Nov. 28, 2011

Tavenner to Lead CMS This Week; Berwick Leaves Dec. 2

Marilyn Tavenner, principal deputy administrator at CMS, will replace Don Berwick as CMS chief.  Berwick plans to depart December 2.  Tavenner was appointed to her post in February 2010 Virginia.  Tavenner, who was secretary of Health and Human Resources in the administration of then-Virginia Gov. Tim Kaine (D) from 2006 until Gov. Bob McDonnell (R) took office, joined CMS as principal deputy administrator, a newly created position that makes Tavenner the second-ranking official at the agency .

Prior to her tenure under Kaine, Tavenner was a nurse and an executive at the Hospital Corporation of America, where she ran two facilities in suburban Richmond and served as chairwoman of the Virginia Hospital Association and a trustee at the American Hospital Association.  Berwick was recess appointed in July 2010, and the Senate never held a confirmation vote as Berwick was not expected to be approved.  Here is the full text of Berwick’s email to the HHS staff he sent November 23:

Dear Colleagues,

I write with bittersweet emotions to share personally what you have probably now seen in a note from Secretary Sebelius. I have informed her of my decision to resign my post as CMS Administrator, effective December 2. Although this does not come as a surprise to many of you, I nonetheless want to take this moment to tell you how honored I feel to have had the chance to work with such a dedicated team of people at CMS and HHS for the past year and a half. We have made history together both in implementing the Affordable Care Act and in conducting and improving the crucial ongoing work of our Agency and Department.

Our work has been challenging, and the journey is not complete, but we are now well on our way to achieving a whole new level of security and quality for health care in America, helping not just the millions of Americans affected directly by our programs, but truly health care as a whole in our nation.

The mission of CMS is inspiring, and the people of CMS are among the most talented I have worked with in my career. You have embraced the “Three-Part Aim” — Better Care, Better Health, and Lower Cost through improvement — in all that we do and have worked tirelessly to keep those we serve at the forefront of our efforts. I have seen firsthand the difference you are all making as I’ve traveled the country, visiting our regional offices and meeting with beneficiaries, health care professionals, and many other stakeholders to discuss CMS programs and the promise of the Affordable Care Act. I am proud of what we have accomplished together and of all that you will continue to do moving forward to improve health and health care for the American people.

I also ask that you now give Marilyn Tavenner the same support and cooperation you have given me. She has been a tremendous partner in our work together and is well prepared to take on this role in her own right at this important moment. You already know, as I do, that she shares deeply our commitment to the important work of CMS especially as we launch new programs that are transforming health and our health care system. With Marilyn, our senior leadership team, and the accomplished CMS staff I am confident that you will continue to make a positive difference in the lives of the millions we serve today and those you will serve in the future.

With sincere thanks,
Don Berwick

Sequestration Hits Hospitals Hardest:  New Analysis

Hospital inpatient reimbursement, followed by nursing homes and physicians, are likely to take the biggest financial hit if sequestration is allowed to take effect in January 2013, according to a new analysis from Avalere – a health care analytics firm.  The study says hospital inpatient payments take 32% of the health care cuts.  Click here to review a very good slide presentation on the impact of sequestration.

Providers Hope to Avoid Cuts

What happens now that the Supercommittee failed and the 2% sequester is the law?  Some health care leaders are already laying the groundwork to redirect a debate they’re expecting in 2013, after the 2012 election. They hope to prevent spending from simply being shifted from one part of the system to another.  Click here for the Washington Post story.

House Dems Urge Boehner to Fix SGR this Year

House Democratic leaders urge Speaker Boehner last week to pass a physician Medicare payment fix (Sustainable Growth Rate) before the end of the year.  In a letter to Boehner last week, Reps. Pelosi, Hoyer and Clyburn suggest that millions of seniors could lose their physicians unless the 27.5 percent payment reduction is not fixed.  Click here to read the letter.

USDA Announces Grants for Rural Health Projects

The Agriculture Department last week announced funding to establish telemedicine and other health care projects to address unmet health care needs in the Delta region.  The grants will help fund healthcare 10 projects in six states that will deliver health services to areas currently lacking adequate care and deliver services to 25 persistent poverty counties.  Click here for details.

ePrescribing a Problem for Mail-Order Pharmacies: New Study

About three-quarters of physician practices reported problems sending new prescriptions and renewals electronically to mail-order pharmacies, according to new study on ePrescribing sponsored by AHRQ.  Many practices were unsure which mail-order pharmacies accepted e-prescriptions and believed that, even when a mail-order company did accept them, the process was unreliable. Click here for details.

CMS Expands Medicare Fraud Program for Seniors

CMS last week awarded $9 million to help Senior Medicare Patrol programs across the nation continue their work fighting Medicare fraud.  Since 1997, HHS has funded Senior Medicare Patrol projects to recruit and train retired professionals and other senior volunteers about how to recognize and report instances or patterns of health care fraud.  More than 4 million Medicare beneficiaries have been educated since the start of the program.  Click here for more.

NAIC Supports Changes to MLR

The NAIC adopted a resolution urging Congress and HHS to “preserve consumer access to insurance agents and brokers” by adjusting the medical loss ratio (MLR) component of the Affordable Care Act.  The National Association of Insurance Commissioners voted on this last here.  Click here to see their resolution.

HHS Points Finger at Insurer; Says Premium Increase is Unreasonable

Everence Insurance is charging small businesses unreasonably high premium increases according to the first federal rate review under the Affordable Care Act, HHS announced.  The insurer is based in Indiana and licensed to do business in Pennsylvania.  Last week’s announcement marks the first of many reviews that HHS will perform in addition to insurance rate reviews already being done by states.  Proposals to raise rates by 10 percent or more will be reviewed. Click here for more.