Obama Administration Delays and Simplifies Rules on Health Care

"As we implement this law, we have and will continue to make changes as needed. In our ongoing discussions with businesses we have heard that you need the time to get this right. We are listening. So in response to your concerns, we are making two changes.  

"First, we are cutting red tape and simplifying the reporting process. We have heard the concern that the reporting called for under the law about each worker’s access to and enrollment in health insurance requires new data collection systems and coordination. So we plan to re-vamp and simplify the reporting process. Some of this detailed reporting may be unnecessary for businesses that more than meet the minimum standards in the law. We will convene employers, insurers, and experts to propose a smarter system and, in the interim, suspend reporting for 2014.

"Second, we are giving businesses more time to comply. As we make these changes, we believe we need to give employers more time to comply with the new rules. Since employer responsibility payments can only be assessed based on this new reporting, payments won’t be collected for 2014. This allows employers the time to test the new reporting systems and make any necessary adaptations to their health benefits while staying the course toward making health coverage more affordable and accessible for their workers.

Click here to read the complete announcement: 

Proposed Medicare Payment Reductions Will Impact Workers' Compensation Costs

A government Medicare advisory panel reported on Friday that sweeping changes should be implemented to reduce increasing medical costs, including higher costs associated with hospital purchased physician practices. The impact of those proposed adjustments will significantly impact the national workers' compensation systems because of both direct and indirect links between the two programs, including medical fee schedules, and Medicare Secondary Payment reimbursements.

The Medicare Payment Advisory Commission (MedPAC)  releases its June 2013 Report to the Congress: 
Medicare and the Health Care Delivery System.

According to Commission Chair Glenn Hackbarth, “This report can inform a dialogue about future 
directions for the Medicare program, as well as about technical refinements to existing Medicare 
payment policy. Whether broad or narrow, the Commission’s work aims to balance the interests of 
Medicare beneficiaries, health care providers, and tax payers.”

Redesigning the Medicare benefit. In the report, the Commission continues its discussion of 
possible ways to redesign the Medicare benefit by focusing on the concept we refer to as competitively
determined plan contributions (CPC). Under CPC, Medicare beneficiaries could receive care through
either a private plan or traditional fee-for-service (FFS), but the premium paid by the beneficiary might
vary depending on the coverage option they choose. How much the federal government pays for a 
beneficiary’s care would be determined through a competitive process comparing the costs of available 
options for coverage. The report identifies key issues to be addressed if the Congress wishes to pursue a 
policy option like CPC. These include how benefits could be standardized for comparability, how to 
calculate the Medicare contribution, the role FFS, and the structure of subsidies for low-income 
beneficiaries.

Reducing Medicare payment differences across sites of care. Medicare’s payment rates often 
vary for similar services provided to similar patients, simply because they are provided in different sites of 
care. For example, Medicare pays 141 percent more for one type of echocardiogram when done in a
hospital outpatient department than when it is done in a freestanding physician’s office. If Medicare pays a 
higher rate for a service in one setting over another, program spending increases and beneficiaries pay 
more in cost sharing without a corresponding increase in quality of care. 

The Commission previously recommended reducing the rate Medicare pays for basic office visits from the 
payment rate in the outpatient setting to the physician office rate. Using similar criteria, this report identifies
additional services that may be eligible for equalizing or narrowing payment differences across settings. 
Bundling post-acute care services. Each year, about one-quarter of Medicare beneficiaries receive 
care following a hospitalization from a post-acute care provider, such as a skilled nursing facility, home 
health agency, or inpatient rehabilitation facility. However, nationwide the use of these services varies 
widely, for reasons not explained by differences in beneficiaries’ health status. Under traditional 
Medicare, the program pays widely varying rates for different settings and—characteristic of FFS—pays 
based on the volume of care provided, without regard to quality or resource use. 

Medicare has begun to explore the possibility of bundling services as a way to encourage providers to 
coordinate and furnish needed care more efficiently. In this report, the Commission explores the 
implications for quality and program spending for different design features of the bundles, such as the 
services included, the length of time covered by the bundle, and the method of payment.

Reducing hospital readmissions. In 2008, the Commission recommended a hospital readmissions 
reduction program to improve patient experience and reduce Medicare spending. In 2012, Medicare 
began such a program, penalizing hospitals that have high rates of Medicare beneficiaries being 
readmitted to the hospital within 30 days of discharge. The readmission penalty has given hospitals a 
strong incentive to improve care coordination across providers, and for that reason Medicare should 
continue to implement the policy. In this report, the Commission suggests further refinements to 
improve incentives for hospitals and generate program savings through reduced readmissions rather than 
higher penalties. 

Payments for hospice services. The Medicare hospice benefit provides beneficiaries an important 
option for end-of-life care. At the same time, the Commission has identified several problems in the way 
Medicare pays for hospices that may lead to inappropriate use of the benefit. The report presents 
information on the prevalence of long-stay patients and the use of hospice services among nursing home 
patients—both of which may inform policy development in the hospice payment system in the future. It 
also presents further evidence to support the Commission’s March 2009 recommendations to revise the 
hospice payment system.

Improving care for dual-eligible beneficiaries. Beneficiaries eligible for both Medicare and 
Medicaid—many of whom have complex medical and social needs—often have trouble accessing 
services and receive little care coordination, resulting in poorer health outcomes and higher spending 
relative to other beneficiaries. Programs that coordinate dual-eligible beneficiaries’ Medicare and 
Medicaid benefits have the potential to improve care for this population. In the report, the Commission 
notes that federally qualified health centers and community health centers may be uniquely positioned to 
coordinate care for dual-eligible beneficiaries because they provide primary care, behavioral health
services, and care management services, often at the same clinic site.

Mandated reports. The report includes three chapters that fulfill Congressional mandates: one on 
Medicare ambulance add-on payments, a second on geographic adjustment of fee schedule payments for 
the work effort of physicians and other health professionals, and a third on Medicare payment for 
outpatient therapy services. In each case, the Commission considers the existing policies—which are not 
permanent statutory provisions—and examines the effect of their continuation or termination on 
program spending, beneficiaries’ access to care, and the quality of care beneficiaries receive, as well as 
their potential to advance payment reform. 

The three congressionally mandated reports are described in further detail in separate fact sheets, posted 
on MedPAC’s website. The full report can be downloaded from MedPAC’s website:
http://medpac.gov/documents/Jun13_EntireReport.pdf

Read more about Medicare and Workers' Compensation

Workers' Compensation: NJ Court Approves Medicare Set-Aside ...

May 18, 2013

A NJ Superior Court deemed a proposed Medicare Set-Aside Agreement to be satisfactory to protect Medicare's interests and granted a Motion to Enforce a Pending Settlement. This action by the Court was taken after CMS ...

http://workers-compensation.blogspot.com/

CMS Publishes Brand New Reference Guide for Medicare Set-Aside

Mar 29, 2013

A new Workers' Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide has been posted and is available to be downloaded on the CMS (Centers for Medicare & Medicad Services) website.

http://workers-compensation.blogspot.com/

Workers' Compensation: Obama signs MSP Medicare bill

Jan 11, 2013

"The legislation changes the way Medicare collects money from people whose negligence caused a patient to incur medical bills. Murphy said the new law will streamline an outdated process, making it easier to close cases ...

http://workers-compensation.blogspot.com/

Related articles

• Federal Panel: Hospitals Charging More Than Doctors Offices For Medicare Services
• Morning Bell: Obamacare's Negative Impact on Seniors
• Medicare Chief: Obamacare Is Extending Medicare's Life
• Study: Immigrants put billions more into Medicare than they use
• Medicare chief: Medicare outlook improves, Obamacare the reason

The Obama Agenda: The Road to Workplace Wellness

As workers compensation programs are being diluted by soaring medical costs, The Obama Administration's policy makers are taking a bold new step to focus on promoting wellness and disease-prevention efforts in the workplace. 

Immediately following the presidential elction last November, the Department of Labor, Internatl Revenue Service and the Department of Health and Human Services proposed regulations to enforce workplace wellness programs under thre Affordable Care Act. The proposed regulations will stimulated employer programs to invite healthier workers and may go as far as penalizing those who maintian poor diets and inadequate exercise regiems. 

"... regulations would increase the maximum permissible reward under a
health-contingent wellness program offered in connection with a group
health plan (and any related health insurance coverage) from 20 percent
to 30 percent of the cost of coverage. The proposed regulations would
further increase the maximum permissible reward to 50 percent for
wellness programs designed to prevent or reduce tobacco use. These
regulations also include other proposed clarifications regarding the
reasonable design of health-contingent wellness programs and the
reasonable alternatives they must offer in order to avoid prohibited
discrimination."

One analysis of the proposal concludes......
"We are cautiously optimistic about the potential of workplace-wellness programs to help contain healthcare costs and to improve the health and well-being of millions of California’s workers. Preventing illness and injury through workplace-based strategies potentially benefits employees and their families, employers, and public and private insurance providers. There is emerging evidence about the effectiveness of WWPs in improving chronic disease outcomes, and a long history of occupational health and safety practices reducing workplace injury and death. Incentives in the ACA have the potential to serve as a catalyst for expanding WWP’s broadly in California. However, policy solutions need to respond to potential unintended consequences and account for the state’s incredibly diverse communities and businesses in order to make wellness programs work for all Californians."

Read The Greenlining Institute's report "Helth, Equity and the Bottom line: Workplace Wellness and California Business

Comments are due on or before January 25, 2013.

Read more about health care and workplace injuries and illnesses.

Workers' Compensation: Curing the Profit Motive in Health Care

Jan 10, 2013

Curing the Profit Motive in Health Care. Soaring medical costs have afflicted the workers' compensation industry with economic distress and have severely impacted the efficient and effective delivery of medical care to injured ...

http://workers-compensation.blogspot.com/

Workers' Compensation: 8 Hazardous Jobs In The Healthcare Industry

Nov 20, 2012

The National Institute For Occupational Safety And Health (NIOSH) has revised and republished informational material concerning the health hazards to healthcare workers were exposed to hazardous drugs. The publication ...

http://workers-compensation.blogspot.com/

Workers' Compensation: Loss of Health Insurance Access: The ...

Nov 05, 2012

Access to health insurance is under attack. President's Obama's comprehensive health care reform law, intended to increase health care coverage for millions of Americans, faced extreme scrutiny by the U.S. Supreme Court ...

http://workers-compensation.blogspot.com/

Workers' Compensation: Health Care Continues to Eat Away at ...

Sep 12, 2012

Throughout the nation Workers' Compensation systems have been impacted by health care costs that now take a large piece of the premium dollar. Traditional health care offered by employers mirrors the same problem of ...

http://workers-compensation.blogspot.com/

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