Health Care Thoughts: Regulatory Bumbling
by Tom aka Rusty Rustbelt
Health Care Thoughts: Regulatory Bumbling
The people who daily manage health care services (and their advisers) have been shocked at the inability of the Obama administration to manage the administrative regs roll out process. The 2009 stimulus act contained multi-year funding for adopting electronic medical records (EMR/EHR) systems.
The funding required “meaningful use” and the published regulations were and are nearly incomprehensible, especially at the physician practice level. EMR/EHRs are making progress but it is largely due to the integration of physician practices into integrated delivery systems.
Then there is PPACA. The first major regulatory effort were the SSP accountable care organization (ACO) regulations, and that was a disaster. Even the administration’s allies ran for the hills. The administration has spent the last half of 2011 creating new ACO sub programs and revising regulations, and has finally convinced some providers to jump on board the pioneer ACO program.
(Some of the desired innovation and integration is happening, but it is being pushed by fear of the future economics of health care rather than directly by PPACA.) .
The C.L.A.S.S. long-term care financing program died in its crib. Early on Secretary Sebelius announced the program was not financially viable, and got into a shouting match with Congressional Democrats when she announced she could change the program without Congress changing the empowering statute. There were attempts at CPR, but the program now appears to be really dead.
The most recent botch (already mentioned in an earlier post here) are the “essential benefits” regulations. As described in WAPO (12/16) the administration punted the decisions to the states. Depending on your perspective, this could be seen as “flexibility” or seen as “surrender.” We are still digesting these rules (it occurs to me multi state employers are going to freak on this). The 2200 pages of PPACA will be backed by many thousands of pages of administrative law.
At the provider and insurer level these regulations are the real meat of the act. A smooth roll out would certainly make PPACA more valuable. Lawyers specializing in health care administrative law are delighted. Consultants and writers are happy as well (I plead guilty). Tom aka Rusty Rustbelt
Anyone else having trouble getting in and out of comments? Darn tec h anyway.
Smart commentary from a smart guy – sorta related.
There appears to be several issues, a couple related specifically to the site. Also the feed is down. The tech guy for AB (me) says its getting too convoluted with code miscues…need to outsource a tech job … any takers? (It’s unfair …. Yves has several tech guys 🙂 )
A very good and informative article indeed . thanks for your site
Rusty’s post is a reflection of much the same information continuously showing up in one information source or another. Even my wife described similar concerns voiced by her doctor during a very recent check up visit. Is it possible that Obama and/or his cohorts that make up his administration were being cynical in pushing hard for “health care reform” legislation that had no real likelihood of implimentation due to its labyrinth of details and the future focus of that implimentation. Isn’t it a DC phenomenon that what is delayed for the future is intended to always be delayed? Was it all just a ploy to abandon universal health care while seeming to pass legislation intended to improve health care, but accomplish nothing Or, am I being too cynical?
Not for me, Jack.
Not cynical enough for me, but getting close.
Welcome to Pottersville2
Jack, I think you are being too cynical.
My hypothesis is this:
liberals, when given the chance, try to fix everything, try to please every constituency, and generally overrate the competence of government.
The result is bills like PPACA and Dodd-Frank, both of which are a spaghetti mess of rules and regulations that are too complex to implement easily.
Also, many liberal staffers and wonks have never worked in the private sector, and have no idea what it is to do the difficult work of implementation (example: meaningful use regulations) and management.
Just my thoughts.
“…liberals, when given the chance, try to fix everything, try to please every constituency, and generally overrate the competence of government.” rusty
I’m not comfortable with your reference to liberals in that statement, especially in regards to the please every constituency piece of it. First, liberals is too broad a stroke and few elected representatives in the Congress deserve to be identified as liberals. They may be Democrats or not Republicans and something other than conservatives. They are certainly not, by and large progressives. What I would agree with is that those people that you are identifying as liberals are trying to appear as though they are addressing the needs of their electoral constituents while they know they are beholding to their financial supporters. The results are a hodge podge of legislative initiatives that are unlikely to work to the benefit of those that are supposedly being served by the legislation.
Take as an example ilsm’s disclosure of military spending absurdities. Are we being better protected? Or is there a profit motive behind all the chest thumping and fruit salad parading around DC? The problems don’t arise out of the need to satisfy disparate constituencies, but rather from the need to disguise the intent of most legislative activity. One vote per person is trumped by a dollar a vote. Liberals have nothing to do with the issue. Our political class sees itself as financially tied to the One Percent, and wants to be sure to be included in at least the top 2nd or 3rd percentile rank, if not the first.
In my long experience with regulatory compliance, bureaucracies behave much differently under Democratic (liberal if you will) administrations than otherwise.
The military procurement mess is forever, regardless of administration. Granted.
In either case, both PPACA and Dodd-Frank require massive regulatory efforts, and the more complexity the lower the chances of success, IMHO.
Speaking of regulations….
Mrs. R. had a used needlestick a couple of weeks ago, trying to give an injection to a dementia patient. That makes probably 6 sticks in 38 years.
While she appreciates the policies that provide her some post-stick protection, she new feels she has decended into some vast paperwork pit with confusing regulations and incoherent policies. So far the elderly gentlemen is negative for everything, so she is not worried much about infection.
But then her daily routine is a vast paperwork pit with confusing regulations.
It’s the documentation aspect that is sinking the boat that carries the product. For those holding the mistaken belief that educators work until three in the afternoon, think again. Teachers and ancillary services offered by the school systems have student contact from about 8:30 AM to 3:00 PM. The documentation of both the activities and the student’s responses to those activities is under greater scrutiny than is the contact time. That documentation is generally prepared by those educators at home for an additional two to three hours daily. Prepare the lessons and note the students’ accomplishments related to those lessons. Some of those ancillary services are Medicaid funded though provided in the schools. The documentation is equivalent to the provision of medical treatment. Notes, notes, and more notes. It’s a quagmire that is soaking up time like a sponge in water.
Personally, I think some regulation in the health care industry is a good thing. It keeps abuse down. It’s like in sports with athlete drug testing. Without the regulation, abuse would probably be rampant. As it is, it’s already pretty bad, so think of how it would be without it. I feel the same about healthcare regulation. We need it. Not too much, of course. But just enough to keep things on track.