs to improve the quality of patient care. In January alone, CMS provided $519 million to eligible providers. EHR incentive payments can total as much as $44,000 under the Medicare EHR Incentive Program and $63,750 under the Medicaid EHR Incentive Program.

According to the Bureau of Labor Statistics, the number of health IT jobs across the country is expected to increase by 20 percent from 2008 to 2018, a pace much faster than the average for all occupations through 2018. In conjunction with her announcement, Secretary Sebelius will tour the Penn Valley Community College Health Science Institute, which trains students for careers in this growing industry. She will also participate in a roundtable discussion with Community College leaders, students training in the health IT field, health care providers, patients and area employers about the importance of health information technology training in both improving patient outcomes and creating jobs.

The Obama administration provides financial support to eligible health care professionals and hospitals to make the switch to health IT and certified EHRs through the Medicare and Medicaid EHR Incentive Programs. These programs are funded by the HITECH Act provisions of the 2009 Recovery Act. The administration has also created a nationwide network of 62 Regional Extension Centers to provide technical guidance and resources to help eligible health care providers participate in the EHR Incentive Programs and meaningfully use certified EHRs.

To meet the demand for workers with health IT experience and training, the Obama Administration has also launched four workforce training programs. Training is provided through 82 community colleges and nine universities nationwide. As of January 2012, over 9,000 community college students have been trained for health IT careers and another 8,706 students have enrolled. And as of February 2012, participating universities have enrolled over 1,200 students and graduated nearly 600 post-graduate and masters-level health IT professionals, with over 1,700 expected to graduate by the summer of 2013.

Two other workforce training programs have resulted in the development of a health IT workforce curriculum and a health IT worker competency examination. The health IT workforce curriculum offers colleges and universities in all 50 states innovative health IT teaching materials at no cost to instructors. And, since its release in May, 2011, over 2,000 individuals have taken the HIT Pro Exam, a competency examination designed to show employers that job-seekers have attained a proficient level of knowledge and skills in health IT.

Health IT can help keep information private and secure. In addition, federal laws require key persons and organizations that handle health information to have policies and security safeguards in place to protect health information—whether it is stored on paper or electronically.

For more information on how health IT can lead to safer, better, and more efficient care, visit

For more information about the Medicare and Medicaid EHR Incentive Programs, see

For more information about the HHS Recovery Act health IT programs see

Source: HHS News Release

TJC Requests Input on New E-App

The Joint Commission (TJC) announced that a new tutorial video is available to help users transition as seamlessly as possible to the new electronic application for accreditation (E-App).

The tutorial provides an overview of the new features and functionality of the E-App, and provides some helpful hints on navigating through the application. The video tutorial can be accessed the following ways:
- The Joint Commission website
- The Joint Commission Connect extranet
- Site Information tab (tab 5)
- E-App Dashboard

You can also click here to watch the video tutorial.

The Joint Commission also wants public input on the new E-App. A short survey is available on the Joint Commission Connect extranet home page. All organizations are encouraged to take the survey. Your input to the survey will help The Joint Commission in planning future E-App enhancement releases.

The enhanced E-App was launched on December 28, 2011 for all accreditation programs, except for the laboratory and certification programs.

Source: TJC News Release

AHRQ Announces Free TeamSTEPPS Training Opportunities

the Agency for Healthcare Research & Quality (AHRQ) announces free training opportunities for TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety), a set of evidence-based, practical tools that helps hospitals and other health care providers strengthen teamwork among caregivers with the goal of improving patient safety.

AHRQ and the Department of Defense designed the TeamSTEPPS program specifically for health care providers for use in a variety of care settings. Free TeamSTEPPS master trainer courses will be offered at six regional training centers throughout the country starting this month. The six regional training centers are NorthShore Long Island Jewish Health System (Roslyn Harbor, NY); Duke University (Durham, NC); Tulane University (New Orleans, LA); University of Minnesota (Minneapolis, MN); Presbyterian St. Luke’s (Denver, CO); and University of Washington (Seattle, WA). Many standard trainings are offered as well as four advanced, special topic trainings on simulation, interprofessional education, and teaching TeamSTEPPS to patients and families. These advanced trainings are designed for individuals who already have a strong background in TeamSTEPPS and an interest in the special topic. All materials, training, and enrollment in the online user support network is free.

To register for a training, please visit Write with any questions.

Source: AHRQ News Release

HHS to Host Roundtable On Mobile Devices

On Friday, March 16, 2012, 8:30 a.m. – 12:30 p.m. EST, HHS will host a Mobile Devices Roundtable. The program is free and open to the public. Persons may participate in person or via webcast.

One of the key goals of the Federal Health Information Technology Strategic Plan is to inspire confidence and trust in health IT and electronic health information exchange by protecting the confidentiality, integrity, and availability of health information. ONC’s Office of the Chief Privacy Officer (OCPO), along with the HHS Office for Civil Rights (OCR), recently launched a privacy and security mobile device project. The project builds on the existing HHS HIPAA Security Rule - Remote Use Guidance and is designed to identify privacy and security good practices for mobile devices. The identified provider use case scenarios and good practices to address those scenarios will be communicated in plain, practical, and easy to understand language for use by health care providers, professionals, and other entities.

The objectives of the roundtable are to address the current privacy and security legal framework for mobile devices accessing, storing and/or transmitting health information;
discuss real world usage of mobile devices by providers and other health care delivery professionals to understand their expectations, attitudes, challenges and needs;
gather input regarding the information (and format) providers and other health care delivery professionals want and need to help them safeguard health information on their mobile devices; and gather input on existing and emerging privacy and security good practices, strategies and technologies for safeguarding data on mobile devices.

The Roundtable will include three panels comprised of federal agency representatives, practicing providers, and representatives of research, provider and industry organizations. The event will be an interactive discussion with moderators encouraging interaction between the panelists and the audience. Questions will be accepted in person, through email, and via Twitter.

The Roundtable event is free and open to the public, through in-person and webcast participation. Registration information will be posted by next Thursday, February 23.
Meeting Details:
Meeting Date & Time: Friday, March 16, 20128:30 a.m. – 12:30 p.m. EST(Registration/check-in begins at 7:30 a.m. EST)
Location:Hubert H. Humphrey BuildingU.S. Department of Health and Human Services – Great Hall200 Independence Avenue, S.W., Washington, DC
Or via webcast

For more information please click here.

Source: HHS News Release

NIST Seeks Health Record System Manufacturers to Assist in Usability Testing

The National Institute of Standards and Technology (NIST) seeks manufacturers of electronic health record (EHR) systems to participate in a research effort to develop methods for assessing the usability of health information systems.

Usability is broadly defined by information technology professionals as a measure of how well a system can be applied by its intended users to achieve specified goals with effectiveness, efficiency and satisfaction. All software systems developers strive for usability, but it is particularly important in health information systems. The usability of a health IT system can be the difference between a good and bad outcome for the patient.

The Healthcare Information and Management Systems Society (HIMSS) has argued that usability may be the single biggest obstacle to widespread adoption and use of electronic health records in clinical settings. EHR systems must present and record often complex medical information, in a wide variety of formats, so that it can be easily accessed and used by clinicians and other users. Accurately assessing usability involves more than simple surveys of user satisfaction. NIST is working to develop a basic framework for assessing the usability of health information technology systems and ultimately recommending performance-oriented user interface design guidelines for EHRs. As part of this effort, NIST seeks system manufacturers willing to provide EHR systems for use in lab-based usability testing. NIST will provide a secure computing environment to safeguard the software and equipment during the course of the research, and the EHR software and equipment will be removed from all computers on which it is installed and returned to the manufacturer at the end of the testing period. The results of the usability testing of each EHR system will be reported to its manufacturer and used to support NIST research. Individual systems will not be identified and linked to test results in any NIST reports. The systems are for research purposes only; no actual patient data will be used or accepted.NIST anticipates that it will take approximately one year to conduct all necessary research.

Full details of intellectual property protections for the research program are in the formal Letters of Understanding that NIST will execute with participating manufacturers. To participate in the program, manufacturers must submit a request and an executed Letter of Understanding by 5 p.m. Eastern time on March 15, 2012. Interested parties should consult the Feb. 14, 2012, Federal Register notice, “Evaluating the Usability of Electronic Health Record (EHR) Systems” (Docket No.: 120123059-2058-01) available at for details of the program and the required Letter of Understanding.

Source: NIST News Release

Health Reform to Require Insurers to Use Plain Language in Describing Health Plan Benefits, Coverage

People in the market for health insurance will soon have clear, understandable and straightforward information on what health plans will cover, what limitations or conditions will apply, and what they will pay for services thanks to the Affordable Care Act – the health reform law – according to final regulations published.

The marketing materials that insurers use can sometimes make it difficult for consumers to understand exactly what they are buying. The new rules, published jointly by the Departments of Health and Human Services, Labor and Treasury, require health insurers and group health plans to provide concise and comprehensible information about health plan benefits and coverage to the millions of Americans with private health coverage. The new rules will also make it easier for people and employers to directly compare one plan to another.

“All consumers, for the first time, will really be able to clearly comprehend the sometimes confusing language insurance plans often use in marketing,” said HHS Secretary Kathleen Sebelius. “This will give them a new edge in deciding which plan will best suit their needs and those of their families or employees.”

Under the rule, health insurers must provide consumers with clear, consistent and comparable summary information about their health plan benefits and coverage. The new explanations, which will be available beginning, or soon after, September 23, 2012 will be a critical resource for the roughly 150 million Americans with private health insurance today.

Specifically, these rules will ensure consumers have access to two key documents that will help them understand and evaluate their health insurance choices:
- A short, easy-to-understand Summary of Benefits and Coverage ( or “SBC”); and
- A uniform glossary of terms commonly used in health insurance coverage, such as “deductible” and “co-payment.”

All health plans and insurers will provide an SBC to shoppers and enrollees at important points in the enrollment process, such as upon application and at renewal.

A key feature of the SBC is a new, standardized plan comparison tool called “coverage examples,” similar to the Nutrition Facts label required for packaged foods. The coverage examples will illustrate sample medical situations and describe how much coverage the plan would provide in an event such as having a baby (normal delivery) or managing Type II diabetes (routine maintenance, well-controlled) These examples will help consumers understand and compare what they would have to pay under each plan they are considering.

The rules finalize the proposed rules issued in August 2011. Input was received from such stakeholders as the National Association of Insurance Commissioners (NAIC) and a working group composed of health insurance-related consumer advocacy organizations, health insurers, health care professionals, patient advocates including those representing people with limited English proficiency, and others. The final rules aim to ensure strong consumer information while minimizing paperwork and cost.

To view the template for the Summary of Benefits and Coverage and the glossary, visit:

To view the Final Rule, visit:

For more information on the rules announced today, visit:

Source: HHS News Release

New Health care Law Helps Expand Primary Care Physician Workforce

The National Health Service Corps (NHSC) awarded $9.1 million in funding to medical students in 30 States and the District of Columbia who will serve as primary care doctors and help strengthen the health care workforce, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced at the Eisner Pediatric and Family Medical Center, a community health center in Los Angeles, Calif.

Made possible by the Affordable Care Act (the new health care law), the National Health Service Corps’ Students to Service Loan Repayment Program provides financial support to fourth year medical students who are committed to a career in primary care in exchange for their service in communities with limited access to care.

“This new program is an innovative approach to encouraging more medical students to work as primary care doctors,” said Secretary Sebelius. “This is an important part of the Administration’s commitment to building the future health care workforce.”

Administered by HHS’ Health Resources and Services Administration (HRSA), Students to Service is a pilot program that provides loan repayment assistance of up to $120,000 to medical students (MDs and DOs) in their last year of education. In return, they commit to serve in a health professional shortage area upon completion of a primary care residency program.

“The average medical school debt of the students receiving these awards is more than $200,000,” said HRSA Administrator Mary K. Wakefield, Ph.D., R.N. “The Students to Service program relieves a tremendous debt burden, allowing them to follow their passion for primary care and serve some of the country’s most underserved rural and urban communities.”
These newest NHSC providers must serve three years of full-time service or six years of half-time service in rural and urban areas of greatest need.

Alongside current NHSC members, Secretary Sebelius spoke with Eric Schluederberg, one of the awardees announced today and a 4th year medical student at Western University of Health Sciences in Pomona, Calif. He was always attracted to the field of primary care, but the story of his fiancé, Nancy, who has Spina Bifida, has helped inspire him to serve in the NHSC and ensure that women get the pre-natal care they need.

“I always knew my calling was primary care, “Mr. Schluederberg said. “I’m not a social researcher, and I’m not an economist. But it seems that there are a lot of underserved people in this nation, and that providing sound primary care is a good economic investment. For example, ensuring that pregnant women know to take folic acid supplements is one way to prevent the cost of the numerous surgeries required to help someone with Spina Bifida become an independent member of society.”

With significant investment from the Affordable Care Act, thousands of new primary health care providers have been added to the ranks of the NHSC. The awardees will join the many NHSC providers already serving and providing culturally competent primary care at more than 14,000 health care sites in urban, rural, and frontier areas.

The NHSC provides financial, professional, and educational resources to medical, dental, and mental and behavioral health care providers who bring their skills to areas of the United States with limited access to health care. The NHSC was established in 1972 and has connected over 41,000 primary health care practitioners to communities all over America.

For more information about NHSC programs, please visit

Source: HHS News Release

Health Care Fraud Prevention and Enforcement Efforts Result in Record-Breaking Recoveries Totaling Nearly $4.1 Billion

Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius released a new report showing that the government’s health care fraud prevention and enforcement efforts recovered nearly $4.1 billion in taxpayer dollars in Fiscal Year (FY) 2011. This is the highest annual amount ever recovered from individuals and companies who attempted to defraud seniors and taxpayers or who sought payments to which they were not entitled.

These findings, released today, in the annual Health Care Fraud and Abuse Control Program (HCFAC) report, are a result of President Obama making the elimination of fraud, waste and abuse a top priority in his administration. The success of this joint Department of Justice and HHS effort would not have been possible without the Health Care Fraud Prevention & Enforcement Action Team (HEAT), created in 2009 to prevent fraud, waste and abuse in the Medicare and Medicaid programs, and to crack down on the fraud perpetrators who are abusing the system and costing American taxpayers billions of dollars. These efforts to reduce fraud will continue to improve with the new tools and resources provided by the Affordable Care Act.

“This report reflects unprecedented successes by the Departments of Justice and Health and Human Services in aggressively preventing and combating health care fraud, safeguarding precious taxpayer dollars and ensuring the strength of our essential health care programs,” said Attorney General Holder. “We can all be proud of what's been achieved in the last fiscal year by the Department’s prosecutors, analysts and investigators – and by our partners at HHS. These efforts reflect a strong, ongoing commitment to fiscal accountability and to helping the American people at a time when budgets are tight.”

“Fighting fraud is one of our top priorities and we have recovered an unprecedented number of taxpayer dollars,” said Secretary Sebelius. “Our efforts strengthen the integrity of our health care programs, and meet the President’s call for a return to American values that ensure everyone gets a fair shot, everyone does their fair share, and everyone plays by the same rules.”
Approximately $4.1 billion stolen or otherwise improperly obtained from federal health care programs was recovered and returned to the Medicare Trust Funds, the Treasury and others in FY 2011. This is an unprecedented achievement for HCFAC, a joint effort of the two departments to coordinate federal, state and local law enforcement activities to fight health care fraud and abuse.

The recently-enacted Affordable Care Act provides additional tools and resources to help fight fraud that will help boost these efforts, including an additional $350 million for HCFAC activities. The administration is already using tools authorized by the Affordable Care Act, including enhanced screenings and enrollment requirements, increased data sharing across government, expanded overpayment recovery efforts and greater oversight of private insurance abuses.

Since 2009, the Departments of Justice and HHS have enhanced their coordination through HEAT and have increased the number of Medicare Fraud Strike Force teams. During FY 2011, HEAT and the Medicare Fraud Strike Force expanded local partnerships and helped educate Medicare beneficiaries about how to protect themselves against fraud. The departments hosted a series of regional fraud prevention summits around the country, provided free compliance training for providers and other stakeholders and sent letters to state attorneys general urging them to work with HHS and federal, state and local law enforcement officials to mount a substantial outreach campaign to educate seniors and other Medicare beneficiaries about how to prevent scams and fraud.

In FY 2011, the total number of cities with strike force prosecution teams was increased to nine, all of which have teams of investigators and prosecutors from the Justice Department, the FBI, and the HHS Office of Inspector General, dedicated to fighting fraud. The strike force teams use advanced data analysis techniques to identify high-billing levels in health care fraud hot spots so that interagency teams can target emerging or migrating schemes along with chronic fraud by criminals masquerading as health care providers or suppliers. In FY 2011, strike force operations charged a record number of 323 defendants, who allegedly collectively billed the Medicare program more than $1 billion. Strike force teams secured 172 guilty pleas, convicted 26 defendants at trial and sentenced 175 defendants to prison. The average prison sentence in strike force cases in FY 2011 was more than 47 months.

Including strike force matters, federal prosecutors filed criminal charges against a total of 1,430 defendants for health care fraud related crimes. This is the highest number of health care fraud defendants charged in a single year in the department’s history. Including strike force matters, a total of 743 defendants were convicted for health care fraud-related crimes during the year.
In criminal matters involving the pharmaceutical and device manufacturing industry, the department obtained 21 criminal convictions and $1.3 billion in criminal fines, forfeitures, restitution and disgorgement under the Food, Drug and Cosmetic Act. These matters included the illegal marketing of medical devices and pharmaceutical products for uses not approved by the Food and Drug Administration (FDA) or the distribution of products that failed to conform to the strength, purity or quality required by the FDA.

The departments also continued their successes in civil health care fraud enforcement during FY 2011. Approximately $2.4 billion was recovered through civil health care fraud cases brought under the False Claims Act (FCA). These matters included unlawful pricing by pharmaceutical manufacturers, illegal marketing of medical devices and pharmaceutical products for uses not approved by the FDA, Medicare fraud by hospitals and other institutional providers, and violations of laws against self-referrals and kickbacks. This marked the second year in a row that more than $2 billion has been recovered in FCA health care matters and, since January 2009, the department has used the False Claims Act to recover more than $6.6 billion in federal health care dollars.

The fraud prevention and enforcement report coincides with the announcement of a proposed rule from the Centers for Medicare and Medicaid Services aimed at recollecting overpayments in the Medicare program. Before the Affordable Care Act, providers and suppliers did not face a deadline for returning taxpayers’ money. Thanks to the Affordable Care Act, there will be a specific timeframe by which self-identified overpayments must be returned. The Obama Administration has made prevention and recollection of overpayments a government-wide priority. These announcements are just the latest in a series of steps that the administration is taking to protect taxpayer dollars and keep money in the pockets of Americans.

The HCFAC annual report can be found here, For more information on the joint DOJ-HHS Strike Force activities, visit:

For more information on the fraud prevention accomplishments under the Affordable Care Act visit:

Source: HHS News Release

HHS Says Consumers Get Better Value for Their Health Insurance Dollar

Health and Human Services Secretary Kathleen Sebelius announced that consumers will soon begin receiving unprecedented information on the value of their health insurance coverage, and some will receive rebates from insurance companies that spend less than 80 percent of their premium dollars on health care.

The Affordable Care Act requires that insurance companies this year begin notifying customers how much of their premiums they have spent on medical care and quality improvement. Beginning in 2011, insurers were required to spend at least 80 percent of total premium dollars they collect on medical care and quality improvement. Insurance companies that do not meet the 80/20 standard (also known as the Medical Loss Ratio) are required to pay rebates to their customers this year.

"Before the Affordable Care Act, insurance companies could spend your premium dollars on administrative red tape and marketing," said Secretary Sebelius. "With today's notice, we're taking a big step toward making insurers accountable to consumers. Some of these insurance companies have already changed their behavior by lowering premiums or spending more on medical care and quality improvement, while the remainder will need to refund this money to their customers this year."

The proposed consumer notices about whether their insurance company has met the new standard have been posted on, and HHS is seeking public comment to help ensure the notices are useful transparency tools for consumers.

In the individual market, the Affordable Care Act allows the Secretary to adjust the medical loss ratio standard for a state if it is determined that meeting that standard may destabilize the state’s individual insurance market. HHS has concluded its review of 18 state requests for adjustments to the medical loss ratio rule. As a result of HHS’ decision to deny insurance companies the ability to spend more premium dollars on administrative overhead costs rather than on medical claims, consumers will receive up to $323 million in rebates this year compared to what would have been owed if all state adjustment requests were fully granted, according to data from state regulators and issuer reports.

These adjustment request determinations were made as a result of a transparent and data-driven process, and the documentation related to each state’s request has been publicly posted.

In total, HHS determined that no adjustment was necessary in ten states, approved an altered adjustment in six states, and approved the request sought by one state. This includes a denied adjustment for Wisconsin, and an altered adjustment for North Carolina.

The announcement is part of the Obama Administration’s effort to increase transparency in the health insurance marketplace. The notification will let consumers know if their insurer did not meet the 80/20 standard -- and that they or their employer will receive a rebate. HHS is also considering requiring insurers notify consumers if their insurer did meet the 80/20 standard.

For the text of these proposed notifications, please visit:

For more information on the MLR provision in the Affordable Care Act, please visit:

For documentation of state requests for MLR adjustments, including specific information on rebates saved by HHS’ MLR adjustment determinations, visit:

For more information on how the Affordable Care Act is creating a transparent market for health insurance, visit:

Source: HHS News Release

Survey: Consumers Like Electronic Health Records But Worry About Security

As more and more consumers see their doctors using electronic health records (EHRs), trust in doctors is high and patients have confidence that health information technology (health IT) can improve the quality and coordination of care. Those with online access to their own medical records are especially supportive of health IT. But consumers have persistent concerns that data breaches will occur.

The federal government is providing incentives for the use of health IT right now, investing tens of billions of dollars in its adoption. Health IT is a foundation for health reform and for many of the new models of care now being developed or tested. At this key moment as health IT is being rolled out, the National Partnership for Women & Families commissioned an unprecedented study to examine consumer views on health IT with research directed by Alan Westin, Ph.D., professor emeritus at Columbia University. It was conducted by Harris Interactive.

"We fielded this survey now, in the early stages of the transformation to EHRs, to assess consumer views and to measure whether the ways doctors and hospitals are using them is what patients want and need," said Christine Bechtel, vice president at the National Partnership. Bechtel also represents patients and families on the federal Health IT Policy Committee. "For health IT to deliver on its promise, consumers must support it. If they don’t, we will see political pressure for repeal and the promise will be squandered. What we found is encouraging, but there are still potential landmines ahead."

"This survey draws attention to a critical, but sometimes overlooked, facet of health information technology — patients and their families need to be at the center of efforts to modernize health care’s information infrastructure," said Dr. Farzad Mostashari, National Coordinator for Health IT, U.S. Department of Health and Human Services.

Making IT Meaningful: How Consumers Value and Trust Health IT takes an unprecedented look at consumer confidence in health IT. Survey respondents had an ongoing relationship with a care provider and knew whether that provider uses an electronic or paper record system. Among the findings:

- Regardless of the type of record their physician uses, patients see value in EHRs. When asked if an EHR is or would be useful for seven key elements of care — such as making sure doctors have timely access to relevant information, and helping patients communicate directly with providers — 88 to 97 percent of those whose doctors use EHRs, and 80 to 97 percent of those whose doctors use paper medical records, said EHRs would be useful.
- Just six percent of respondents whose doctors use EHRs are unsatisfied with the medical record system their doctors are using.
- Three in four respondents whose doctors use paper records said it would be valuable if their doctors adopted EHRs.
- The one in four respondents who have online access to their medical records (26 percent) were even more supportive of health IT than those who do not, particularly when it comes to the ways in which EHRs benefit them personally. They were also more trusting of doctors to protect their privacy.
- Overwhelming majorities of respondents, regardless of record system, trust their doctors to protect the privacy of their health information.
- Consumers rated EHRs higher than paper records when it comes to giving patients confidence their information is safe, complying with privacy laws, giving patients more control over their health information, earning their trust, and seeing a record of who has accessed their information.
There are concerns about data breaches and current privacy laws. Three in five respondents whose doctors use EHRs (59 percent) agree that widespread adoption of EHRs will lead to even more personal information being lost or stolen, as do 66 percent of respondents whose doctors use paper records. Similarly, more than half of those whose doctors use EHRs (51 percent) and 53 percent of those whose doctors use paper records agree that the privacy of personal medical records and personal health information is not currently well protected by federal and state laws and organizational practices.
- Those with paper records today who are most worried about their privacy in this survey were men, those with a college education, respondents ages 35 to 46, and those living in the east and west.

An oversample of Hispanic adults found that those whose doctors use EHRs were significantly
more likely than others to see them as valuable in helping them personally in some important ways, such as maintaining a healthy lifestyle, understanding their health conditions and keeping up with their medications. At the same time, they were more likely both to report having experienced a data breach and to worry that more widespread adoption of EHRs will lead to even more such breaches.

"The survey shows that patients see tremendous value in the power of electronic health records to improve the way care is delivered by facilitating better communication and helping them become active partners in their own care. Its findings offer important messages about how to build, implement and use health IT systems in ways that are meaningful and beneficial to patients and their families," Mostashari said.

"At the same time, patients are also saying the success of advanced information technology rests on a foundation of trust that must be vigilantly protected," he added. "Encouraging the adoption and meaningful use of electronic health records is important, but the ultimate goal should be to leverage information technology in ways that lead to higher quality care, more coordinated care, and care that is truly patient-centered."

"At a time when America’s taxpayers have made such a large investment in the implementation of health IT, we have an obligation to use their dollars wisely and get this right," the National Partnership’s Bechtel said. "Amplifying the voices of consumers is key to success. This survey gives consumers a voice."

The survey was conducted from August 3 to August 22, 2011. The respondent pool was 1,961 adults. It was funded by the Commonwealth Fund, Merck & Co., Inc., WellPoint, Inc. and the California HealthCare Foundation. It is intended to serve as a baseline for longitudinal tracking, and the survey instrument has been made available for public use.

The survey report includes a series of policy recommendations in the areas of consumer education, and functional and privacy requirements for a variety of federal programs.

Source: NWPF News Release

New AHRQ Toolkit Supports Hospital Efforts To Improve Quality and Safety

The Agency for Healthcare Research and Quality (AHRQ) released a free toolkit designed to guide hospitals through the process of using the AHRQ Inpatient Quality Indicators (IQIs) and Patient Safety Indicators (PSIs) to improve care. The AHRQ Quality IndicatorsTM Toolkit for Hospitals is designed and tested to meet the needs of a variety of hospital-based users, including senior leaders, quality staff, and multistakeholder improvement teams. AHRQ developed these research-based tools through a 2-year contract with RAND in collaboration with UHC.

The toolkit includes an “Introduction and Roadmap” to help users identify the resources that are best suited to their specific needs at any given point in the improvement process. It is organized into seven sections:

- Determining Readiness To Change
- Applying QIs to the Hospital Data
- Identifying Priorities for Quality Improvement
- Implementing Improvements
- Monitoring Progress for Sustainable Improvements
- Analyzing Return on Investment
- Using Other Resources

Download the toolkit at:

Source: AHRQ News Release

Monday, February 6, 2012

Bipartisan Policy Center Task Force Recommends More and Better Use of Health IT to Improve Quality and Reduce Costs

Recognizing that health information technology (IT) plays a critical role in improving the quality and cost-effectiveness of care, the Bipartisan Policy Center’s (BPC) Task Force on Delivery System Reform and Health IT today released a set of recommendations for the most effective use of health IT dollars to support delivery system and payment reforms to achieve improved health, better health care, and reductions in the cost of care. Click here to read the full report.

Watch the event video here.

The recommendations range from realigning incentives and payments to support higher quality, more cost-effective care to increasing the use of electronic health records (EHR) and health information exchange to improve care coordination by enabling doctors, hospitals, and patients to securely share health information when patients receive their care in multiple settings.

“There is strong bipartisan support for health IT, and for moving away from a payment model that largely focuses on volume — rewarding providers for doing more — rather than on quality outcomes or value,” said Senator Daschle, Co-leader of BPC’s Health Project at today’s release.
Health IT is seen as critical to supporting this shift in payment models, and as an essential improvement tool in a system where a patient’s records can be scattered throughout various health care offices and facilities.

“To deliver high-quality, cost-effective care, a physician or hospital needs good information,” said Senator Frist, who also co-leads BPC’s Health Project, at today’s event. “Data about patients has to flow across primary care physicians, hospitals, labs, and anywhere that patients receive care.”

The Task Force’s recommendations come during a time of unprecedented public and private spending on health IT. A record investment of nearly $30 billion was triggered by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, spurring significant investments by the private sector. A majority of the federal investment is in the form of incentive payments through the Medicare and Medicaid EHR Incentive Programs, informally known as “Meaningful Use.” The Task Force recommendations aim to channel these investments into health IT capabilities shown to be most effective at improving quality and reducing cost.

The Task Force recommends actions for aligning incentives and payment with higher quality, more cost-effective care, along with the health IT-enabled, coordinated, accountable, patient-centered delivery models that support such outcomes.

To further accelerate health information exchange, the Task Force recommends that the next phase of Meaningful Use and related standards and certification programs support the more robust exchange of standards-based data across multiple settings; public-private sector agreement on and execution of a common set of principles, policies and methods for exchange in the near-term; and the development and execution of a long-term strategy for the data standards and interoperability needs associated with delivering care, empowering patients, and improving population health.

Educating consumers about the benefits of electronic tools, and promoting their use, is an additional focus of the Task Force’s recommendations. “We need a bold campaign to raise awareness among consumers about the benefits of using these tools,” said BPC Health Project State Co-Chair and former Governor Ted Strickland. “We need to make it easier for consumers to navigate the health care system and take control of their health.”

The Task Force also recommends several actions to promote the use of electronic tools to improve patient-provider communication, coordinate care, expand access and empower individuals to manage their health and health care. They include expanding considerably upon the current consumer awareness campaign; educating and supporting providers in the adoption of electronic tools to support patient engagement; and making tools widely available so that patients can easily download health information from their provider’s EHR into their own personal health record.

The Task Force also recognizes that it is necessary to issue consistent, comprehensive and clear guidance on federal privacy and security laws covering personal health information and calls for consistent protection of personal health information.

Additionally, the Task Force calls for an expansion of education and implementation assistance programs to help providers achieve Meaningful Use – with a particular focus on small physician practices and community hospitals and clinics that deliver care to rural and underserved populations.

Finally, the Task Force recommends further alignment of health IT requirements across federal health care programs so that common health IT solutions can meet the multiple needs of programs supporting delivery system transformation, payment, public health, coverage and access, and administrative improvement. The Task Force urges coordination of quality measurement programs and alignment of measurement specifications with federally adopted data standards.

“Coordinated, accountable, patient-centered models of care—previously implemented by only a handful of high-performing organizations—are poised for more widespread adoption,” said Janet Marchibroda, Chair of BPC’s Health IT Initiative. “Health IT not only plays a critical role in the success of these organizations, it also enables the rapid spread of the very functions that have made these models successful, to the rest of the U.S. health care system.”

The Task Force included 24 nationally recognized and respected health system experts and leaders. Findings were based on a review of the literature and in-depth interviews with nearly 40 high-performing health care organizations. For a full list of Task Force members, click here.

Source: Bipartisan Policy Center News Release

Health Reform Saves $2.1b for 3.6m Americans With Medicare

Nearly 3.6 million people with Medicare saved $2.1 billion on their prescription drugs in 2011 thanks to the Affordable Care Act according to data issued by the Department of Health and Human Services (HHS). Savings for people with Medicare will increase over time. According to a new report issued today from HHS, the average person with Medicare will save nearly $4,200 by 2021 because of the new law.

“The Affordable Care Act is already saving money for millions of Americans with Medicare,” said HHS Secretary Kathleen Sebelius. “As we move forward, we will close the donut hole completely and save even more money for everyone with Medicare.”

The Affordable Care Act provides a 50 percent discount on brand-name prescription drugs and this year, a 14% discount on generics. Last year, it provided a seven percent discount on covered generic medications for people who hit the prescription drug coverage gap known as the donut hole, with 2,814,646 beneficiaries receiving $32.1 million in savings on generics.

In 2011, the 3.6 million Americans who hit the donut hole saved an average of $604 on the cost of their prescription drugs.

Data also show that women especially benefitted from the law’s provision with 2.05 million women saving $1.2 billion on their prescription drugs.

By 2020, the donut hole will be closed completely. The new report released today by the Department of Health and Human Services finds that this provision and other features of the health reform law will generate substantial savings for people with Medicare. Typical Medicare beneficiaries will save an average of nearly $4,200 from 2011 to 2021. People with high prescription drug costs could save as much as $16,000.

The savings are a product of provisions in the Affordable Care Act and other cost trends that:
-Decrease prescription drug costs for seniors
-Make preventive services like mammograms free for everyone in Medicare
-Reduce growth in Part B premiums (for physician services)
-Reduce growth in cost-sharing under both Parts A (hospital care) and Part B.

These announcements come after HHS announced that in 2012, Medicare Advantage premiums have fallen by seven percent on average and enrollment has risen by about 10 percent since last year. For more details on that announcement, visit

For state-by-state savings figures for donut hole announcement, visit:

For a fact sheet about donut hole savings, visit
or the report regarding savings those with Medicare will see over time, visit

Source: HHS News Release

Wednesday, February 1, 2012

Medicare Advantage Premiums Fall; Enrollment Up

Medicare Advantage premiums have fallen by 7 percent on average and enrollment has risen by about 10 percent since this time last year, HHS Secretary Kathleen Sebelius announced.

The enrollment numbers confirm projections from last September that enrollment in Medicare Advantage plans would continue to rise and average premiums would continue to fall. Average premiums have fallen from $33.97 in 2011, to $31.54 in 2012, while enrollment has risen from 11.7 million in 2011 to 12.8 million in 2012.

“The Medicare Advantage program is stronger than ever,” said Secretary Sebelius. “Premiums are down on average, enrollment is up, and thanks to the Affordable Care Act we have unprecedented new tools to ensure that seniors and people with disabilities are getting the best value out of their coverage.”

In addition to the enrollment and premium numbers, there is more evidence that the Medicare Advantage program remains strong:
- On average, there are 26 Medicare Advantage plans to choose from in nearly every county across the country;
- Access to Medicare Advantage remains strong: 99.7 percent of Medicare beneficiaries have access to a Medicare Advantage plan; and
- Since 2010, when the Affordable Care Act was passed, Medicare Advantage premiums have fallen by 16 percent and enrollment has climbed by 17 percent.

“Not only are average premiums lower, but plans are better, with more beneficiaries enrolled in 4 and 5 star plans,” said CMS Acting Administrator Marilyn Tavenner. “The Affordable Care Act has strengthened Medicare Advantage by motivating plans to improve the quality of their coverage.”

In 2012, thanks to the Affordable Care Act, Medicare Advantage plans will start receiving incentives to achieve high quality scores through the use of quality bonus payments. As an extra incentive for high quality performance, CMS is allowing Five-Star Medicare Advantage and Part D plans to continuously market and enroll beneficiaries throughout the year.

To find the most recent publicly available MA and Part D contract and enrollment data, visit:

Source: HHS News Release