In addition to the many hotly contested insurance and access-related provisions in the America’s Healthy Future Act of 2009, the Chairman’s Mark from Senator Baucus on behalf of the Senate Committee on Finance, released Wednesday, there is in the bill a section that addresses in a substantive way reform of the health care delivery system with a focus on quality. Much of the underlying thinking in Title III of the bill, entitled “Improving the Quality and Efficiency of Health Care,” draws from the Institute of Medicine’s seminal publication in 2001 of Crossing the Quality Chasm. Especially in Subtitle A, “Transforming the Health Care Delivery System” (pages 75 to 110), one can see the impact of the IOM’s definition of quality as six aims: care that is safe, effective, efficient, patient-centered, equitable and timely. As a current member of the IOM’s Board on Health Care Services, I am gratified to see these ideas captured in important proposed legislation.
Perhaps in recognition of its benefits to areas affected by shortfalls in specialists and primary care physicians or the need for remote monitoring, telemedicine received significant funding in the ARRA. For instance, the Rural Utilities Service was allocated $2.5 billion to fund “shovel-ready” distance learning, telemedicine, and broadband program; the Indian Health Services received $85 million to fund telemedicine; and a portion of the $2 billion allocated to the Office of the National Coordinator is to be used to support the “infrastructure and tools for the promotion of telemedicine.” However, in contrast to the ARRA, the current reform proposals publicly available are missing language facilitating telemedicine which otherwise could be a key component to one of the goals of health reform, bending the cost curve.
The only attention telemedicine receives in the House Tri-Committee Bill – the America’s Affordable Health Choices Act of 2009 – is in the creation of the Telehealth Advisory Committee. This Committee will advise and make recommendations to the HHS Secretary regarding policies for payment of telemedicine services. However, the Senate HELP’s Bill – the Affordable Choices Act – does not even mention telemedicine.
On July 27, 2009, the U.S. Court of Appeals for the Ninth Circuit held that a corporation’s managers can be held personally liable under the Fair Labor Standards Act (“FLSA”) for wages that the corporation failed to pay to employees prior to the employer’s filing for bankruptcy. This opinion serves as a cautionary reminder of the risks managers potentially face when a corporation files for bankruptcy and has failed to pay its employees for all wages earned prior to the filing.
In Boucher v. Shaw, —- F. 3d —-, 2009 WL 2217517 (9th Cir. 2009), former employees of the Castaways Hotel, Casino and Bowling Center sued three senior managers for unpaid wages under Nevada state law as well as federal law. The managers moved to dismiss the claims based on, among other grounds, the fact that the hotel had filed for bankruptcy protection. The Ninth Circuit asked the Nevada Supreme Court to address the issue of whether, under state law, the managers could be personally liable as “employers” for the unpaid wages. The Nevada Supreme Court ruled that individual managers are not “employers” under state law. However, the Ninth Circuit ruled against the managers on the federal FLSA claims and allowed the employees’ claims to proceed.
Recently, the Ark Group’s WOMENLEGAL 2009 forum brought together gender-diversity thought-leaders in New York for an important conference on women in the legal profession. The forum focused on the key career issues facing women lawyers today, and practical solutions for both women lawyers and law firms regarding retaining and advancing women in the legal profession.
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.