Texas Tech University Health Sciences Center
The expanding role of the federal government in health care

The expanding role of the federal government in health care

the-expanding-role-of-the-federal-government-in-health-care- image0I will repeat myself, but it is amusing to hear people say they do not want the federal government involved in health care. That ship has already left the port. Furthermore, it left approximately 50 years ago when Medicare and Medicaid became the law of the land, and it could actually be traced back further. There is no question the role of the federal government in health care continues to expand. I am not saying it is all negative, but I am saying it is reality.

Here are some issues involving the federal government that will have a major effect on Texas Tech Physicians in 2014, or as John Berry, senior clinical administrator in Pediatrics might say, these issues “bear watching.”

• Meaningful use of electronic health records (EHR) to which physicians must attest by Sept. 30. Physicians who do not attest to fulfilling the meaningful use requirements by the deadline will be subject to Medicare penalties in 2015. Craig Bradley, M.D., and his team have worked hard (and successfully) on prior deadlines and we have confidence that we will meet this one, but continued success cannot be assumed. Rebecca Iffert has been most helpful in keeping us current in our reporting on meaningful use.

• Implementation of the ICD-10 code set, scheduled for Oct. 1. Under the new code set, Texas Tech Physicians and coders will have to deal with approximately 68,000 outpatient diagnostic codes — a five-fold increase over the 13,000 ICD-9 codes we currently use. I semi-jokingly call this a tsunami — we must be ready for it and people are working hard to get us prepared. Corlis Norman in the Compliance Office is taking the lead.

• Implementation of the Affordable Care Act (ACA). Aspects of the roll out have been difficult, as everyone knows. Many of the features of ACA are set to start this year. Texas Tech Physicians has not seen any measurable affect yet, but that could change. Jimmy Williams in Provider and Payor Relations is paying strict attention to the ACA.

• Repeal of Medicare’s failed Sustainable Growth Rate (SGR) formula. SGR is the method currently used by the Centers for Medicare and Medicaid Services to control Medicare for physician services. Before the holidays, the U.S. House of Representatives Ways and Means and U.S. Senate Finance committees passed similar bills to repeal SGR — the closest Congress has ever come to reaching a bipartisan, bicameral agreement. We will be watching to see if the full House and Senate can pass a bill that would change or do away with the SGR formula.

• Physician data will be published by Sept. 30 under the Sunshine Act. I do not expect this to affect Texas Tech Physicians to a great degree, but what the act intends to do is bring transparency to financial relationships between medical device and drug manufacturers and physicians to decrease the potential for conflict of interest in selecting appropriate treatments for patients. Providers will have 60 days to dispute any reported information before it is made available to the public.

Actually, it will take more than watching on most of these — it will take concerted effort.