We here at NBCH recently received a letter from the American Medical Association asking for our agreement on their new Guidelines for Reporting Physician Data. We are also aware that several of you have received the same letter.
We wanted to take this opportunity to let you know that NBCH’s position is to not agree to the guidelines. The guidelines are very detailed and discreet, and deal mostly with the mechanics of data display. Our position is that work should continue to be done on more important broader policy questions among the various stakeholders already engaged in this work. In addition, the guidelines state that they would apply only to private sector reporting, and rely only on administrative (claims) data. As we all know, important work on measurement is being done in public programs, and measurement science is continuously evolving to include data beyond just claims, such as clinical data from EHRs. Therefore, we believe that these guidelines serve to actually add more confusion to the measurement arena, rather than simplify it.
NBCH is preparing a response letter to send to the AMA; look for this letter in your email soon.
On Monday, March 12, HHS released thefinal rule for health insurance exchanges, which includes specifics about state functions and responsibilities. The final rule outlined the minimum standards states must meet in establishing and operating their exchanges, such as individual and employer eligibility for enrollment. The rule also outlines minimum standards that health insurers must meet to participate in an exchange and the standards employers must meet to participate in the exchange. The regulation aims to offer states "substantial discretion" in both the design and operation of their exchanges, according to the rule.
The final rule incorporated provisions of two separate but related proposed regulations issued last year, on July 15 and Aug. 17. It included more flexibility than the earlier draft rules for states to determine eligibility for their exchange; provided greater detail on the role of agents and brokers in the exchange; and specified more privacy protections for enrollee data. The rule also codified a “conditional approval” status for states that have made significant progress in creating an exchange but are expected to miss the January 2014 start date. The regulation's goal of offering states “substantial discretion” in both the design and operation of their exchanges drew praise from insurers. Read more here. (Modern Healthcare requires a free subscription)
Insurers and other industry representatives will get to fill as many as half the seats on the governing boards for state health insurance exchanges, while at least one seat must be reserved for a consumer representative. The long-awaited rules are likely to disappoint consumer advocates who would have preferred the governing boards be dominated by consumers. But they may also frustrate insurers who had sought to prevent the governing boards from imposing requirements on plans beyond what is included in the 2010 health care law. HHS left that possibility in place, however, writing, “We continue to believe that states are best equipped to adapt the minimum exchange functions to their local markets and the unique needs of their residents.” Read more here.
Many observers are concerned cost sharing could be undermined if small employers with relatively healthy insured populations stay out of the Small Business Health Options Program (SHOP) in the health insurance exchanges. Firms with sicker employees would face increasing premiums because there wouldn't be enough healthy workers to balance the risk, HealthLeaders Media reports. According to the National Federation of Independent Businesses' Kevin Kuhlman, there so many unknowns in the ACA, including essential benefits, that small businesses are likely to try to stay away, using grandfathered health plans or self-insurance instead. Read more here.
While it’s clear that the health insurance exchange regulation will have a big impact on insurers and consumers, less obvious is that it’s a big deal to hospitals as well. In large part, that’s because of the requirements that health plans must meet for contracting with providers. Read more here.
Brokers and other third-party administrators will be allowed to direct people to state insurance exchanges and check to see if they are qualified for tax credits under long-awaited final regulations released on Monday. That means a possible new business model for insurance brokers or any other companies looking to set up an access point to the state insurance exchanges — something that concerns some consumer groups. Read more here.
For those interested in learning more about the operational requirements for setting up a state health insurance exchange, the National Association for State Health Policy (NASHP), in conjunction with its www.statereforum.org website, is hosting a webinar on April 12 featuring exchange directors from three states – California, Colorado, and Alabama. Register here.
*If you haven’t done so already, and you are especially interested in following state health insurance exchange implementation, consider signing up for the bi-weekly newsletter on state health insurance exchange implementation from Health2Resources (H2R). H2R is a highly respected consulting firm/think tank in the DC area that is following and reporting on this important provision of the ACA. Sign up here.
Health Reform Hits Main Street
Health care reform explained in "Health Reform Hits Main Street."Confused about how the new health care reform law really works? This short, animated movie -- featuring the "YouToons" -- explains the problems with the current health care system, the changes that are happening now, and the big changes coming in 2014. Written and produced by the Kaiser Family Foundation. Narrated by Cokie Roberts, a news commentator for ABC News and NPR and a member of Kaiser's Board of Trustees. Creative production and animation by Free Range Studios.
