Healthcare Financial News

In results released today by the Medical Group Management Association (MGMA) from its study of MGMA member satisfaction with major health plans, members gave top marks to Medicare Part B on questions related to responsiveness, transparency, prompt payment, and overall satisfaction with general administrative functions. The study focused on seven large payers.

"Despite the fact that Medicare consistently underpays and places member practices in an increasingly difficult financial situation–with a looming 21 percent cut to physician payments–MGMA members were positive about the standardized and predictable nature of how the program is administered," said MGMA President and CEO William F. Jessee, in a press release.

MGMA members expressed a high level of satisfaction with the major private health plans regarding their provider credentialing processes, but citied dissatisfaction with this process for Medicare.

More than 1,700 practice professionals participated in the poll. Results reflect MGMA members’ perceptions of the payer environment in areas of payer communications, provider credentialing, contracting, payment policies, system transparency, and overall satisfaction. The study did not address payment levels.

The Center for Medicare & Medicaid Services (CMS) is expected to notify state Medicaid programs within the next 30 days that states may exempt hospitals from a federal mandate to collect national drug codes (NDCs) on physician-administered infusion products and injectable drugs if such drugs are billed at their “purchasing cost” as defined under a state’s Medicaid plan. The CMS transmittal will also advise the states that if a hospital drug qualifies for the exemption, it is not subject to a rebate under the Medicaid drug rebate program.

The CMS action follows settlement of August 2008 litigation filed against the federal agency, which was announced by the Safety Net Hospitals for Pharmaceutical Access, representing about 500 safety-net hospitals. That lawsuit attempted to reverse the implementation of the July 2007 CMS Medicaid regulation mandating the NDC reporting by hospitals. The hospitals said the reporting requirement would cost them millions of dollars and would be very difficult to implement, and sought a permanent injunction prohibiting the federal government from requiring and encouraging state Medicaid agencies to collect the information.

Lawmakers on both sides of the aisle have reacted strongly to a report released Sunday by America’s Health Insurance Plans (AHIP) criticizing the reform bill that was passed by the Senate Finance Committee yesterday. The AHIP report said selected provisions of the bill could increase premiums 18 percent more than they would otherwise rise in the next decade, to an average of nearly $26,000 for families and $9,700 for individuals in 2019.

The New York Times reported that Jonathan Gruber, a healthcare economist at the Massachusetts Institute of Technology, evaluated the AHIP report at the request of Senate Democrats and found it “deeply flawed.” Gruber reportedly said the report failed to account for the effects of government subsidies for the purchase of insurance and for reductions in administrative overhead costs resulting from insurance exchanges.

The Times also quoted Sen. Michael B. Enzi (R-Wyo.): “This report confirms what I have been saying all along: the combined impact of new taxes, mandates, and entitlement expansions in the Baucus bill will substantially increase the price that many Americans pay for their health insurance.”

As the debate continues, the Finance Committee bill will be merged with the Health, Education, Labor, and Pensions Committee bill before heading to the full Senate for a vote.