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"Medicare Regulatory Burdens"
June 22, 2001
AIM and the Progressive Policy Institute (PPI) co-sponsored a June 22nd briefing on Medicare regulatory burdens. The briefing consisted of two panels - one panel of provider organization representatives and the second panel of key Congressional committee staff. Speakers on the first panel included Ms. Helene Weinraub, Highmark Blue Cross Blue Shield; Mr. Bruce Kelly, Mayo Foundation; and Ms. Stephanie Mensh, AdvaMed. Speakers on the second panel included Mr. Jonathan Blum, Senate Finance Committee Democratic staff; Ms. Monica Tencate, Senate Finance Committee Republican staff; Mr. Patrick Morrisey, House Energy & Commerce Committee majority staff; and Mr. John McManus, House Ways & Means Health Subcommittee Majority staff. Jeff Lemieux, Senior Economist, represented the Progressive Policy Institute.
Ms. Moorhead provided opening remarks and announced the
release of AIM's report, "Improving Medicare Management for Everyone." The report, copies of which are available from AIM, outlines regulatory burdens on both beneficiaries and providers and provides
recommendations for administrative action. Ms. Moorhead reported that the beneficiary section, based upon survey responses from Congressional Medicare caseworkers, finds the lack of easily accessible
information on Medicare eligibility and benefits to be the number one senior citizen concern with the Medicare program.
Ms. Moorhead outlined regulatory burdens on providers and noted that inconsistent program policies, excessive data collection requirements, and slow responses to provider inquiries were common themes from providers such as hospitals, health plans and medical technology organizations. Finally, Ms. Moorhead noted that while AIM's long term goal remains comprehensive reform of the Medicare program, the recommendations in the AIM report represent an interim, short-term step toward program improvement for both beneficiaries and providers.
Ms. Helene Weinraub, Vice President Senior Products,
Highmark Blue Cross Blue Shield, outlined regulatory burdens faced by health plans participating in the Medicare managed care program, Medicare+Choice. Generally, Ms. Weinraub stated that regulatory burdens
such as repetitive data collection increase administrative costs and reduce health plan resources which could be put toward benefits and services. She advocated "guidelines, not standards" especially for
development of beneficiary communication documents and urged the Center for Medicare and Medicaid Services (CMS - formerly known as HCFA) to reward innovation among health plans and to allow more flexibility to
serve beneficiaries.
Mr. Bruce Kelly, Director of Government Relations, Mayo
Foundation, outlined burdens faced by hospitals and other inpatient care facilities. He specifically urged CMS to relieve providers of onerous cost reporting requirements which are no longer necessary for
payment and reimbursement purposes. Mr. Kelly outlined four principles which CMS should adopt for regulating providers: 1) obtain input from providers before drafting new program rules; 2) focus on goal
oriented rules; 3) coordinate rulemaking releases and effective dates; and 4) change the attitude and culture of CMS to allow a better working relationship with providers.
Ms. Stephanie Mensh, Health Policy Advisor, AdvaMed, spoke on behalf
of advanced medical technology firms.
Ms. Mensh highlighted the unnecessary delays to obtain final Medicare program approval for new technologies and devices and noted that these approval processes are in addition to similar approval systems already in place at FDA. She advocated a new Office of Technology and Innovation to speed approval and improve coordination within the Medicare program, improvements in decision deadlines for new technology approval, and corrections to problems with outpatient and inpatient reimbursement.
The second panel consisted of staff representing
Congressional committees of jurisdiction for the Medicare program who were invited to discuss activities and goals for Medicare regulatory burden relief in the 107th Congress. These speakers recognized that many regulatory reforms can be achieved through administrative actions and noted that their committees are working with HHS Secretary Tommy Thompson and CMS Administrator Tom Scully to recommend and ensure implementation of specific regulatory reforms.
Mr. Patrick Morrisey, Deputy Staff Director, House Energy
& Commerce Committee, Majority staff, stated that comprehensive Medicare reform is a priority for Committee Chairman Billy Tauzin (R-LA) and Health Subcommittee Chairman Michael Bilirakis (R-FL).
He outlined the following Committee priorities for action this year: 1) regulatory relief for providers; 2) contractor reform; and 3) appeals process reforms.
Mr. Jonathan Blum, Professional Staff Members, Senate
Finance Committee, Majority staff, stated that Finance Committee Chairman Max Baucus (D-MT) is committed to comprehensive reform which includes a prescription drug benefit and provider reforms. He noted a
clear consensus among Committee members on four key problems: 1) ensuring beneficiaries and providers have a clear understanding of Medicare program rules; 2) ensuring consistency in program regulatory activities;
3) improving the appeals system for both beneficiaries and providers; and 4) ensuring that CMS has the tools and resources necessary to manage the Medicare program.
Ms. Monica Tencate, Health Policy Advisor, Senate Finance
Committee, Republican staff, noted that the legislative component of regulatory reform efforts will likely be small. She stated that improving communications between CMS and both beneficiaries and providers
will alleviate many problems with the Medicare program. Improving communications, she believes, will also improve the overall perception of the Medicare program.
Mr. John McManus, Majority Staff Director, House Ways
& Means Subcommittee on Health, noted that CMS reform, focusing on creating a more responsive and flexible program, has bipartisan support among Ways & Means Committee members.
He outlined five issues which the Committee will address in Medicare reform: 1) improving timeframes for development and implementation of new regulations; 2) increasing collaboration between providers and CMS on new regulations and improving provider education efforts; 3) providing more technical assistance for providers, particularly in the form of a Medicare Ombudsman; 4) reforming the Medicare appeals process; and 5) ensuring improved processing of corrections to DRG coding errors to ensure equal treatment of all corrections.
In response to a question regarding US Department of
Justice involvement in Medicare fraud and abuse cases, Committee representatives unanimously supported more open communications between CMS and providers to resolve payment problems. Mr. McManus stated the
importance of having CMS work with providers to resolve cases before any DOJ involvement. Ms. Tencate noted Senator Chuck Grassley's (R-IA) leadership on the original Fair Claims Act (FCA) and stressed the
need to improve communications with providers. Mr. Morrisey stated that Chairmen Tauzin and Bilirakis would be "loathe" to open the FCA for amendments to alter DOJ enforcement activities and stated that the
Energy & Commerce Committee would address the underlying problem of poor relations between CMS and providers. Mr. Blum also noted Finance Chairman Baucus' opposition to opening the FCA to new amendments.
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