HCFA computer upgrades may delay pay raises
HCFA computer upgrades may delay pay raises
Prodded by President Clinton's recent mandate that federal agencies make protecting their computer systems from the much-maligned year 2000 computer bug a top priority, HCFA is saying it might have to delay scheduled increases in provider pay to comply with this mandate.
Forced to choose between making the scheduled provider fee hikes or being able to process the estimated one billion Medicare claims for some $288 billion in annual benefit payments, HCFA says it will pick the claims processing option. In turn, the agency wants the Clinton administration's permission to ask Congress to legislatively delay implementation of several key activities that would require major changes in HCFA's computer programs, HCFA administrator Nancy-Ann Min DeParle said in a June 11 memo to the U.S. Department of Health and Human Services.
Among the programs HCFA wants postponed are increases in Medicare's physician fee schedule for fiscal year 2000, along with prospective payments for hospitals and outpatient and per-episode home health services.
Agency officials also say HCFA is working on a "partial system fix" for beneficiary enrollment in health plans, new preventive coverage requirements, a competitive bidding demonstration for durable medial equipment, and implementation of skilled nursing facility prospective pay rates.
These tentative delays have already come under harsh criticism from key congressional leaders. "I am particularly troubled by the fact that the two prospective payment systems that the administration wants to delay were originally proposed by the administration as part of the president's fiscal year 1998 budget proposal," says Rep. Bill Thomas (R-CA), chairman of the House Ways and Means Health subcommittee. "It's not fair to the seniors in this country to promise them more health care choices and then deny them the means to make these choices."
If a delay was approved, many physician groups wonder what impact it could have on implementation of the changes in HCFA's long-debated practice expense formula.
"We would like a clear explanation of how this would effect implementation of annual fee schedule updates, resource-based practice expenses, and physicians' cash flow," says Jamie Winson, spokeswoman for the American College of Physicians-American Society of Internal Medicine in Washington, DC.
Rep. Fortney "Pete" Stark (D-CA) has proposed an alternative bill, the Medicare Contracting Flexibility Act of 1998 (HR 4186), giving HCFA authority to require contractors to comply with year 2000 corrections and include year 2000-compliant technology in any new information systems equipment they install. He says this would take the burden off HCFA for complying with the year 2000 computer upgrades.
"HCFA is in danger of missing numerous statutory deadlines for modernizing Medicare because the program's contractors have failed to aggressively prepare for the year 2000," says Stark. "Congress needs to do something to avert what could be a larger potential crisis."
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