Affordable Care Act provision cuts red tape, saves up to $4.5 billion

FOR IMMEDIATE RELEASE January 5, 2012. New standards for electronic funds transfers in health care, required by the Affordable Care Act, will reduce up to $4.5 billion off administrative costs for doctors and hospitals, private health plans, states, and other government health plans, over the next ten years, according to estimates included in new rules published today by the U.S. Department of Health and Human Services (HHS).  The standards build upon regulations published earlier this year that set industry-wide standards for how health providers use electronic systems to quickly and easily determine a patient’s eligibility for health coverage and check on the status of a health claim.

Together, the two regulations implementing the Administrative Simplification provisions of the Affordable Care Act and the Health Insurance Portability and Accountability Act (HIPAA) are projected to save the health care industry more than $16 billion over the next 10 years.  These savings come from the adoption of electronic standards that will help eliminate inefficient manual processes and reduce costs.

“Thanks to the Affordable Care Act, health care professionals will spend less time filling out paperwork and more time focusing on delivering the best care for patients,” said HHS Secretary Kathleen Sebelius.

A May 2010 study in the journal Health Affairs found that physicians spend nearly 12 percent of every dollar they receive from patients to cover the costs of filling out forms and performing other excessively complex administrative tasks. The study found that simplifying these systems could save four hours per week of professional time per physician and five hours of support staff time every week – time that could be better spent on patient care.

“As a nurse, I know the importance of giving health care professionals time to focus on patient care,” said CMS Acting Administrator Marilyn Tavenner.  “The less time a physician has to spend on paperwork is that much more time that can be devoted to patient care. Having standardized procedures across the health care industry can only lead to lower costs and greater efficiencies all around.”

Today’s rule—the Adoption of Standards for Health Care Electronic Funds Transfers and Remittance Advice — adopts streamlined standards for the format and data content of the transmission a health plan sends to its bank when it wants to pay a claim to a provider electronically (through an electronic funds transfer) and to issue a Remittance Advice notice.  Remittance Advice is a notice of payment sent to providers that may or may not accompany the payment the provider receives.

For example, currently when a provider submits a claim electronically for payment, a health plan often sends a Remittance Advice separately from the Electronic Funds Transfers payment.  The disconnect between the two makes it difficult or sometimes impossible for the provider to match up the bill and the corresponding payment.  Today’s rule addresses this by requiring the use of a trace number that automatically matches the two.  The new tracking system will allow health care providers to eliminate costly manual reconciliation that must currently be done.

Future administrative simplification rules will address adoption of:

A standard unique identifier for health plans;

A standard for claims attachments; and

Requirements that health plans certify compliance with all HIPAA standards and operating rules.

The regulation is effective January 1, 2012.  All health plans covered under HIPAA must comply by January 1, 2014.

To view the Interim Final Regulation with comment period, go to: http://www.regulations.gov

For more information on the June 2011 HIPAA Administrative regulation: Adoption of Operating Rules for Eligibility for a Health Plan and Health Care Claim Status, visit: http://www.hhs.gov/news/press/2011pres/06/20110630a.html

Contact: CMS Press Office (202) 690-6145x

Partnership for Patients initiative to improve hospital care

FOR IMMEDIATE RELEASE.December 14, 2011. Hospitals across the country will have new resources and support to make health care safer and less costly by targeting and reducing the millions of preventable injuries and complications from healthcare acquired conditions, the U.S. Department of Health and Human Services (HHS) announced.  As a part of the Partnership for Patients initiative, a nationwide public-private collaboration to improve the quality, safety, and affordability of health care for all Americans, $218 million will go to 26 state, regional, national, or hospital system organizations. As Hospital Engagement Networks, these organizations will help identify solutions already working to reduce healthcare acquired conditions, and work to spread them to other hospitals and health care providers.

“At some point in our lives many of us are going to need hospital care and we need to be confident that no matter where we live, we’re going to get the best care in the world,” said HHS Secretary Kathleen Sebelius.  “The Partnership for Patients is helping the nation’s finest health systems share their knowledge and resources to make sure every hospital knows how to provide all of its patients with the highest quality care.”

The Hospital Engagement Networks’ will be funded with $500 million from the Centers for Medicare & Medicaid Services Innovation Center, which was established by the Affordable Care Act.  Hospital Engagement Networks will work to develop learning collaboratives for hospitals and provide a wide array of initiatives and activities to improve patient safety.  They will be required to conduct intensive training programs to teach and support hospitals in making patient care safer, provide technical assistance to hospitals so that hospitals can achieve quality measurement goals, and establish and implement a system to track and monitor hospital progress in meeting quality improvement goals.  The activities of the Hospital Engagement Networks will be closely monitored by CMS to ensure that they are improving patient safety.

Launched in April 2011, the Partnership for Patients now consists of more than 6,500 partners, including over 3,167 hospitals, along with 2345 physicians, nurses, patient advocates, 892 consumers and consumer groups, and 256 employers and unions. In addition, health plans, Area Agencies on Aging, and state and federal government officials who have pledged to work together to reduce the number of hospital-acquired conditions by 40 percent and reduce hospital readmissions by 20 percent by the end of 2013.

“In just the past eight months we’ve seen an overwhelming response from doctors, employers, patient advocates and other partners who believe the time is now to improve patient safety—as a former ICU nurse and hospital administrator, I’m proud to see hospitals stepping up to the plate,” said Marilyn Tavenner, acting administrator of CMS, the HHS agency sponsoring the program.  “We look forward to working with the Hospital Engagement Networks and the hospitals on the critical and important work of making care safer, more reliable, and less costly and achieving the goals of the Partnership for Patients.”

Achieving the Partnership for Patients’ objectives would mean approximately 1.8 million fewer injuries to patients in the hospital, saving over 60,000 lives over three years, and would mean more than 1.6 million patients to recover from illness without suffering a preventable complication requiring re-hospitalization.

The 26 organizations receiving awards are:

American Hospital Association;
Ascension Health;
Carolinas HealthCare System;
Catholic Healthcare West;
Dallas-Fort Worth Hospital Council Foundation;
Georgia Hospital Association Research and Education Foundation;
Healthcare Association of New York State;
Hospital & Healthsystem Association of Pennsylvania;
Intermountain Healthcare;
Iowa Healthcare Collaborative;
Joint Commission Resources, Inc.;
Lifepoint Hospitals, Inc.;
Michigan Health & Hospital Association;
Minnesota Hospital Association;
National Public Health and Hospital Institute;
New Jersey Hospital Association;
Nevada Hospital Association;
North Carolina Hospital Association;
Ohio Children’s Hospital Solutions for Patient Safety;
Ohio Hospital Association;
Premier;
Tennessee Hospital Association;
Texas Center for Quality & Patient Safety;
UHC;
VHA; and
Washington State Hospital Association.

HHS has committed up to $1 billion in Affordable Care Act funding to help achieve the Partnership for Patients.  In addition to the funding to help reduce health care acquired conditions, $500 million has been made available through the Community-Based Care Transitions Program to ensure patients safely transition between settings of care to bring down readmissions.  Recently, seven organizations were selected as the first participants for the Community-Based Care Transitions Program.

In addition to the Hospital Engagement Contract awards, HHS has awarded three other contracts to assist in achieving the Partnership for Patients’ goals: the National Content Developer Contractor, the Beneficiary and Medical Professional Engagement Contractor, and the Evaluation Contractor.

For more information on the Partnership for Patients, please visit http://www.healthcare.gov/partnershipforpatients.

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President Obama announces new efforts to end the AIDS epidemic in the United States

HSS. FOR IMMEDIATE RELEASE. December 1, 2011. President Barack Obama  announced accelerated efforts to increase the availability of treatment to people living with HIV/AIDS in the United States in conjunction with World AIDS Day 2011.  The president directed the U.S. Department of Health and Human Services (HHS) to invest approximately $50 million in new funding to support AIDS Drug Assistance Programs in states and increase access to HIV/AIDS care services.

“President Obama has laid out a compelling vision that has the power to change the course of the epidemic,” said HHS Secretary Kathleen Sebelius.  “Now it’s up to all of us to make our National HIV/AIDS Strategy real.  Treatment not only improves and extends the lives of people living with HIV, but it also drastically reduces their risk of spreading the virus.  Today we have a unique opportunity to significantly alter the course of the AIDS epidemic in the United States.”

The president emphasized that critical HHS resources will help ensure that HIV-positive Americans get the best care and treatment possible.  HHS will commit approximately $35 million in new funding and enhanced technical assistance through the Health Resources and Services Administration (HRSA) to support state AIDS Drug Assistance Programs so that approximately 3,000 people living with HIV/AIDS will have access to life-saving medications.  In addition, HHS will provide $15 million in new funding to support experienced community-based providers of care for individuals with HIV/AIDS.

As part of today’s announcement, HHS will sponsor new activities focused on improving adherence to medications and encouraging consistent access to HIV care.  The Centers for Disease Control and Prevention (CDC) estimates that 34 percent of HIV/AIDS patients do not receive consistent care and only 28 percent of HIV/AIDS patients have their HIV under control.  Consequently, HHS will help providers improve quality of health care delivered and states monitor and improve the continuum of HIV care for patients.

Today’s announcement builds upon the Obama Administration’s new testing initiatives to help the estimated 240,000 Americans living with HIV who are not aware that they are infected.  For example, CDC has launched a new campaign to encourage testing among one of the hardest hit populations in the United States, black men who have sex with men.  Testing Makes Us Stronger is part of Act Against AIDS, CDC’s national campaign to bring attention to the importance of HIV prevention and testing.  In 2012, CDC will also be working with partners to expand its successful campaign for African American women.

Recognizing that the federal government’s efforts are only part of the solution, President Obama also applauded commitments by other public and private sector partners to expand and improve HIV/AIDS care services.  The National Alliance of State and Territorial AIDS Directors announced a new agreement with Gilead Sciences to extend additional voluntary discounts and rebates for most Gilead medications purchased by state AIDS Drug Assistance Programs, as well as a continued price freeze through 2013.

To learn more about World AIDS Day activities, visit AIDS.gov.

Contact: HHS Press Office
(202) 690-6343s

We Can't Wait: Obama Administration takes new steps to encourage doctors and hospitals to use health information technology to lower costs, improve quality, create jobs

FOR IMMEDIATE RELEASE.November 30, 2011.U.S. Department of Health and Human Services (HHS).Cleveland, OH —Today, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius released a report showing that doctors’ adoption of health information technology (IT) doubled in two years.  HHS also announced new actions to speed the use of health IT in doctors’ offices and hospitals nationwide, which will improve health care and create jobs nationwide.

While protecting confidential personal information, health IT can improve access to care, help coordinate treatments, measure outcomes and reduce costs.  The new administrative actions announced today, which were made possible by the HITECH Act, will make it easier for doctors and other health care professionals to receive incentive payments for adopting and meaningfully using health IT.

“When doctors and hospitals use health IT, patients get better care and we save money,” said Secretary Sebelius.  “We’re making great progress, but we can’t wait to do more. Too many doctors and hospitals are still using the same record-keeping technology as Hippocrates. Today, we are making it easier for health care providers to use new technology to improve the health care system for all of us and create more jobs.”

In addition to improving the health care system, data indicate that the national transition to health IT is creating jobs.  Over 50,000 health IT-related jobs have been created since the enactment of the HITECH Ac. According to the Bureau of Labor Statistics, the number of health IT jobs across the country is expected to increase by 20 percent from 2008 to 2018, much faster than the average for all occupations through 2018.

HHS also announced its intent to make it easier to adopt health IT.  Under the current requirements, eligible doctors and hospitals that begin participating in the Medicare EHR (electronic health record) Incentive Programs this year would have to meet new standards for the program in 2013.  If they did not participate in the program until 2012, they could wait to meet these new standards until 2014 and still be eligible for the same incentive payment. To encourage faster adoption, the Secretary announced that HHS intends to allow doctors and hospitals to adopt health IT this year, without meeting the new standards until 2014. Doctors who act quickly can also qualify for incentive payments in 2011 as well as 2012.

These policy changes are accompanied by greater outreach efforts that will provide more information to doctors and hospitals about best practices and to vendors whose products allow health care providers to meaningfully use EHRs.  For example, in communities across the country HHS will target outreach, education and training to Medicare eligible professionals that have registered in the EHR incentive program but have not yet met the requirements for meaningful use.  Meaningful use is the necessary foundation for all impending payment changes involving patient-centered medical homes, accountable care organizations, bundled payments, and value-based purchasing.

These efforts will complement existing outreach efforts to doctors and hospitals including the Obama Administration’s work to create a nationwide network of 62 Regional Extension Centers.  The extension centers are comprised of local nonprofits that provide guidance and resources to help eligible health care providers participate in the Medicare and Medicaid EHR Incentive Programs and meaningfully use health IT.

Also released today, a new Centers for Disease Control and Prevention (CDC) survey found 52 percent of office-based physicians in the U.S. now intend to take advantage of the incentive payments available for doctors and hospitals through the Medicare and Medicaid EHR Incentive Programs.  EHR incentive payments for eligible health care professionals can total as much as $44,000 under the Medicare EHR Incentive Program and $63,750 under the Medicaid EHR Incentive Program.  The CDC data also show the percentage of physicians who have adopted basic electronic health records in their practice has doubled from 17 to 34 percent between 2008 and 2011 (with the percent of primary care doctors using this technology nearly doubling from 20 to 39 percent).

To meet the demand for workers with health IT experience and training, the Obama Administration has launched four workforce development programs that help train the new health IT workforce.  The training is provided through 82 community colleges and nine universities nationwide.  As of October 2011, community colleges have had 5,717 professionals successfully complete their training in health information technology.  Currently there are 10,065 students enrolled in the training programs across the nation.  As of November 2011, universities have graduated over 500 post-graduate and masters-level health IT professionals, with over 1700 expected to graduate by July 2013.

While improving the health care system, health IT can help keep information private and secure.  Federal laws require key persons and organizations that handle health information to have policies and security safeguards in place to protect health information—whether it is stored on paper or electronically.

For more information on how health IT can lead to safer, better, and more efficient care, and for a fact sheet about today’s announcement, visit http://www.healthit.gov/

For more information about the Medicare and Medicaid EHR Incentive Programs, see http://www.cms.gov/EHRIncentivePrograms

For more information on the 2011 CDC survey data referenced above, seehttp://www.cdc.gov/nchs/surveys.htm

For more information about the HHS Recovery Act health IT programs, see http://www.hhs.gov/recovery/announcements/by_topic.html#hit

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Unprecedented tool developed for small businesses to find and compare health insurance plans

U.S.Department of Health and Human Services.FOR IMMEDIATE RELEASE. November 18, 2011 A greatly expanded website to give small business owners an unprecedented detailed review of their health insurance plan choices was announced today by the U.S. Department of Health and Human Services.

Just in time for 2012, this powerful new tool allows small business owners to compare the benefits and costs of health plans and choose those that are best for their employees. For the first time ever, it will allow small businesses to research locally available products in an unbiased manner and foster a more transparent and competitive marketplace.

“This new information will help business owners navigate what has traditionally been a complicated and confusing decision,” said HHS Secretary Kathleen Sebelius. “Both owners and their employees can feel more confident that the plans offered will be the best to suit everyone’s needs.”

In addition to the market being difficult to analyze, small businesses do not fare as well large employers when negotiating health care prices, on average small businesses spend 18 percent more for the same health insurance coverage. This new tool brings needed transparency to the marketplace, which will help ensure insurance companies will compete for business on the basis of price and quality.

The tool is located on www.HealthCare.gov, which was created under requirements contained in the Affordable Care Act, the new health care law of 2010. The website is the first of its kind to bring information and links to health insurance plans to one place, and to make it easy for consumers to learn about and compare their insurance options. The Centers for Medicare & Medicaid Services worked to define and collect detailed benefits and premium rating information from insurers across the country to develop the site.

The new information added gives small business owners access to the following:

• Insurance product choices for a given ZIP code, sorted by out-of-pocket limits, average cost per enrollee, or other factors.
• A summary of cost and coverage for small group products that shows the available deductibles, range of co-pay options, included and excluded benefits, and benefits available for purchase at additional cost.
• The ability to filter product selection based on whether the plans are Health Savings Account eligible, have prescription drug, mental health, or maternity coverage, or allow for domestic partner or same sex coverage.

More than 530 insurers have provided information for more than 2,700 coverage plans across all states and the District of Columbia.

“Tens of thousands of small businesses from across America have already logged-on to www.HealthCare.gov to see what health coverage options are available to them,” said Steve Larsen, director of the Center for Consumer Information and Insurance Oversight. “The new, unprecedented ability to search at this level of detail will bring the marketplace into better balance by giving insurance purchasers the power of information.”

In addition, the website provides extensive information about consumer rights, tips for how to navigate the market’s complexities, and details on how the Affordable Care Act provides new protections for beneficiaries.

To access the small business Insurance Finder, go to the home page of www.HealthCare.gov and click on the blue tab at the top of the page.

For more information, visit www.HealthCare.gov, or access the HHS Facebook page or Twitter account. To download a www.HealthCare.gov Insurance Finder widget visit www.HealthCare.gov/stay_connected.html.

HHS announces refined survey standards to examine and help eliminate differences in care based on race, ethnicity, sex, primary language, or disability

The U.S. Department of Health and Human Services today released final standards to more consistently measure race, ethnicity, sex, primary language, and disability status, thereby improving the ability to highlight disparities in health status and target interventions to reduce these disparities.

“It is our job to get a better understanding of why disparities occur and how to eliminate them. Improving the breadth and quality of our data collection and analysis on key areas, like race, ethnicity, sex, primary language and disability status, is critical to better understanding who we are serving,” said HHS Secretary Sebelius. "Today, through these new standards, we are providing a new set of powerful tools to help us achieve our vision of a nation free of disparities in health and health care.”

The Affordable Care Act requires new standards for the collection and reporting of health care information based on race, ethnicity, sex, and primary language. Making data standards consistent will help identify the significant health differences that often exist between and within ethnic groups, particularly among Asian, Hispanic/Latino and Pacific Islander populations.

For example, a study showed that the diabetes-related mortality rate for Mexican Americans (251 per 100, 000) and Puerto Ricans (204 deaths per 100, 000) was twice as high as the diabetes-related mortality rate for Cuban Americans (101 deaths per 100, 000). However, this information would have remained unknown if only the umbrella terms of “Hispanic” or “Latino” had been used.

By adding Mexican American and Chicano/a, Puerto Rican, Cuban, and other Hispanic Latino/a or Spanish origin as explicit categories required on all HHS-sponsored health surveys, we can better capture the individual ethnic group challenges that are often found within minority populations. This specificity allows for better measurement and tracking of health differences in these populations and target interventions appropriately.

The new data collection requirements also will improve researchers' ability to consistently monitor more dimensions of health disparities among people with disabilities. Collection of all data will take place under HHS’ longstanding, strict commitment to protecting privacy.

“Many racial and ethnic minorities, people with limited English proficiency, people with disabilities, and other populations face unique health challenges, often have reduced access to health care and often pay the price with poorer health,” said Garth Graham, M.D., MPH, HHS deputy assistant secretary for minority health. “Today we are implementing an important provision of the Affordable Care Act that reinforces our commitment to reducing these health disparities. These new standards will help us carry forward the HHS Action Plan to Reduce Racial and Ethnic Health Disparities and our work to address disparities in people with disabilities as well.”

The standards, effective upon publication today, apply to health surveys sponsored by HHS where respondents either self-report information or a knowledgeable person responds for all members of a household. The standards will be used in all new surveys and at the time of revision to current surveys.

For more information on the final data standards, visit www.minorityhealth.hhs.gov/section4302.