Legislative and administrative activities seeking to minimize the regulatory burden on physicians are abundant. Significant changes have already occurred with the recent announcement by Tommy Thompson, Secretary of Health and Human Services, renaming the Health Care Financing Administration (HCFA) to the Centers for Medicare and Medicaid Services (CMS).
This “new” agency will now consist of three distinct centers. The Center for Medicare Management will be responsible for the traditional fee-for-service program (overseeing most physician payment policies and programs). The Center for Beneficiary Choices will focus on Medigap and Medicare+Choice programs. The Center for Medicaid and State Operations will have jurisdiction over Medicaid and the children’s health insurance programs.
Thompson pledged that the new agency will be significantly more responsive to the concerns of physicians and promised a series of administrative reforms aimed at reducing the regulatory hassles that physicians now face.
Congressional Pressure
The House Energy and Commerce Committee has launched a comprehensive Medicare administrative reform initiative and has been conducting oversight hearings in preparation for developing reform legislation. The House Ways and Means Committee has conducted its own hearings with the same purposes in mind. The Senate Finance Committee is likewise preparing to draft legislation along these lines.
Don Manzullo (R-IL,) Chairman of the House Small Business Committee, also has been using his committee as a place to highlight the unreasonable paperwork burden placed on healthcare providers. The House Budget Committee has conducted its own set of hearings on Medicare reform, and James R. Bean, MD, an AANS member, recently testified before this committee. The Medicare Payment Advisory Commission (MedPAC) is currently working on a comprehensive report to Congress evaluating the regulatory burdens of Medicare on all providers. Finally, the General Accounting Office (GAO) has also weighed in with its own reports to Congress on this topic.
Key components of Medicare that could be reformed include:
- Requiring CMS to adequately educate physicians about Medicare’s ever-changing billing rules and procedures;
- Standardizing the timing and issuance of new rules and regulations on a quarterly basis;
- Reforming CMS’ audit process by giving physicians new due process rights, including an equitable right of appeal;
- Curtailing CMS’ use of unfair “extrapolation”-a process whereby CMS assumes that one mistake on a filing indicates the same mistake has occurred on all filings to that point;
- Eliminating random pre-payment audits, absent cause;
- Reassessing CMS’ Evaluation and Management documentation guidelines project and requiring that the new guidelines be pilot tested before they are implemented;
- Reassessing the rules and regulations of the Emergency Medical Treatment and Active Labor Act (EMTALA) to ensure that they are consistent with the original intent of the law;
- Reducing the number of carriers administering the program;
- Standardizing local medical review policies (LMRPs) to eliminate inconsistent Medicare coverage policies nationwide; and
- Streamlining and reducing Medicare’s paperwork burdens.
Outlook for Reform
Regulatory reform remains a high priority for President George W. Bush and Thompson. It is clear that some sort of Medicare administrative reform will occur before the end of the 107th Congress. Perhaps the testimony of William J. Scanlon, Director of Health Care Issues for the GAO, before the House Budget Committee best highlights the challenges:
“Medicare is a popular program that millions of Americans depend on to cover their essential health needs. However, the management of the program is not always responsive to beneficiary, provider, and taxpayer expectations. CMS, while making immprovements in certain areas, may not be able to meet these expectations effectively without further congressional attention to the agency’s multiple missions, limited capacity, and constraints on program flexibility.
“The agency will also need to do its part by implementing a performance-based management approach that holds managers accountable for accomplishing program goals. These efforts will be critical in preparing the agency to meet the management challenges of administering the growing program and implementing future Medicare reforms.”
Let’s hope that all parties to this debate will take heed of this message so physicians will see some meaningful change that will help them better deliver care to Medicare beneficiaries without the hassles and frustrations of the current system.
Katie Orrico, JD, is Director, AANS/CNS Washington, D.C. Office.