The Waiting Game

So we wait. Tick, tick, tick. Our worksheets queued up, our message points awaiting details. When will Senator Baucus release his mark and will it be a "bi-partisan" effort?

Our job is to analyze, compare, contrast, inform. We do not editorialize. That's a good thing, I think. There's plenty of that going on already.

Here's what we're looking at to model in our analyses: Medicare marketbasket reductions, Medicare and Medicaid DSH reductions, payment reductions for readmissions, redistribution of dollars under Medicare Value-Based Purchasing. On the plus side, how much would it mean to have some percentage (97 % ?????) of the uninsured now covered? We're up to the challenge.

In the meantime, we're working on a number of interesting Quality reporting projects for various entities. That is an area that is going to gain alot more interest as Health Reform unfolds. Hospitals are going to want to see how/if their performance improvement efforts are making a difference and they are going to want to see it in real time - not lagged by months. So, we're looking at several alternative reporting formats, from graphs to "stop-light" reports.

The work that the DataGen Group is doing with GE in this area is extremely timely. They are making some great progress on a prototype for the first generation Forecaster. This should also tie-in nicely to our work with the Krasnoff Institute and the South Carolina Hospital Association. There are a couple of additional irons in the fire, but it's too early to discuss them yet.

So, we're busy and Health Reform is helping to keep us that way. It's exciting to be involved at the cusp of great change.

Anticipation

President Obama will be speaking before the Joint Houses on Wednesday to try to reclaim the "upper hand" in the Health Reform discussion. The New York Times has been covering this topic in great detail over the course of the summer - with at least one full page of reporting, commentary, and charts each day; sometimes even more. Their blog is also very comprehensive. One interesting article in today's paper discusses the frustration of many conservative policy experts (those who are truly interested in policy issues and not just about throwing barbs at Democrats) that the public debate has been derailed by the many bogus arguments out there (like the absurd notion of Death Panels).

Well, let's see what Wednesday brings, shall we?

Clearing the Decks

Well, we're getting all of our analyses of the final PPS rules done and out the door so we should be all ready when Congress returns to work on Health Reform. Long Term Care Hospital PPS is the last analysis and should go out by Wednesday.

Next on our list is our DRG Product Line reports, which will show hospitals how their Medicare case-mix will change with the new 2010 DRG weights. It's always interesting to see how the impacts vary by service area (e.g. medical vs. surgical).

Meanwhile, the press coverage of Health Reform is persistent and pervasive. Amazing the power of the media. HANYS has posted an excellent slide show summary of where we are and what's ahead w/r/t Health Reform. No editorializing, just the facts on what's in the House bill and what lies ahead. And, of course, we'll be there every step of the way with our Excel worksheets at the ready to model whatever they throw at us.

And Then There Were 35

I am very happy to report that the MHA - An Association of Montana Health Care Providers has asked to sign a full-service contract with DataGen. That brings our tally up to 35 full-service State Associations, plus the three large Catholic Systems. DataGen has certainly grown over the past five years, and I am most proud and happy to be part of it.

Meanwhile, we have posted our analysis and summary of the final Inpatient PPS rule - the only rule analysis left to do is the Long Term Care Hospital rule, which will be done this week. So, we're in good shape to start cranking out analyses and summaries when the House and Senate return after Labor Day.

We've started our own internal discussions as to how we can best model the positive impact of increased health insurance coverage. We're thinking of developing a template that will allow hospitals to input their own data and model various "what if" scenarios. I'd like to have that in place in time to respond to whatever comes out of the two legislative branches.

It's been a bit disheartening to hear all the noise surrounding health reform. It's never a good thing when people start spouting opinions that are based on other people's opinions rather than their own, first-hand knowledge of an issue. That's what seems to be going on right now w/r/t Health Reform. One person's Facebook post fuels countless rants. It's like one of those old-fashioned games of telephone - each time the message is passed, it is distorted just a little more.

The Summer Rules and Regs

We're taking some time out from the Health Reform discussions to summarize and analyze all the PPS rules and regs that were released this summer. Most of our analyses are completed now, but we're still holding back on the IPPS analysis.

We've received numerous inquiries as to the status of our analysis of the final IPPS rule and why it's taking so long. We had promised to have it done by Friday, then by Monday, now it's Wednesday - what's up?

The hold-up is due to all the changes regarding hospital-specific rates for special rural providers (Sole Community Hospitals and Medicare Dependent Hospitals). Although these providers represent a small proportion of the membership, it is still crucial that we provide meaningful analyses for them.

We always struggle to estimate the hospital-specific rates correctly because the rates we calculate from hospitals' Cost Reports don't always comport with the rates CMS publishes in its Impact Files PLUS the data we get from the CMS Impact Files do not always comport with other CMS sources. We do our best to reconcile and sometimes we must make a best guess as to which number is correct.

This year, the CMS Impact File provides hospital-specific rates that are supposed to include re-basing to 2006 for SCHs and removal of prior years' budget neutrality for MDHs. The problem is that the we cannot tie into these rates using any of our usual tricks. We need to verify whether the CMS numbers are correct or if we should use our own numbers. We do not want to put out reports that lead your members astray or cause them to question the analysis - not when we know that is a possibility.

So, we are waiting to hear back from CMS and/or the AHA. We will allow a reasonable amount of time for a response after which, if we have not heard anything, we may need to reassess our strategy. That's where we stand.

The Big Announcement

On Wednesday, we were treated to the big announcement from the White House, Senate Finance, and the hospital industry - the industry will pony up its share of health care savings dollars in return for consideration of the issues that are important to us. Our share of the pot will be $155 billion over ten years. That's a number so large, I can't even tell whether it seems reasonable. And how can we even begin to be accurate about predictions this large and over such a long period of time?

Today, I'm reading that some of the other participants in this national sacrifice are not as willing to put in. Yes, it's always easier to say you're going to reduce spending than it is to try to increase revenues (aka taxes).

So, now the numbers are flying left and right. If the Senate does not tax health benefits, there's another $300 billion hole to fill. And wait, the House may need to find more money for its plan. The CBO has come out with some guesstimates as to the costs/benefits of the House Discussion Draft. The CBO comes up with a net reduction in healthcare spending of $152 billion, but that includes some gives as well as takes, and it is not looking at what the proposal would cost i.e. we still don't know how big of a hole needs to be filled.

I feel like I'm walking a tightrope without a net. Everyone wants hospital-specific impacts and there's just not that kind of detail out there.

A Busy Weekend; A Busy Week

This is the week where we are expecting a mark bill from the Senate Finance Committe on their version of health reform. The press has certainly been busy reporting on the behind-the-scenes posturing. Kaiser Health News and Politco both have stories about an impending deal between the hospital industry, the White House, and the Senate Finance Committe that would guarantee savings over 10 years in the neighborhood of $150 to $170 billion - a bit better than what the WH had originally proposed. The reports are mixed as to whether the SFC will propose a public plan, but Senator Schumer seemed pretty confident that they would.

Meanwhile, the Seante HELP Committee will be busy this week marking up their bill - who knows how that will fit in with the SFC's plans. And let's not forget that the huge House bill is still not done. Where does all this deal-making leave them? One thing is for certain, the CBO will be very busy toting up scores for all these bills. The Associated Press has a nice comparison document of the coverage options out there under all the various proposals.