Healthcare Tuesday

Created by the new health reform law, the high risk pools are temporary insurance plans catering to those with preexisting conditions until exchange plans launch in 2014. To qualify for enrollment, patients must also have been uninsured for six months. And that, Rell says, is the problem.

A state-sponsored plan, she said, also has a six-month waiting period, but it includes exceptions for patients who lose coverage (including COBRA) due to extreme economic hardship, or lose Medicaid or CHIP eligibility for any reason.

Rell is urging the White House to make similar exceptions for the high-risk pools. The success of the program, she warned, depends on it. 

A look at the future of nursing: The Institute of Medicine (IOM) will release a report on Tuesday recommending how better use of the nation’s nurses can improve care and save money. Among those presenting the findings at the National Press Club will be IOM President Harvey Fineberg and Donna Shalala, former head of HHS.

One step closer to medical loss ratio rules: A subcommittee of the National Association of Insurance Commissioners (NAIC) voted Monday to adopt draft rules for determining medical loss ratios (MLRs).

The guidelines — required of NAIC as a part of the Democrats’ new health reform law — will eventually dictate which insurance company outlays will count toward the 80 to 85 percent of revenues companies must spend directly on healthcare services.  

Sticking points remain. For one thing, the insurance lobby is fighting to have the ratios determined on a national basis, rather than per state, as the NAIC draft proposes. 

Moreover, the draft rules allow insurers to exclude a number of taxes when crunching the MLRs — effectively including those expenses as medical costs — while leading Democrats want fewer taxes to count as direct care for the purpose of determining MLRs. Stay tuned… http://bit.ly/aG2UAn

Lieberman diagnoses congressional failure to pass climate bill: Sen. Joe Lieberman (I-Conn.), whose climate change legislation never got even as far as the floor this year, blamed the long-drawn partisan battle over healthcare reform for sinking his bill before it could ever be considered.

“Congress was suffering from what might be called post healthcare reform traumatic stress syndrome,” Lieberman said Monday at an energy conference in his home state, according to The Associated Press.

“My colleagues — for reasons I understand but was disappointed by — got risk averse,” he added. “You can’t pass a major change like this if you’re risk averse.” http://bit.ly/bQo1rp

For-profit health colleges get disproportionate share of federal student aid: Vocational schools that specialize in training healthcare professionals rely more on federal student aid than other for-profit schools, the Government Accountability Office (GAO) reported Monday.

Roughly 75 percent of total revenues for the average for-profit health school came from federal loans and grants in 2008, GAO found. That’s well below the 90 percent cap on federal aid to those schools, but it’s also much higher than the average rate for all other career college specialties, which get about 63 percent of total revenues from federal taxpayers, according to GAO.

Citing industry sources, GAO researchers suggested that for-profit health schools “tend to attract lower-income students that rely more heavily on federal student aid, leading these schools to have higher [rates].” http://bit.ly/aRJArx

GPOs pushing back against Grassley audit: Group Purchasing Organizations (GPOs), the intermediaries that buy medical products for hospitals, are taking issue with Sen. Charles Grassley’s (R-Iowa) interpretation of a new Government Accountability Office (GAO) study on the ability of GPOs to save the government money. http://bit.ly/9MqKbs

“With so many votes of confidence affirming the value of GPOs, and 98% of all hospitals reliant on GPO low-cost contract pricing, the market has spoken loudly and the facts are clear,” Curtis Rooney, president of the Health Industry Group Purchasing Association, said in a statement. 

“We urge people to read the GAO report for themselves to get unbiased, non-political information proving that GPOs operate in a competitive market that is working and bending the healthcare cost curve.” http://bit.ly/aCaXoh

Last week, Grassley said there’s no good indication how GPOs are affecting taxpayers.

“Whether Group Purchasing Organizations are able to help save money on medical supply costs, or not, impacts federal health care spending,” Grassley said. “There’s no data with which to independently verify the effect, one way or another, and that’s a shortcoming in the current system.”