Pro(tech)t Act update

Pro(tech)t Act update

The House Energy and Commerce Committee cleared by voice vote a modified version of the Pro(tech)t Act, H.R. 6357, that would complicate health plan use of electronic medical records by injecting a consent requirement, would formally extend certain HIPAA requirements and penalties to business associates, would create requirements for handling security breaches by covered entities and business associates, and would begin to expand the scope of HIPAA. A Govexec.com article discusses other new privacy and security requirements found in the bill. The bill also would provide financial incentives to health care providers that adopt electronic medical record technology according to Modern Healthcare Online. (Bear in mind that the bill is 107 pages long.)

The bill also is pending with the House Ways and Means Committee and the Science and Technology Committee. As I mentioned on Sunday, there is not much time to enact legislation in this election year. I don’t think that it will happen but the $560 million now on the table for the docs may cause the AMA to push hard for this bill.

Tuesday Tidbits

  • The House Energy and Commerce Committee plan to mark up the Pro(Tech)T Act, HR 6357, tomorrow according to the Healthcare IT News. I agree with “Dave Roberts, a lobbyist for the Healthcare Information and
    Management Systems Society, [who] said he believes the House has “achieved
    what it’s going to achieve” this session in regards to health care IT.
    He said a provision aimed at encouraging doctors to use electronic
    prescriptions that was included in the recently passed Medicare
    physician payment bill was a good first step (Noyes, CongressDaily, 7/21).”
  • AHIP, the health insurance industry’s trade association, has launched a reform campaign called Campaign for an American Solution.
  • The Federal Times reports that Federal employees were paid an average salary of $69,000 last year. The Asbury Park Press maintains a database of federal employee salaries covering 70% of the total workforce.

More on the Medicare Fix Act, H.R. 6331

The House Ways and Means Committee has posted a series of fact sheets about H.R. 6331. I read in BNA this morning that the new law also postpones until September 30, 2009, Medicaid’s adoption of the average manufacturer price reimbursement methodology for generic drugs dispensed by retail pharmacies. This was a reform mandated by the Deficit Reduction Act of 2005. Pharmacies argued that the change would bankrupt them.

CMS posted a fact sheet explaining how it will implement the new law. The fact sheet explains that

Physician PayAs a result of the new law, the mid-year 2008 Medicare Physician Fee Schedule (MPFS) rate reduction of -10.6 percent is retroactively replaced with the fee schedule rates in effect from January – June, 2008, which reflected a 0.5 percent update from 2007 rates. In addition, MPFS payment rates are being revised to increase the fee schedule amounts for certain mental health services. Effective immediately, CMS has instructed its contractors to implement the new law. However, it may take up to 10 business days to implement these changes. To minimize physician disruption during this transition, CMS will post the new physician fee schedule as soon as possible and will continue its rolling 10 day hold and release of claims. This means that, until the new fee schedule rates are implemented, some claims may still be paid at the lower rates that were in effect between July 1st and July 15th. To the extent possible, contractors will begin to automatically reprocess any claims paid at the lower rates in a timely manner. CMS will issue guidance about the collection of corrected co-insurance payments in the next few days.

Weekend Update / Miscellany

  • OPM has released an request for proposals to fill the government wide indemnity benefit plan slot in the FEHB Program that has been vacant for nearly 20 years. Aetna was the indemnity benefit plan carrier from the Program’s inception in 1960 through 1989. OPM is seeking to fill the slot for the 2010 contract year. Attachment 1 to the RFP includes interesting FEHBP demographic data for you statistical mavens.
  • The Senate Finance Committee held a health information technology hearing on July 17. The Director of the Congressional Budget Office blogs about his testimony here.
  • HHS Secretary Leavitt blogged about his reflections on the enactment of the Medicare fix bill. On the bright side, CMS announced on July 15 “payment of more than $36 million in bonus payments to many of the more than 56,700 health professionals who satisfactorily reported quality information to Medicare under the 2007 Physician Quality Reporting
    Initiative (PQRI).”
  • The Wall Street Journal reported last week that “the number of prescriptions dispensed by pharmacies in the U.S. is growing at its worst rate in at least a decade as consumers are squeezed by both a troubled economy and the growing burden of out-of-pocket health-care costs.” Preliminary data indicate that the number of prescriptions dropped in the second quarter for the first time since 1994. “In May, branded medicines accounted for 30.6% of treatments dispensed, down from 45.9% in 2003, according to IMS.” This change could be attributable to the push to generics lead by Medicare Part D and commercial health plans. It’s also hard to locate the Goldilocks point because of all the direct to consumer advertising.

HHS Gets Tough

Healthcare IT News reports that HHS has imposed a $100,000 civil penalty on Providence Health and Services of Seattle for HIPAA violations. “The violation, involving unprotected backup tapes, optical disks and laptops three years ago, compromised the protected health information
of more than 386,000 patients, HHS officials said.”

I don’t recall HHS previously exercising its civil penalty enforcement authority.

Medicare fix bill becomes law

Congress voted to override the President’s veto of the Medicare fix bill (HR 6331) today, according to the Washington Post. Hopefully, this means that the new law will be implemented in a manner that does not require FEHB carriers to adjust Medicare secondary claims.

Staying Healthy at over 50

“The Agency for Healthcare Research and Quality and the AARP today released two new
checklists designed to help men and women over the age of 50 learn what they can do
to stay healthy and prevent disease.” It’s good information for FEHB Program enrollees who tend to be over 50, like me.

Weekend update / Miscellany

  • News reports indicate that President Bush may veto the Medicare fix bill which Congress enacted last week with veto proof margins. However, both of the Republican Senators from Texas have announced that they would vote to override any veto. CMS has said that it will hold claims with July dates of service until Tuesday. Robert Pear of the New York Times reported on why it is so difficult to enact a permanent fix to the doctor reimbursement cuts mandated by a 1997 law. Pear’s article also points out the problems associated with a single payer system.
  • As noted in an earlier post this week, the Medicare fix bill will include financial incentives for doctors to use electronic prescribing. Also last week, the Drug Enforcement Administration proposed rules to allow e-prescribing of controlled substances, such as painkillers and stimulants, and will accept public comments until Sept. 25. This is a big deal to those who support e-prescribing.
  • New reports are continuing to confirm that House and Senate negotiators have resolved the policy differences between their respective mental health parity laws, making passage likely this summer. (Enactment in 2008 creates a 2010 effective date for the FEHB Program.)
  • Speaking of 2010, Healthcare IT News reported that “The federal government is expected to set the [ICD-10] transition date within the next few weeks, and it could be as early as October 2010, Bernard said. The ICD-9 is the diagnosis and hospital procedure code set that HHS requires covered entities to use in their HIPAA compliant electronic claims. The ICD-10 change is a big deal to IT folks and it can require costly programming and hardware changes.
  • According to CNN Money.com, Rep. Joe Barton (R Tex.) announced last week that the full House Energy and Commerce Committee may vote on a bipartisan electronic medical records bill (HR 6357, PRO(TECH)T Act of 2008) as early as this coming week.