March 2nd was the first time since the Truman administration that a US President has visted Savannah.  During his historic trip tour of Savannah, President Obama stopped at Chatham Steel, one of SBG’s member companies.  Mr. Bert Tenenbaum, President and CEO of Chatham Steel, acccompanied the President through on walk of Chatham Steel facilities.

We at SBG congradulate Chatham Steel on being honored to host the President during his tour of Savannah.

Here are some web sites with commentary and photos.

http://www.nytimes.com/2010/03/03/us/politics/03obama.html

http://iplextra.indiatimes.com/photo/01xz1wcfOi8T0?q=Barack+Obama

http://spotted.savannahnow.com/galleries/index.php?id=374153

Congradulations to Chatham County and our community partner - Chatham County Safety Net Planning Council - for being selected by the Association of County Commissioners of Georgia (ACCG) as one of Georgia’s 2010 Counties of Excellence. 

The Chatham County Safety Net Planning Council has been working on health issues for Chatham County’s uninsured and underinsured for a long time.  The Council oversees the only operational health information exchange (HIE) in Georgia.

We at SBG are proud to be a part of the Council and support the Council in thier efforts. 

Read the story in Georgia Trends magazine.

A proposal by Georgia’s Governor Sonny Perdue to impose a 1.6 percent “sick tax” on Georgia’s hospitals.  The Bill’s intent is to apply a ’sick tax’ on hospitals as a way to generate revenue to be used in the State Medicaid program.  An alternative funding is being offered that would raise the tax on a pack of cigarettes by $1.

Opposition to the Bill is rapidly growing across the state, including hospitals and Georgia’s Academy of Family Physicians.  This tax would cost St. Joseph’s Candler Health System in Savannah at least $4.1 million a year.

For more information you may click on the following links.

Savannah Morning News

WSAV

Atlanta Examiner

Text of the Georgia House Bill 307

Democrats clearly are not of one mind on how to proceed with health care reform (HCR) legislation as well as their overall domestic policy agenda after last week’s stunning loss in Massachusetts. In the House, liberal Democrats seem to be worried that Scott Brown’s election to the seat that Senator Kennedy held for 46 years would cause their party to shy away from a progressive agenda, while moderates cast the election outcome as evidence of the need to rein in federal spending.  Tonight, January 27^th, is President Obama’s second State of the Union address of his presidency.  It will air at 9pm eastern time on most major network stations.  Most likely his speech will provide more direction on the next steps for HCR and the domestic policy agenda for 2010.  In the meantime, below are some of the options being discussed by both parties relative to the next steps on health care reform legislation.   Please bear in mind that these are just the potential options on the table:

1)      GOP Crossover:  Democrats finish negotiations after Brown is seated, but work to obtain a 60^th vote from a Republican Crossover.

Outlook: Nearly impossible at this point.

 

2)      Ram a Bill Through Before Sen. Brown is Seated:  Senate and House Democrats could rush to finish negotiations to merge their bills, and pass new bills in the House and Senate, before Brown is seated. A new bill would take 5-10 days for a CBO report, and the political dynamics are extremely challenging.

Outlook: Highly unlikely as the MA Sec. of State has said he will seat Brown quickly.

 

3)      House Acquiesces to the Senate Version: House passes Senate-passed bill, verbatim, no changes. All the negotiations of the past month would be thrown out. The bill could be on the President’s desk for his signature with 24 hours of passage.

Outlook:  Very difficult due largely to abortion and union “deal” struck last week on the Cadillac plan excise tax issue.

 

4)      Budget Reconciliation: This means the bills must go back to Committees, many parts would be diced up under the Byrd Rule (Under the Byrd rule, the Senate is prohibited from considering extraneous matter as part of a reconciliation bill or resolution or conference report The Term “extraneous matter” is subject to considerable interpretation. The Byrd Rule is sustain/enforced against an “offending” title, provision or amendment unless its proponent can muster a 3/5 (60) Senate super majority vote to waive the rule.) and the non-tax provisions would expire after 5 years. The unions are pushing this strategy. Further, the “doc fix” will also need to be done in coming weeks.

Outlook:  Politically, very difficult but not off the table.

 

5)      Two-Bill;Two-House Strategy:  The House may pass Senate bill IF they first get a “clarifying” or “corrections” side-car bill passed to “fix” everything they don’t like in the Senate bill. This would provide Democrats the assurance they need to vote for the Senate bill.

Outlook: As of this week, this option is being looked at as the most likely scenario, though very difficult.  The caveat is that the House is being promised the opportunity to amend/improve the bill afterward through the budget reconciliation process, which only requires a standard majority but is a very tricky parliamentary maneuver (i.e the Senate Byrd Rule).

 

6)      Clean Insurance Reform Bill Only:  The House and Senate may realize the battle is over and may scale back significantly opting to push a streamlined Insurance Reform bill through the House and Senate.

Outlook:  May be a potentially viable option for Democrats, as they shifted their rhetoric over the summer from “Health Reform” to “Health Insurance Reform”

 

7)      HCR Dead:  No bill passes in the year 2010. Democrats may decide to take a break from health reform and focus on jobs and the economy.

Outlook:  Will know more as time progresses and political fallout is realized and Reid, Pelosi and the White House revisit their priorities.  (Source: US Chamber; CQ Health Beat)

(NBCH Governmental Affiars update January 27, 2010)

In an interview on ABC World News (1/15, lead story, 6:00, Sawyer), President Obama criticized the crafting of the congressional healthcare reform measures, admitting to “a legitimate mistake that I made in the course of the year, and that is that we had to make so many decisions quickly in a very difficult set of circumstances, that after awhile, we started worrying more about getting the policy right instead of getting the process right. … I think the healthcare debate, as it unfolded, legitimately raised concerns, not just among my opponents but also amongst supporters, that we just don’t know what’s going on. And it’s an ugly process and it looks like there are a bunch of backroom deals.” Pressed about “these deals with Nebraska, with Florida,” Obama replied, “Let’s hold on a second, Diane. I think that this gets into a big mush. So let’s just clarify. I didn’t make a bunch of deals, alright. There is a legislative process that is taking place in Congress.”

(From the NAHU Newswire January 26, 2010)

I missed an opportunity today at our coalition’s annual Board meeting to thank my staff.  Sometimes I am so wrapped up in the agenda and business at hand that I forget that I need them and would not be where I am without them.  My staff is comprised one person, Kristen, who has been with me since I became the Executive Director.

So to Kristen, I salute you and recognize that your work is what makes me shine.  Thank you.

Editorial from Erica Massey from the Self-Insurance Institute of America

 As healthcare reform reaches its possible endgame, two powerful interest groups have pulled out the “long knives” and directing them toward self-insurance.

The National Association of Insurance Commissioners (NAIC) sent a formal letter to Congressional Leaders this week expressing their concerns with the healthcare reform bills. They cite as negative consequences that the reform might bring, are that some of its provisions might encourage more businesses to self-insure in order to avoid costlier coverage that would result from the bill. They express that an increase in the self-insurance marketplace will be “devastating” for businesses, employees and healthcare providers.

The self-insurance industry was also attacked yesterday by the President of the America’s Health Insurance Plans (AHIP), Karen Ignagni. In order to help fund the proposed reforms, the House healthcare reform proposal assesses fees on commercial insurance carriers as well as self-insured plans. SIIA was successful in keeping self-insured plans from having to pay these fees in the Senate’s version. AHIP is arguing that self-insured plans should be paying these fees just as their plans will have to. AHIP is claiming that as a significant number of Americans are covered through self-insured plans, these plans, and their employer sponsors, should be contributing to the funding as well.

While these are not new threats and while they are not from new advisories, they should not be taken lightly by our industry. These efforts once again show that we must continue to educate to our elected-officials about self-insurance and defend against these baseless claims.

SIIA Urges the Self-Insurance Industry to Make our Message Heard
SIIA urges all those in the self-insurance industry interested in preserving the way we do business and the benefits we provide to 75 million Americans covered by self-insured plans, to use the resources provided in SIIA’s Grassroots Toolkit and contact their Members of Congress to voice our message.

The threat to the self-insurance industry and the employer-based system under which we operate in has never been more significant. Now is the time to voice our powerful and unified voice to politicians in Washington that we will not stand for any proposals that would cause significant damage to our industry and to those lives we cover.

SIIA’s Grassroots Toolkit can be found by clicking here. If you have any questions, or would like any further information, please contact SIIA’s Government Relations office.

Join SIIA and Let Your Voice Be Heard
SIIA’s 24th Annual Legislative and Regulatory Conference, March 10th-12th in Washington, DC is your opportunity to hear directly from the policy-makers and experience the political process first hand. Participate in SIIA’s popular “Walk on Capitol Hill” and let your voice be heard! For more information click here or call SIIA’s Government Relations office.

(Following is an editorial written by Greg Scandlen from the Heartland Institute.)

During the Bolshevik revolution Lenin reportedly said that capitalists would sell him the rope by which they would be hanged.
 
More recently in 1971, Chicago’s Saul Alinsky wrote in Rules for Radicals, “I feel confident that I could persuade a millionaire on a Friday to subsidize a revolution on Saturday out of which he would make a huge profit on Sunday even though he was certain to be executed on Monday.”
 
Alinsky is, of course, the radical community organizer that Barack Obama studied when he was organizing in the same city twenty years later. The lesson was not lost on him.
 
The most remarkable thing about the health reform battle of the past year is how all the powerful interest groups have jumped on the bandwagon to their own execution.
 
In some cases there are short term gains that perhaps have addled their thinking, but in other cases there is no gain whatsoever for their members, but still they have supported, or at least not vigorously opposed, the legislation.
 
– Greg Scandlen

AARP First, there is AARP. This whole bill is “paid for” through two sources - about half a trillion in tax hikes, and another half trillion in Medicare cuts. AARP has traditionally been a vehement opponent of Medicare cuts of any kind, but not this time. Why? Because much of those cuts come from cutting Medicare Advantage.   Medicare Advantage enrolls 10 million elderly and provides such generous benefits that these folks do not have to buy “Medicare supplemental” coverage to fill in the many holes in regular Medicare. Yet AARP makes a fortune selling MediGap coverage. Indeed the whole organization is nothing more than a marketing scheme for selling this coverage. Getting rid of Medicare Advantage will create ten million more people for AARP to sell coverage to.   So, who cares if the elderly are hurt? Who cares if their care is rationed and their benefits cut? Not AARP. In fact the less Medicare pays, the greater the need for AARP-endorsed Medicare Supplemental coverage. Take it to the bank.   SOURCE: CBS News AARP Press Release

 

The American Medical Association (AMA) Here again, the AMA has violated every principle it ever stood for. And not just principles, but the direct financial interests of its physician members. The official policy of the AMA is to fix the “Sustainable Growth Rate (SGR)” cuts in Medicare payments. The official policy is opposed to “Pay For Performance” schemes. The official policy is to protect the ability of physicians to practice medicine.   Yet all of these things have been thrown out the window, and the AMA still provides full-throated support to this legislation. Why? Well, for one thing the AMA’s membership is so reduced (it now represents only about 20% of all physicians) that the “real” doctors, i.e., the ones who actually see patients and rely on Medicare for part of their income, are no longer influential in the organization. The rest - corporate medical directors, professors in medical schools, medical students, etc. - aren’t worried that Medicare payments are scheduled for a 21% cut in a few months.   But there is a deeper reason, as well. As the Chicago Tribune reports, the AMA no longer gets most of its income from membership dues, but from having “the exclusive rights to the medical billing codes that doctors are required to use when they submit bills to insurance plans.” This is granted to it by the federal government and started with Medicare billing but was expanded to include private insurers as the result of the standardized billing required by HIPAA. So, the AMA is in fact a “partner” with the federal government. Any expansion of federal health care is a boon to AMA finances.   So, who cares if physicians are hurt? Who cares if their practices are dictated by bureaucrats and their pay is cut? Not the AMA. In fact, the more the federal government does, the richer the AMA gets. You can take that to the bank, too.   SOURCE: Chicago Tribune

 

The Pharmaceutical Research and Manufacturers of America (PhRMA) In one of the most amazing turnabouts ever in Washington, PhRMA went from full-throated opposition to ObamaCare to full-throated support - in just a matter of months.   On November 14, 2008, just a week after the election, the Washington Times reported that, “The nation’s largest pharmaceutical lobbying group is preparing a multimillion-dollar public relations campaign to tout the importance of free-market health care and undercut an expected push by the Obama administration for price controls of prescription drugs.” The article went on, “the stakes are especially high for drugmakers, which stand to lose as much as $30 billion in revenue if President-elect Barack Obama’s plan to let the federal government negotiate Medicare drug prices is implemented.”   Just nine months later, in August 2009, the publication Medical Marketing & Media was reporting just the opposite - “PhRMA will launch a big advertising push for healthcare reform later this week, with TV spots airing in key states and on cable channels nationally.”  The story continues, “News outlets including The New York Times and the Associated Press put spending on the ads in the range of $150 million - a figure that PhRMA SVP Ken Johnson called speculative.”   What happened? The story quotes PhRMA president Bill Tauzin, “We were assured (by the White House): ‘We need somebody to come in first. If you come in first, you will have a rock-solid deal.’”   Apparently, PhRMA agreed to $80 billion in cuts aimed at filling the Medicare drug program’s “donut hole” and to spend $150 million in advertising to support Obama in exchange for a pledge that the White House would oppose price controls and re-importing drugs. This was probably the best deal of the lot. There was a direct quid pro quo and each side got what it wanted - for now.   Problem is, of course, that these deals don’t last. Deals with the Devil never do. There is already pressure from the left to scuttle this deal, as witnessed in a report that ran on Air America that called this deal the “absolute fascist nightmare.” And meanwhile, the rest of us are left in the dust, subject to all the mandates, taxes, and penalties of the rest of the legislation.   SOURCE:   November 14, 2008 August 10, 2009 Air America

 

America’s Health Insurance Plans (AHIP) The health insurance industry has become the poster child for everything that is wrong in American health care. This is not fair, but it is not entirely wrong, either. It is true that third-party payment is the cause of most of the problems we have. This underlying reality was aggravated in the 1990s with the industry’s misadventure with managed care. The industry squandered any good will it might have had with the public by becoming the force that stepped between patients and doctors. It quickly became the most reviled industry in the country.   So it did not have a lot of cards to play when this new challenge came along. It has been trying to cut deals to survive. It has offered to give up most of its controversial practices in exchange for a guarantee of new customers. But like most political deals this does not result in very good public policy.   In fact, most of what the industry does is entirely defensible. Risk-based rating and medical underwriting are important tools in this business. The real problem for the industry is that it has become too intrusive in medicine. Insurance is a financial service, not a medical service. But the people who run the companies have gotten confused about their mission. This is the lingering effect of managed care.   There was hope that, with the advent of consumer driven care, the industry would return to its core competency - pooling risk and adjudicating claims. But that would have required a considerable downsizing of the companies. They might have been smaller, but more efficient and more profitable. But power is hard to surrender once you have it. The industry was not willing to step away from managing care to focus on financing care.   So now it has surrendered. It is content to become a highly regulated public utility as long as it gets to stay in business. It has already given up on underwriting, and has even accepted price controls and minimum loss ratios. In return it wants no “public option” and a strict mandate on individuals to buy what it sells. But it has already lost on the strict mandate. The Senate bill has a weak mandate that will invite the young and healthy to stay out of the insurance market until they become sick.   It is certain that this legislation will dramatically raise premiums and will fail to cover many more people. So, in a few years the stage will be set for a complete government takeover. The argument will be that we tried using the private sector and it failed. But by then AHIP leaders will be retired and living in luxury in Italy, so who cares   SOURCE: Associated Press Market Watch Wall Street Journal

 

National Association of Health Underwriters (NAHU) The biggest puzzle of this season is NAHU. Now, many agents and brokers have been saying for many years that people should be required to buy coverage and that insurers should stop denying applicants. It is an understandable sentiment. It would certainly make the job of an agent easier. But there is a price to be paid.   Whenever reformers talk about cutting administrative costs, what they really mean is cutting out the middleman. That is the low hanging fruit of administrative costs. In this case, with the loss ratio requirements and the insurance exchanges, there is virtually no role for agents and brokers (known collectively as “producers’) and no money to pay them. Indeed, the job of the producer has been made so easy, there is no longer a need for them.   NAHU has sacrificed a lot to get its seat at the table. But it has very little influence, so I’m not sure what good it has done. On the eve of the Senate cloture vote, NAHU president Janet Trautwein sent a strongly worded letter to the Senate complaining about what is in the bill. This was literally just hours before the vote. Kind of late in the game.   One of her biggest complaints was that the bill was insufficiently punitive! She wrote, “Under this legislation, millions of healthy individuals will likely find it more financially advantageous to forgo coverage until they are sick and then utilize the guarantee-issue protections to temporarily obtain coverage and then drop it again.” That is undeniably true. It is in fact exactly what I plan to do if this thing ever goes into effect. But her remedies are draconian. She would: Make financial penalties “in line with the actual cost of coverage.” Apply late-enrollment fines “in addition to other penalties for those who have more than a 63-day break in coverage.” Have an annual open enrollment period so people cannot just come in and out at will. Require employers to help with enforcement through automatic enrollment. Require employers to reveal to the government anyone who opts out of the employer’s plan. “Requir(e) coverage verification as a condition of receiving services at facilities like the state department of motor vehicles, schools and hospitals.” Now this is a peculiar way to represent the interests of one’s clients. But NAHU doesn’t like to be criticized. The last time I questioned its strategy, they complained to my employer, and then told me to stop sending this newsletter to anyone employed by NAHU.   It’s a pity. I have always supported the role of brokers and defended them against attacks by single-payer advocates, over-zealous regulators, physicians, hospital administrators, and other critics. I think they serve an important role, especially with small employers who don’t have the time to become well informed about their coverage options. I think it’s tragic that NAHU is letting them down.    Source NAHU communications

Effective January 1st 2010, Medciare will no longer reimburse physicians for consulting services (CPT codes 99241 through 99255).  Physicians will have to adjust their coding to reflect Medicare’s new rules. 

There is a good article on Medical Coding Pro’s blog that will help.

Or you can read the official Medicare Claims Processing Manaual changes.

SBG is evaluating these changes and will be incorporating adjusted fees in our next Fee Schedule update.  The changes will impact consulting codes, admission codes,  and the standard office visit codes.

There is an e-mail circulating that states that the “Investor Business Daily” published some health statistics from the United Nations International Health Organization.

It is a hoax; a fake.

There never was an article in Investors Business Daily and there is no such organization as the UN International Health.

[Below is a letter received from Chris Harrison, Region 5 of the National Association of Health Underwriters.]

Good evening Region 5 members, I know many of us are concerned about what has passed the Senate over the past several days. We are equally concerned about how this will affect us as “agents/brokers/consultants”.

I can tell you that all of us have been concerned about the 11th hour deals that would be made and what provisions would be added. While many of them are troublesome, we (NAHU) have been successful in many of our efforts. We have mitigated some of the items that remain troublesome and will continue to work through our legislators who are, or will be, ultimately part of the Conference Committee to merge the House and Senate Bills. Janet Trautwein has prepared a short video to share with you are primary concerns and action plans that we the members can take. I encourage you to listen to it on the You Tube site. 

Like many of you, I will be watching the next several days and weeks with great interest. This fight is far from over; the Conference Committee is still a venue for us to find additional success. I wish each of you a Happy Holiday season and hope you will continue to stay tuned in this lively debate.

Sincerely, Chris Harrison NAHU Region 5

Link to the letter NAHU has prepared for Congress with thier concerns. 

[It should be noted here that some provisions of the Senate bill will go into effect as early as 2011.  Brokers are concerned that the health exchange and requirements for a high loss ratio will lessen their commissions or eliminate them entirely.   They are also worried about individual product elimination and the requirements for a employer voucher system for those employers who opt out of the employer fully funded plan.]

Chatham County Safety Net Planning Council is on the fast track with the build out of its Chatham County Health Information Exchange . CCSNPC chose its health IT vendor, Orion Health, in October and anticipates the pilot project going live in March 2010.

CCSNPC was founded in 2004 by the Chatham County Commission and includes providers, government, advocates, employer representation, funders and consumers to help address the uninsured and underinsured problems in the county, said Patricia Lavely, chair of CCSNPC’s IT Consortia and senior vice president and CIO of Memorial University Medical Center, one of two hospitals systems in Savannah. Of the more than 251,000 residents in Chatham County (2008 data), between 44,000 and 60,000 are uninsured – 24 percent of the population at the high end, she said. The state of Georgia’s uninsured rate is between 17 to 18 percent of the population. Both percentages are above the national average, she pointed out.

Access and capacity are problems for the uninsured people, who typically go to the emergency departments (EDs) for healthcare, Lavely said. The pilot HIE, which will connect Memorial University Medical Center’s ED and one Federally Qualified Health Center (FQHC) in the county, is expected to decrease costs of duplicative and unnecessary tests, as well as help provide appropriate care in the right setting. “We’re hoping to intervene and get patients to the appropriate venue for their healthcare,” she said.

The project has come a long way. The Georgia Dept. of Community Health chose CCSNPC’s HIE as one of three state demonstration projects. One of the major challenges was the lack of EMRs among the providers. “You need EMRs to be able to exchange clinical data. We needed to ensure that all parties have the capability to exchange data,” she said. The free clinics were able to get EMRs through grants, and the FQHC purchased one with their funding. Thus far, four of the six clinics have EMRs and are ready to exchange data, Lavely said. “It took creativity to bring EMRs to these clinics,” she said. Lack of IT support created a challenge in pulling it all together, but through the grants CCSNPC was able to implement new secure interfaces, she said.

When the infrastructure is in place, providers will be able to exchange data, message and participate in public health recording through a secure Web-based portal. The infrastructure will also have a master patient index and record locator service.

CCSNPC chose a central data repository to exchange data because it’s the only infrastructure model that allows access to outcomes data, which will enable providers to impact population health, Lavely said. A central data repository model requires consensus on governance and privacy and security policies, among other policies. Historically, policy-making is major obstacle for RHIOs and HIEs. But it hasn’t been a problem for CCSNPC. “We have been in place since 2004 to address the healthcare issue,” she explained. “We have already worked through the barriers for other issues. We already brought the competitors to the table. This has paved the way for our health information exchange discussion. It’s made a difference.”

To date, the Chatham County HIE has been funded by state grants and a Health Resources and Services Administration grant to purchase equipment and software, which covers funding for the next 12 months, she said. The business model has not been developed because CCSNPC wants to establish the HIE’s value to the community based on usage, Lavely said. The first goal once the HIE is up and running is to measure the effectiveness of the pilot. Once that is done, CCSNPC will solicit funding from stakeholders to keep it going.

“We’re here for a common goal – ensuring access for the uninsured and underinsured, and improving patient care and the quality of healthcare for consumers,” Lavely said. The HIE pilot would serve the county, but CCSNPC hopes to include all regional healthcare providers, including the remaining safety-net providers, regional hospitals, private providers and public health department.

http://www.nhinwatch.com/news.cms?newsId=5152

The status quo in health care is unacceptable – with high and rising costs, inconsistent quality and millions uninsured, we agree that change is essential.  There is growing consensus that changing how we pay for health care must be a central element of reform.  The current fee-for-service model isn’t working, and we have an opportunity to address that problem as we reshape the nation’s health care system. Current proposals include many new models of payment that reward better health care outcomes and foster efficiency.  These models are essential if we are to slow the rate of growth in costs while also improving care.  As the reform debate enters the important window when compromises are being made and potentially final details are being negotiated, it is more important than ever to be sure that any ultimate reform package includes not only substantive payment reform, but also a clear path to harmonize public and private payment policies.

 

Yesterday, the New England Journal of Medicine published an article — Payment Reform: The Need to Harmonize Approaches in Medicare and the Private Sector — co-authored by Dr. John Tooker, CEO of the American College of Physicians, which represents 129,000 internal medicine physicians and students across America, Dr. Robert Berenson, who knows about payment as a senior staff with the CMS’s predecessor, as a practicing physician and as an astute public policy participant, and myself representing both those who pay for and receive health care.  This article was in large part the product of dialogue we and others had at the ABIM Foundation Forum in August of this year and productive follow-up discussions organized by the Foundation.  We are grateful to many for their contributions to the ideas reflected in this article and look forward to continuing this work through the Center for Payment Reform, which brings together consumers, clinicians, employers, labor and more to change payment to reward better value instead of volume. 

 

In this article, we highlight a handful of simple but critically important actions that need to be taken to harmonize payment approaches among public and private purchasers.  These provisions are reflected in the current legislation and in particular in some of the amendments recently proposed by a group of freshmen Democrats in the Senate.  But, as you know, details matter and the process is far from over.

 

Because of that, I encourage you to continue to add your voice to the important issue of not only changing payment to foster delivery reform, but to be sure that these changes align public and private payers.  To that end, you can:

·         Share this information and the NEJM article with your colleagues and others, noting your agreement with the role that payment plays in shaping delivery;

• Communicate to members of the Senate, the House and the Administration your belief in the importance of this alignment and your support for their taking the simple steps reflected in this article; and
• Work with payers outside of Medicare – both other public payers and private plans at the national, state and regional levels – to engage in active partnerships with one another that seek to align their efforts to promote higher value.

 It is critically important that health reform include the alignment of public and private sector payments.  We have a unique opportunity to create a new delivery system and improve the quality and value of health care in America.

 

Sincerely,

 

Peter V. Lee
Executive Director, National Health Policy
Pacific Business Group on Health
221 Main Street, Suite 1500

San Francisco, CA 94105

Phone: 415-281-8660

E-mail: plee@pbgh.org

 

 

 

 

 

                                                                                        

 

Georgia Receives HIT ARRA Funding

State First in Region to be Awarded Funds

 

ATLANTA – U.S. Health and Human Services, Centers for Medicare and Medicaid Services (CMS) awarded the Georgia Department of Community Health (DCH) $3,171,328 to create a State Medicaid Health Information Technology Plan (SMHP) and complete initial planning activities related to promoting the adoption and utilization of electronic health records (EHR) among Medicaid providers.  The funding is made available through the American Recovery and Reinvestment Act (ARRA) Medicaid incentive program.

 

The SMHP will outline Georgia’s strategy for providing payment incentives to Medicaid providers for purchasing an EHR system and re-engineering their practices to maximize the use of health information technology.  The plan will also define the reimbursement methodology for Medicaid providers who adopt EHRs in accordance with the meaningful use criteria.  The plan will enable Georgia to achieve its overarching goal of ensuring every Medicaid provider has access to an electronic medical record system and the capacity to participate in an electronic health information exchange (HIE).     

 

Georgia is the first state in the region and the fourth in the nation to receive such an award from CMS. 

 

“DCH is ready to hit the ground running with the resources provided by CMS for the development of our state’s Medicaid Health Information Technology plan,” said Dr. Rhonda Medows, Commissioner, DCH.  “This plan will align with each of the state’s health information technology goals, including the development of a state health information exchange, the launch of Georgia Healthe Connect – a HIE that provides access to an EHR to Medicaid providers who desire software as a service, and the work of the Regional Extension Center.”

 

Georgia requested funds to:

• Plan the Medicaid incentive payment program as outlined in section 4201 of the 2009 ARRA and further described in the Letter to State Medicaid Directors dated September 1, 2009, including tracking meaningful use of certified EHR technology by Medicaid providers;

 

• Plan for the Department’s capability of providing management and oversight of the incentive program, including routine tracking of meaningful use attestations and reporting mechanisms;

 

• Plan initiatives that encourage the adoption of EHR technology certifiable in accordance with CMS criterion (to be determined) to promote health care quality and the exchange of health information among Medicaid providers and members;

 

• Plan that Georgia implements a program that is in support of the applicable laws and regulations governing HIE, while ensuring the privacy and security of the data provided by the data exchange partners; and

 

• Plan a comprehensive program that aligns the Medicaid incentive program with the existing state HIT initiatives and new activities funded by ARRA.

 

DCH will leverage existing relationships across the health care and HIT community to ensure that stakeholders are engaged in the development of HIT in Georgia. 

 

For more information about this and other Georgia HITT Initiatives, visit www.dch.georgia.gov/gahitt.   

FOR IMMEDIATE RELEASE   

December 7, 2009                             

                                   

CONTACT: Lisa Marie Shekell 404-657-9118

 

We as citizens and employers are already paying for the health care of the uninsured.  We pay for the coverage today but it is hidden in our insurance premiums and reimbursements to providers.  Families USA estimated that to be at least $1,000 per family.  So expanding Medicaid to bring in more of the uninsured could be another way of paying for their coverage.  However I fear that the expansion will not lower our premiums and it will not lower reimbursements.  As I was told; “It is easy to give someone something but you can never take it back.”

There are several issues.  One is that expansion of Medicaid will not bring all of the uninsured into a health plan.  There are large numbers of uninsured who refuse available coverage. 

The second issue is that Medicaid reimburses providers significantly below the cost of providing the service.  The last numbers I saw showed that Medicaid reimbursed at around 75% of costs.  This gap between cost and reimbursement is where we as covered lives pay extra to the insurance companies and providers.  By expanding the number of lives in Medicaid the total amount of unpaid costs gets higher.  Our premiums will not go down.  The providers will ask for more money from paying patients and insurance companies to offset the gap.

Third - We cannot forget that Medicaid is a State program funded by a combination of State and Federal funds.  The funds come from our taxes.  An expansion of the program requires an increase in taxes.  As I stated at the beginning, we already pay for this care.  I do not believe the increased taxes will ever replace what we spend now in premiums because our premiums will not be adjusted.  We will be told that the monies were absorbed pay administrative costs, or inflation, or something else, we will never see our premiums go down.  We will be paying both; increased taxes and higher premiums.

As a societywe need to have a serious discussion about how we cover the poor, how it is being paid for, what should be covered, and what is a reasonable fair price for that service. 

I wrote this is response to a editorial column that appeared in the December 3rd issue of the Savannah Morning News, Georgia wins if Medicaid expands.