Monday, January 26, 2009

Tom Daschle's health care book - Part III

Five functions of the Federal Health Board

1. set rules for the expanded Federal Employee Health Benefits Program

2. promote "high value" medical care, i.e., recommending coverage of drugs and procedures backed by solid evidence, and ranking services and therapies

(how we gather this evidence for new drugs and procedures is not exactly clear)

3. align incentives with high-quality care

4. increase transparency

5. play a role in nationalizing (his words) our health-care infrastructure  (although he then proceeds to discuss resource allocation rather than infrastructure)

Solid proposal or cliche' fest? Discuss.

Pages 171-178

Tom Daschle's health care book - Part II

Senator Daschle wants to build on the current private system, but also expand the scope and reach of federal government programs.

The Federal Health Board, modeled after the Federal Reserve Board, would initially be directed at the federal government programs, but Daschle makes it clear that with enough influence the FHB would assert signficiant control over the entire U.S. health care system.

"I believe a Federal Health Board should be charged with establishing the system's framework and filling in most of the details. This independent board would be insulated from political pressure [emphasis mine] and, at the same time, accountable to elected officials and the American people. This would make it capable of making the complex decisions inherent in promoting health system performance. It also would give it the flexibility to make tough changes that have eluded Congress in the past." (page 169)

"The Federal Health Board would have regional boards that would have a say in national decisions, but would focus primarily on promoting best practices and quality of care locally...... Over time, the regional boards might assume other roles, such as ensuring an adequate supply of certain services or linking payments to performance....." (page 170)

Next post, the five functions of the proposed FHB.

Saturday, January 24, 2009

Tom Daschle's health care book - Part I

Senator (retired) Tom Daschle, new Secretary of the Department of Health and Human Services (and health care czar!?) wrote a book in 2008 about the health care system (before he knew about this position I believe).

Given Daschle's major influence in the new administration, I am studying the book to look for insights into possible reform plans.

(Daschle has been working at a DC law firm which also does lobbying, but Daschle was apparently kept insulated from the lobbying operation.)

We open with something v-e-r-y interesting. From the dustcover....

"Daschle's solution lies in the Federal Reserve Board, which has overseen the equally complicated financial system with great success. A Fed-like board would offer a public framework within which a private health care system can operate more effectively and more efficiently - ...."

To be fair to Daschle, I believe this book was written before the current financial meltdown, but this concept is a little scary. More in the next post.

Critical: What We Can do About the Health-Care Crisis - Daschle, Greenberger, Lambrew, Thomas Dunne Books, St. Martin's Press, 2008

Saturday, January 17, 2009

Billing News - Technical Pronouncements

ICD-10 HIPAA transaction standards

The current set of outpatient diagnoses codes, the International Classification of Diseases, 9th edition, Clinical Modification (ICD-9-CM) will be replaced by the tenth edition (ICD-10-CM). Physician practices and others must begin submitting ICD-10-CM diagnoses codes by Oct. 1, 2013.

Administrative transactions standards

CMS released the final rule mandating the latest set of administrative transactions standards as part of the Health Insurance Portability and Accountability Act (HIPAA). The ASC X12N 5010 standards replace the current ASC X12N 4010A1 version of the electronic transactions standards. CMS has set Jan.1, 2012, as the compliance date for the 5010 standards.


These will require an immense amount of work by provider and tech geeks to make this work.

The government's attempts to make health care billing totally incomprehensible continue apace.

(Sources include Modern Healthcare and the Medical Group Management Association.)

Thursday, January 8, 2009

Daschle Confirmation Hearings

The hearings for Secretary of DHHS (and health care czar) start this morning. So far it is a love fest.

I have picked up Daschle's book and will have a post on that soon.


The usual preening by Senators, followed by Daschle's assurances that he can fix any problem.