As the “Three Tenors” (Chairmen Waxman, Miller and Rangel) struggle to finance the access enhancements that are central to the President’s health reform aspirations, the need for meaningful payment reform continues to challenge. This week House Speaker Nancy Pelosi urged the Chairmen to sharpen their pencils in this regard. Moreover, in a letter to the Speaker and Majority Leader Steny Hoyer, the fiscally-conservative “Blue Dog” coalition of House Democrats has now said that the current drafts fail to include sufficient structural reforms likely to succeed in lowering costs and incenting “value” (in purchasing).
I recently read an enlightening study by Development Dimensions International (DDI) — “Holding Women Back: Troubling Discoveries and Best Practices for Helping Female Leaders Succeed” — which reveals that, worldwide, women are simply not getting the same career opportunities as men. The study is based on responses from 12,800 leaders in 76 countries and approximately 1,500 organizations. However, the study also offers advice on how to overcome such challenges.
We learn that, in addition to earning lower salaries than men, women are often overlooked when employers single out “high potentials” — employees who have strong leadership potential. High-potential employees are placed in accelerated development programs to foster their leadership skills. The DDI study reveals that the gap between men and women in high-potential programs widens as management levels increase: “there were 28 percent more men than women in high-potential programs at the first level of management and 50 percent more men than women in such programs at the executive level.” As a result, fewer women than men reach senior leadership positions.
For the last week or so, the health reform public policy debate has been keyed to the Senate HELP Committee’s draft and thus dominated by whether or not the “Exchange” to be employed in access reform should include a “public plan” and, if so, whether such a plan should have the power to access provider payment rates tied to Medicare and whether Medicare participating providers would be required to contract with it. With this week’s release of the Senate Finance Committee’s draft, it will be interesting to see whether payment reform can similarly capture the attention of the press. Frankly, we have low expectations in this regard insofar as the consequences that the prevalence of fee for service payment methodologies have on health care output are hard to grasp relative to the easier concept of “universal coverage”. Perhaps it is ultimately less important that payment reform capture the air waves than the degree to which payment reform is incorporated in whatever pieces of health reform make it through this session of Congress.
Although there are some big issues that remain unresolved, such as the “public plan” component, it appears that we will see reform legislation pass in 2009. Drafts of the legislation are being prepared now by various members of Congress and their staffs.
The focus on medical homes, physician hospital organizations and accountable care organizations is very real, as is the focus on payment reform, including bundled payments and other forms of capitation-like reimbursement. A key element of the debate relates to “how integrated” a provider organization will need to be to qualify for bundled payments. Can it be virtual? Can it be physician only or must a hospital be involved? What should be the role of private payors?
Written by Paul Campbell and Maura Farrell
The Washington Post has reported that Congressional Democrats have reached a tentative agreement on President Obama’s $3.5 trillion budget, including reconciliation instructions which would allow health reform legislation to pass the Senate with only 51 votes. The agreement would charge each of the Committees with jurisdiction over authorization of healthcare legislation to find $1 billion in savings. If the agreement moves forward and is passed by the full House and the Senate (as expected), these “instructions” would allow for the Senate to bypass normal Senate parliamentary rules requiring 60 votes for approval. The tentative conference agreement would also extend for two years the Medicare physician payment “fix”. The extension reduces a budget savings needed for a complete repeal of the current payment methodology, which applies a sustainable growth rate (SGR) limit.
Barack Obama signed an executive order on April 8, 2009 to formally lay infrastructure in the executive branch to facilitate health care reform activities. The executive order officially creates the White House Office of Reform (the “Health Reform Office”) and lays out its principle functions, including coordination across executive departments and agencies, outreach activities with state and local policymakers, and working with Congress for the purpose of enacting and implementing health care reform. As we reported on March 6, 2009, Nancy Ann DeParle was selected to be the Director of the Health Reform Office. The order grants DeParle the discretion to work with “established or ad hoc” committees, task forces, or interagency groups. It remains to be seen how DeParle will use this authority to promote the goal of the Obama Administration to have an open, inclusive and transparent process for health care reform.
Updated from 2/25/09
On February 17, 2009, President Obama signed into law the American Recovery and Reinvestment Act of 2009 (H.R. 1, S. 1) (the “Act”), which, among other things, amends the Consolidated Omnibus Budget Reconciliation Act of 1985 (“COBRA”).
The Act provides:
- for a government subsidy of up to 65 percent of the COBRA premiums (including state “mini-COBRA” coverage) to certain eligible individuals (known as “assistance eligible individuals”);
- that the COBRA subsidy applies only to individuals who are eligible for COBRA due to an involuntary termination from employment from September 1, 2008, through December 31, 2009; and
- that the COBRA subsidy applies for a maximum of nine (9) months of coverage (beginning on March 1, 2009).
With the start of 2009, New Jersey employers may find it useful to review the notification requirements relating to employees’ workplace rights and responsibilities under both state and federal law.
Employers are mandated under both New Jersey and federal law to display official posters informing employees of the law relating to their rights and responsibilities. An employer who fails to comply with these requirements may face monetary fines or other penalties. Generally, to comply with these regulations, an employer must post the most recent version of the posters in locations visible to all employees and applicants for employment. Employers should display these notices in areas accessible to all employees, such as a lunchroom, break-room or human resources office. New Jersey also requires that certain of the notices be distributed to employees. This article serves as a reminder and summary of New Jersey’s notification requirements applicable to most employers.
The worldwide economy crisis is now a reality. All countries are suffering the effects, one more than others and no sector or industry is not shielded against it.