Government Delays Fuel Industry Procrastination for ICD-10 Compliance

The delay in the compliance deadline for the implementation of the 10th revision of the International Classification of Diseases coding system (collectively referred to as ICD-10) has negatively affected testing and transition timelines for health care organizations, according to a Workgroup for Electronic Data Exchange (WEDI) survey. According to an iHealthBeat report, when CMS announced a final rule establishing October 1, 2015, as the compliance date for ICD-10, as an extension over the prior compliance date of October 1, 2014, some providers delayed their preparation efforts (see, One year ICD-10 delay is now official, August 4, 2014).

Survey

WEDI has conducted nine surveys, beginning in 2009, to track industry preparedness for the coding transition. The most recent survey evaluated 514 respondents that included: 324 providers, 103 health plans, and 87 vendors.

Findings

The survey found that efforts have been made across the industry since October 2013 to begin preparing for the transition. However, the survey also discovered that many stakeholders have not prepared basic impact assessments, external testing, or the release of ICD-10 compliant documentation and billing products because they have pushed those steps back into 2015. Specifically, the survey found that 50 percent of respondents had completed impact assessments, 40 percent indicated that they were unsure when they would complete them, 35 percent of providers had begun external testing, and 50 percent of providers indicated that they did not anticipate starting external testing until 2015. The survey also demonstrated that smaller providers were less likely to have completed external testing than their larger counterparts.

Warning to HHS

WEDI Chair and ICD-10 Workgroup Co-Chair, Jim Daley, authored a letter to HHS Secretary Sylvia Burwell expressing the significance of the study’s findings. The letter cautioned that, although the pushed back compliance date gave providers the opportunity to undergo adequate testing and preparation, some providers, particularly smaller ones, “are not taking full advantage” of the extra time. The letter warned HHS that without dedicated efforts taken by procrastinating organizations to move forward with ICD-10 compliance, there is a risk that the industry will see “significant disruption” when ICD-10 compliance becomes mandatory on October 1, 2015.

Part D Plan Switch May Leave High Costs and Donut Hole Behind

Only five percent of Medicare beneficiaries are enrolled in the Medicare prescription drug plan (PDP) that provides him or her with the lowest total out-of-pocket costs, according to a recent study by eHealth®. The study, which pulled data from 22,000 users of the eHealthMedicare.com and PlanPrescriber.com online Medicare plan comparison tools, found that while 42 percent of Medicare beneficiaries were projected to hit the Medicare prescription drug coverage cap, also known as the donut hole, in 2014, that number could be dropped as low 19 percent if those same users switched to the lowest out-of-pocket cost plan available to them. An eHealth report summarizing the study’s findings suggests that, in light of the findings of the study, Medicare beneficiaries should reevaluate their PDP choice when Medicare’s annual election period opens between October 15, and December 7, 2014.

Study

The user data was used to make over 17,000 stand-alone PDPs comparisons and over 5,000 comparisons of Medicare Advantage Prescription Drug plans (MA PDPs). The study’s comparisons evaluated existing user plans with other available plans in a beneficiary’s area. The comparison was made by cross referencing information like a user’s known prescription drug costs, monthly premiums, co-pays, co-insurance, and deductibles. For the purposes of comparing prices, the study assumed that prescription drug needs did not change for the beneficiaries in question.

Findings

Regarding MA PDPs, only 11 percent of users were enrolled in the lowest cost plan in terms of out-of-pocket cost. The study also determined that, on average, switching to the lowest cost plan would have saved Medicare beneficiaries with MA PDPs $218 annually. Stand-alone PDP beneficiaries fared even worse with only 3 percent enrolled in the lowest cost plan. Additionally, stand-alone PDP beneficiaries would have realized a projected annual savings of $961 if they had switched to the lowest out-of-pocket cost plan.

Reasons for Change

The summary of the study evaluated some of the reasons that PDPs change in order to explain why a beneficiary may want to reevaluate a prior plan selection. The study suggests that formularies, premiums, deductibles, coinsurance amounts, co-payments, and drug tiers that assign costs to certain drugs all can change dramatically from year to year. As a result, eHealth suggests that the lowest cost plan for a beneficiary one year may not be the lowest cost plan the following year.

Popular Drugs

The study also looked at search data from the 22,000 users and determined that the most common drugs Medicare beneficiaries search for are generic versions of popular brand name drugs. Some of the most popular generics sought by beneficiaries were those used to treat gastroesophageal reflux disease, high blood pressure, high cholesterol, coronary artery disease, type II diabetes, and hypertension.

Global Health Budget Tracker Eases Funding Analysis

In August 2014, the Kaiser Family Foundation (KFF) launched a new interactive tracking tool designed to provide the latest data on the U.S. government’s global health funding budget in an easy-to-use format. The U.S. Global Health Budget Tracker is a regularly updated tool that enables users to monitor the entire budget process and budget trends, from the President’s budget request through the appropriations process in Congress, with dates ranging from 2006 to 2015. The tool tracks funding data for program areas such as HIV, Tuberculosis (TB), Global Fund, Neglected Tropical Diseases (NTD), Family Planning and Reproductive Health, and Malaria.

The user-friendly tracker has four menus from which to view funding information. Users can click on the Fiscal Year (FY) Snapshot (FY appropriations status), Agency, Program Area, and/or Initiative menus. Funding information is calculated in U.S. million dollar increments for each category.

Each page of the four menus has unique filter data features. The FY Snapshot contains a legislative financial comparison feature that allows users to analyze the difference in millions spent by the House and Senate and the difference between those amounts and the requested funding amount.

The Agency function breaks down what each federal agency, such as the Centers for Disease Control and Prevention (CDC) or Department of Defense (DOD), has allowed or will allow for each program area. For example, in FY 2015, USAID requested $330 million for HIV and $14.5 million for Vulnerable Children (VC) programs. Users may also choose all agencies’ budget data to compare in one window.

The Program Area highlights the dollar amounts certain agencies have funded or will fund per each global health problem. For FY 2015, using the same program areas as above, the DOD has not budgeted any funding for HIV, while overall agency requests for HIV funding in 2015 total approximately $4.9 billion. Overall agency requests for VC remained at $14.5 million.

The federal Initiative menu provides cumulative amounts for the President’s Emergency Plan for AIDS Relief (PEPFAR) budgets for HIV and the Global Health Initiative (GHI) budgets, which can be customized by either using a sliding scale to view varying time ranges between 2006 and 2015 or by selecting a two-year comparative button.

Each Agency and Initiative page provides informative historical background at the bottom of the page. The tracking tool is up and running. Those interested in U.S. health budget analysis should find the tool useful.

Seeing Medicare’s Future Through Public Deliberation

 

A recent study took a novel approach to federal health care reform and asked the public for answers about how to reform Medicare. Mary Ginsburg of the non-partisan Center for Healthcare Decisions decided to explore Medicare reform by putting hard questions about reimbursement, quality, and coverage in the hands of ordinary Americans. The findings of the California Medicare CHAT Collaborative (MedCHAT) demonstrated that some Americans, or at least the 810 Americans that took place in the study, find a lot of common ground when it comes to redesigning Medicare.

Study

According to the MedCHAT report, MedCHAT is a computer-based interactive simulation where participants are confronted with comprehensive information regarding things like costs, coverage options, and current Medicare spending over a three our public deliberation.  The simulation is premised on the CHAT® (Choosing All Together) exercise. Participants are asked, in a group setting of eight to 15 people, to negotiate the best group of coverage options as well as indicate the reasons for arriving at given conclusions. Additionally, participants are asked to evaluate their decisions as citizens and not as individuals seeking coverage. The MedCHAT simulation is intended to replicate the kinds of decisions that lawmakers undertake when reforming health care programs by requiring participants to impose restrictions in one area any time they want to expand coverage in another area.

Findings

One of the key findings of the MedCHAT project was that 82 percent of participants agreed to a network model in place of the traditional Medicare model that provides relatively unrestricted physician choice. A key factor in that choice was the significant cost savings realized through the implementation of a network. In another cost saving measure, 85 percent of participants were willing to reduce spending on current and future Medicare beneficiaries in order to ensure the continued existence of the Medicare program.  Participants also heavily favored value based care, with 88 percent signing on to the idea. Adding additional benefits was another area where the majority of participants agreed. In the case of long-term care, 77 percent of participants agreed to at least one additional year of coverage.  Additionally, 69 percent of participants believed that long-term coverage for treatment of less severe mental health problems was a worthwhile additional benefit to expand what participants considered to be an underfunded and underutilized health care need.  A large majority of participants, about 81 percent, also believed that transportation costs should be an added Medicare benefits for seniors without support networks.

Rewards and Penalties

Latching on to the growing trend among private insurers, 85 percent of participants agreed that it was a good idea to include rewards and penalties as incentives for beneficiaries to improve health status while lowering the cost of health care.  Participants also felt strongly about having higher-income seniors pay higher premiums than they do now.

Weight of Public Opinion

The MedCHAT findings were revealed at a forum held by the American Enterprise Institute and the Engelberg Center for Health Care Reform at the Brookings Institution. The responses from a panel at that forum suggest that the findings might not carry much weight among politicians. According to a Kaiser Health News (KHN) report, John Rother, CEO of the National Coalition on Health Care, cautioned that what took place in California will not be an accurate predictor of how Congress will go about solving the problem. According to KHN, Ginsburg recognizes that Medicare reform will be a slow process; yet, Ginsburg indicated that the MedCHAT program was part of a “gradual process of enlightenment.” Whether the opinions of 810 Californians will have any sway on Capitol Hill remains to be seen. Although the likely influence of the MedCHAT findings is small, the study represents a novel perspective to a difficult question that few want to be responsible for answering.