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A Planning Playbook for Opening a New Orthopedic ASC
The ASC market continues its rapid growth. In 2023, roughly 116 new ASCs opened in the U.S., many of which were orthopedic-specific in nature....
HCFA Changes Name; Promises Agency Reform
Promising that it is the first step in more substantive changes, Health and Human Services Secretary Tommy Thompson has announced that the name of the Health Care Financing Administration (HCFA) has been changed to the Centers for Medicare and Medicaid Services (CMS). The change is effective immediately.
In addition to the name change, Thompson has promised an institutional overhaul. In a June 14, 2001 press release, HHS outlined a plan for changing the structure of the former HCFA that is intended to make the agency more responsive to needs of beneficiaries, healthcare providers, and payors.
CMS will be organized around three centers: The Center for Medicare Management, the Center for Beneficiary Choices, and the Center for Medicaid and State Operations.
The Center for Medicare Management will focus on overseeing the traditional fee-for-service Medicare program. This includes development of payment policy and management of Medicare contractors.
The Center for Beneficiary Choices will manage the Medicare Choice plans, consumer research and demonstrations, and perform grievance and appeal functions. They will also provide information to beneficiaries on their Medicare, Medicare Select, Medicare Choice, and Medigap options.
The Center for Medicaid and State Operations will focus on state-administered health programs, including Medicaid and insurance regulation.
CMS set three primary goals for itself: Enhancing Medicare education for beneficiaries; creating a more responsive agency to beneficiaries, healthcare providers, and states; and developing Medicare-contracting reform legislation and increasing its ability to reward well-performing contractors.
Among other pledges, CMS has promised to develop a better system to train providers and resolve problems by offering formal training on new requirements, improving its internet-based information for healthcare providers and offering satellite broadcasts geared toward providers. Furthermore, the agency has promised to expand the role of the Physicians' Regulatory Issues Team, an agency-wide group headed by a physician, to "find specific workable solutions to problematic Medicare requirements," according to the press release. Finally, the agency has committed to improve the CMS' Professional Relations Staff to enable it to "develop partner-like relationships with healthcare practitioner associations and health plans," according to the release.
A CMS spokesperson reports that some changes that will affect providers and payors are already in place. One of the changes concerns healthcare facilities that have contracts with Medicare Choice organizations (HMOs that have contracted with Medicare). In the past, these facilities have had to submit voluminous levels of paperwork and patient encounter data to qualify for risk-adjustment payments, which are higher payments that compensate the facility for caring for sicker patients. The Secretary has decided to suspend the requirement to submit patient encounter data through July 1, 2002, while the agency explores a new way to develop risk-adjustment payments without unnecessary administrative burden. CMS will also be designing more user-friendly claim forms; the spokesperson was unable to comment on what specific forms will be redone or when they will be available.
The spokesperson added that, in order to better work with physicians and facilities, the agency is adding doctors to all CMS panels, including those that are studying which requirements need to be changed and how the changes can be implemented.
Most of the concrete steps that the agency has taken so far are geared toward beneficiaries; for example, it has launched a $35 million advertising campaign to clarify options for beneficiaries, it has implemented an 800 information line that will be available around-the-clock, and it has instituted a training program for librarians that will aid them in guiding patrons through the CMS web site. As of this writing, the web site's address is still http://www.hcfa.gov; the CMS spokesperson reports that the agency will be publicizing these changes on the web site in the near future.
So far, the reaction from medical community has been mixed. Some have said that they believe Thompson is legitimately committed to improving the agency's dealings with doctors and healthcare facilities. Others have said they have heard such promises before with no results..Most people are taking a wait-and-see attitude. Says ob/gyn William McDonald, MD, of Cherry Hill, NJ, "We'd all welcome real change to HCFA. Right now the agency is a prime example of bureaucracy at its worst. But all I see so far are a lot of lofty promises and no real concrete ways to accomplish those goals. I realize that change will take time. For now, though, I'd have to say that I'll believe it when I see it."
Promising that it is the first step in more substantive changes, Health and Human Services Secretary Tommy Thompson has announced that the name of the Health Care Financing Administration (HCFA) has been changed to the Centers for Medicare and Medicaid Services (CMS). The change is effective immediately.
In addition to the name change, Thompson has promised an institutional overhaul. In a June 14, 2001 press release, HHS outlined a plan for changing the structure of the former HCFA that is intended to make the agency more responsive to needs of beneficiaries, healthcare providers, and payors.
CMS will be organized around three centers: The Center for Medicare Management, the Center for Beneficiary Choices, and the Center for Medicaid and State Operations.
The Center for Medicare Management will focus on overseeing the traditional fee-for-service Medicare program. This includes development of payment policy and management of Medicare contractors.
The Center for Beneficiary Choices will manage the Medicare Choice plans, consumer research and demonstrations, and perform grievance and appeal functions. They will also provide information to beneficiaries on their Medicare, Medicare Select, Medicare Choice, and Medigap options.
The Center for Medicaid and State Operations will focus on state-administered health programs, including Medicaid and insurance regulation.
CMS set three primary goals for itself: Enhancing Medicare education for beneficiaries; creating a more responsive agency to beneficiaries, healthcare providers, and states; and developing Medicare-contracting reform legislation and increasing its ability to reward well-performing contractors.
Among other pledges, CMS has promised to develop a better system to train providers and resolve problems by offering formal training on new requirements, improving its internet-based information for healthcare providers and offering satellite broadcasts geared toward providers. Furthermore, the agency has promised to expand the role of the Physicians' Regulatory Issues Team, an agency-wide group headed by a physician, to "find specific workable solutions to problematic Medicare requirements," according to the press release. Finally, the agency has committed to improve the CMS' Professional Relations Staff to enable it to "develop partner-like relationships with healthcare practitioner associations and health plans," according to the release.
A CMS spokesperson reports that some changes that will affect providers and payors are already in place. One of the changes concerns healthcare facilities that have contracts with Medicare Choice organizations (HMOs that have contracted with Medicare). In the past, these facilities have had to submit voluminous levels of paperwork and patient encounter data to qualify for risk-adjustment payments, which are higher payments that compensate the facility for caring for sicker patients. The Secretary has decided to suspend the requirement to submit patient encounter data through July 1, 2002, while the agency explores a new way to develop risk-adjustment payments without unnecessary administrative burden. CMS will also be designing more user-friendly claim forms; the spokesperson was unable to comment on what specific forms will be redone or when they will be available.
The spokesperson added that, in order to better work with physicians and facilities, the agency is adding doctors to all CMS panels, including those that are studying which requirements need to be changed and how the changes can be implemented.
Most of the concrete steps that the agency has taken so far are geared toward beneficiaries; for example, it has launched a $35 million advertising campaign to clarify options for beneficiaries, it has implemented an 800 information line that will be available around-the-clock, and it has instituted a training program for librarians that will aid them in guiding patrons through the CMS web site. As of this writing, the web site's address is still http://www.hcfa.gov; the CMS spokesperson reports that the agency will be publicizing these changes on the web site in the near future.
So far, the reaction from medical community has been mixed. Some have said that they believe Thompson is legitimately committed to improving the agency's dealings with doctors and healthcare facilities. Others have said they have heard such promises before with no results..Most people are taking a wait-and-see attitude. Says ob/gyn William McDonald, MD, of Cherry Hill, NJ, "We'd all welcome real change to HCFA. Right now the agency is a prime example of bureaucracy at its worst. But all I see so far are a lot of lofty promises and no real concrete ways to accomplish those goals. I realize that change will take time. For now, though, I'd have to say that I'll believe it when I see it."
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