Dr. Don Berwick’s Appointment to CMS in Danger

Last July, President Obama appointed Dr. Donald Berwick to serve as the Chief Administrator of the Centers for Medicare and Medicaid Services (CMS) through a recess appointment, meaning the president is putting Berwick in place while Congress is on recess.

However, Dr. Berwick still needs Senate approval eight months later and Republicans have gathered enough support to block his Senate confirmation. This shock came with a letter signed by 42 Republican Senators. This number is large enough to defeat his confirmation because 60 “yes” votes are required to confirm Dr Berwick. This majority in the Senate has called on the administration to withdraw Dr. Berwick’s nomination citing his past statements about healthcare rationing, and his lack of experience managing an organization of CMS’s size disqualify him.

Last Tuesday, Berwick said that the administration has sufficiently gone to bat for him as Republicans make him a central political target for their opposition to the healthcare reform law enacted last year.

“You may have seen a response from the White House a few days ago,” Berwick told reporters after a speech at an America’s Health Insurance Plans conference. “It was positive. I’m very grateful for that response.”

After the Senators sent the letter, White House spokesman Reid Cherlin said the administration would not withdraw Berwick’s nomination.

“The president nominated Don Berwick because he’s far and away the best person for the job, and he’s already doing stellar work at CMS: Saving taxpayer dollars by cracking down on fraud and implementing delivery-system reforms that will save billions in excess costs and save millions of lives,” Cherlin said in a statement to the New York Times.

Berwick’s past statements of support for Great Britain's National Health Service and his call for "rationing with our eyes open" created controversy when he took the lead at CMS, which manages about 100 million individuals. 

Nothing  further has been heard on a possible confirmation hearing with the Senate Finance Committee.  Dr. Berwick stated he is willing to talk with any senators who signed onto last week’s letter.

President Obama re-nominated Dr. Berwick at the end of January. His recess appointment allows him to serve through the end of this year.

Changes in the industry continue to be opportunities for Merrill.  As individuals come and go in the political arena, we know we must adapt quickly to these moves and look for methods of strengthening and improving communication to our clients and their membership. Working together to inform one another of changes will help us remain informed and progressive thought leaders.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Health Reform Legislation Threatens Mini-Med Plans

If there has been one clear victim of the new health plan regulations, Mini-Med Plans are it. Last year when the new MLR percentages became reality, hundreds of Mini-Meds began seeking alternative measures to survive. HHS has provided a solution for 1,040 such plans. Out of all the Mini-Med Plans that applied, 94% have been granted a waiver, allowing the plans to be considered exempt from the new law. The exemption lasts only for one year, but is renewable until the full weight of the reform falls in 2014.

The waivers are required because the Mini-Med Plans, which provide care for over 2.6 million people, do not meet the minimum annual dollar limit on essential benefits as outlined in the reform legislation. This limit starts at $750,000 in 2011, increasing to $2 million in 2013. By 2014, the law states that there is to be no annual limit on essential benefits.

Mini-Med Plans cater to low-income or part-time workers, who often do not qualify for more expensive plans. Unless the reform legislation is re-written to account for these smaller providers, 2014 will see the end of Mini-Meds, and those employees will be forcefully folded into the government-created health exchange planned for 2014.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Will the new Budget Leave CMS in Trouble?

The national deficit is spiraling out of control; this is common knowledge. However, with the President’s delivery of his new budget, much conversation has surrounded his potential cuts and investments. Because much, if not all, of the low hanging fruit has been picked, the choices surrounding reducing the deficit are enormously tough now.

In reviewing the high level line items from the House Appropriation Committee's 2011 CR Reductions, I quickly scrolled to CMS’s budget (page 14) to peruse how our friends made out in the budget decision making process. With a net budget change of $25.9 million, CMS did well compared to other agencies within the Federal Government's domain.  However, the change only comes in only two categories: Health Reform-Affordable Care Act (full on-boarding) and Research, Demonstration and Evaluation.  Other areas such as Medicare Contract Reform remain neutral.

One interesting side note is all Earmarks have been removed from CMS’s budget and overall throughout the budget in totality. Is this a means for the Executive branch to fully implement health reform legislation with little interference or is Congress self governing with disclosure of names and family ties with companies on earmarked monies? I suggest time will tell and it most likely is a combination of the two.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Clarity of Health Reform

The debate rages on regarding health reform and the focus has now shifted to the constitutionality of the legislation. A Virginia judge ruled the individual mandate was unconstitutional and a Florida judge ruled the entire legislation was unconstitutional. This has sparked the 26 states included in the fight against the health reform legislation to withhold from implementing the act. 

Such states as Alaska have openly commented they will not enact the legislation but begin developing their own plans for health reform within their state. Gov. Sean Parnell said the state would pursue lawful, market-based solutions of its own. That includes planning for a health insurance exchange, meant to offer a choice of health plans.

This action compelled the White House to quickly respond stating while the Virginia and Florida judge have sited unconstitutionality of the law the law must not be upheld and implementation must continue. 

The main theme cited was the cost savings associated with the Medicare payment reform on 100 million Medicare claims that are processed each month. As the constitutionality of health reform continues to be at the forefront it appears only a ruling by the Supreme Court can conclude the acts fate.

For more information, read the Associated Press article on the topic here and to learn more via webinar, click here.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Will Healthcare Reform Lead to Improved Marketing Communications?

As expected, the Healthcare Reform package has triggered the tightening of CMS regulations and disclaimer notations in the 2011 Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) documents for Medicare Part C and Part D plan sponsors. Plans must adhere to these changes and not modify these standardized documents except as noted in the instructions and allowed by CMS.

These changes to the ANOC/EOC are just the tip of the iceberg, as mandated communications are predicted to become more prevalent and standardized with the passing of Healthcare Reform. Plans will need to evaluate how they’re positioned to manage these required communications. Does your data to produce the communications come from disparate sources? Do you have adequate staffing to handle the increased workload? Does your organization have access to the approved templates? What happens if your membership dramatically increases?

With regulatory bodies vowing to closely monitor the accuracy of these communications, Merrill Corporation sees this as an opportunity for organizations to reconsider their marketing communications strategies. Identifying a partner who can help streamline the execution of these mandated communications, ensuring accuracy, timeliness and adherence is a necessity for success. Merrill is equipped with the latest ANOC/EOC templates, and our unique knowledge of the evolving regulations will provide your organization with 100% compliant communications.

Communicating the Healthcare Reform Bill

As a continuation on the brief synopsis we supplied on last week’s blog on the Healthcare Reform Bill, we wanted to share some additional components of the law, but also share ideas on how to convey the information to the public.

There have literally been thousands of articles written over the past week on different aspects of the legislation. I've been reading many of them for both personal and professional reasons to learn about the law, review the different opinions, and most importantly, research the best ways to communicate it. I found that this one which discusses the most well-known changes that will take effect either immediately or eventually, as well as a brief description on some of the lesser known components of the bill, including:

Transparency in Insurance Companies

• Insurers must now reveal how much money is spent on overhead

New Insurance Plans must include Preventative Care

• New plans must cover checkups and other preventative care without co-pays. All plans will be affected by 2018

Deductions for non-profit organizations

• Non-profit organizations will be required to maintain a medical loss ratio -- money spent on procedures over money incoming -- of 85 percent or higher to take advantage of IRS tax benefits

Encouraging Investment in New Therapies

• A two year temporary credit (up to a maximum of $1 billion) is in the bill to encourage investment in new therapies for the prevention and treatment of diseases

Strengthened Fraud and Abuse Checks

• New screening procedures will be implemented to help eliminate health insurance fraud and waste

Medicare Expansion to Rural Areas

• Medicare payment protections will be extended to small rural hospitals and other health care facilities that have a small number of Medicare patients

Customer Appeals Process

• Any new plan must now implement an appeals process for coverage determinations and claims

Of the many articles I’ve read, this is an example of one that not only presents the key information that different segments of the population need to know (with the potential to expand on it in the future), but as a communications professional, an example of method that organizations should consider when developing their own collateral on behalf of their clients.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

The Real Debate in D.C. (Part 2)

Last week, we discussed the difference between the Bipartisan Summit and other, less publicized but more comprehensive events, such as the Managed Healthcare Business Forum.

As a follow-up, let's talk about some of the outcomes. There has been a great deal of coverage on the event with elected officials, but none on the other. So, here is first-hand account on some of the key topics discussed:

Health Reform: The discussions were much like what was happening across town. What are the next steps? Where do we go from here? What should we expect from our regulatory bodies and the current administration? The truth is that much is known and yet unknown at this point. It is expected by most that some type of health reform will be developed this year. However, the size, scale and price tag remain a mystery.

Streamlining Cost and Quality of Care: Cost reductions and the management of costs are at the forefront of all discussions. Being creative is essential, thus newer ways to incent (i.e. work with) providers are emerging, such as payment programs and quality metrics to determine performance within their patient base and to their peers. Most would see this as the old standard capitation methodology with a twist. However, when you delve deeper, you can see the potential cost savings and the new horizon for quality metrics reporting, monitoring and performance.

Health and Wellness of the Membership Base / Moving Health and Wellness to the Next Level: Health and wellness of our membership continues to be a key to any solution worth implementing, and therefore new ways to carve out components of our membership and incent them to actively participate in wellness campaigns is on the horizon more so now than ever before. There are two basic reasons:

1. To enhance/improve a members overall quality of life.
2. To streamline/enhance cost savings.
   

Examples of ways to accomplish this were discussed, including how to develop customized, well-rounded plans that would allow individuals to potentially lower their premium costs if utilized. So, if a member had diabetes, they would be in a plan specifically designed for them with tailored programs to facilitate education, wellness, and healthy lifestyle habits that would not only benefit them, but in a small way, help the industry become more efficient.

Service: This concept continues to be a major separator in the playing field. While price and benefits continue to be the top components, service is a close second. With a competitive price in the market place, service will be the key component that separates plans. Members are looking for "first call resolution" (as opposed to be being transferred multiple times) and a one-stop shop for answers. Those that can perfect (or come closest to) a model in which a single phone number can result in a live body that can handle all their needs will have a leg-up on competitors.

The event provided all that attended with an abundance of information, with the added benefit of zero television cameras, so ideas could be shared without 'post-event wrap-up commentary.' The next step is the hardest, though. We need to take these ideas and philosophies back to our respective corners of the world and turn them into solutions.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

The Real Debate in DC

In the future, we may look back at February 2010 as a key month for healthcare. There is significant news being generated on almost a daily basis, including the potential reorganization of the CMS office and HHS's repot on organizations reporting breaches of healthcare information.

While we will cover these topics in future posts, it is imperative that we address the event in D.C. this week, which will include discussion on healthcare by some the leading experts in the field.

No, not the Bipartisan Summit. I’m referring to the lesser promoted, but more educational, Managed Healthcare Business Forum.

While President Obama and legislators will be holding a televised forum on healthcare reform and how to make it more accessible and affordable to more people, true insight on the healthcare issues will be made at a similar event that is happening in D.C at the same time.

The Managed Healthcare Business Forum will bring individuals from across the country together to learn about best practices from people that live-and-breath the healthcare industry. It will include keynotes from Manitoba Blue Cross CEO Andrew Yorke and Kaiser Permanente Senior Vice President Christopher Ohman; insight into how state governments are dealing with the administration and implementation of healthcare guidelines; and workshops covering automated health information networks and next-generation network contracting.

We recommend you watch the bipartisan debate on the numerous news stations and/or websites that will stream it. There will be information shared that is important, including remarks from the President and party leaders, followed by an “open and moderate discussion on four critical topics: insurance reforms, cost containment, expanding coverage, and the impact health reform legislation will have on deficit reduction.” While these are key policy points that are in need of decisions, they are too broad to matter to the average person, and because of the players and politics involved, it is nearly impossible to get any specific results on any issues that will truly affect the public. To get honest insight on topics that really matter, look into outcomes of the event that will be happening across town.