HCFA: DeParle Highlights Agency’s Needs
Health Care Financing Administration head Nancy-Ann Min DeParle, joined by a General Accounting Office official, testified yesterday before the House Ways and Means health subcommittee that "Congress has given [HCFA] too much to do and not enough money to do it with." DeParle said, "We are doing everything we can do get the job done with the resources we have. ... [But] [t]he fact remains that our budgets have decreased in real terms, while our responsibilities have grown." DeParle attributed the problem to the "raft of new missions resulting from passage of the 1996 Health Insurance Portability and Accountability Act, CongressDaily reports. The GAO came to a similar conclusion. William Scanlon, GAO director of health financing and systems issues, said, "Substantial program growth and greater responsibilities appear to outstripping HCFA's capacity to manage its increasing workload." He said, "HCFA seems to be focusing most of its energy on important deadlines and pressures, but other critical functions may be receiving the back burner attention." In addition, Scanlon noted that the problems are exacerbated by the reorganization of HCFA that took place last summer and its focus on preventing possible "year 2000" computer glitches.
Private Contracting Concerns
Committee members expressed concern about the provision in the 1997 budget act that prevents physicians from entering into private contracts with patients. When asked by Rep. Pete Stark (D-CA) whether "beneficiaries need a private contract to pay for services not covered by Medicare," DeParle answered, "No, and they never have." In addition, she said, "In a case where coverage is questionable, the law provides that physicians should give patients an 'advance beneficiary notice' that Medicare might not cover the procedure," but physicians would be allowed to provide the service without having to drop out of Medicare (1/29).
In related news, a panel of health care experts yesterday proposed reforms designed to "inject innovation into the traditional fee-for-service part of the Medicare program as it heads into the 21st century." According to the National Academy of Social Insurance, at the heart of the reforms lies the belief that modern techniques from the private sector can help reduce costs and improve services. According to the panel, Congress should mandate that Medicare become "accountable for the quality and costs of services provided to beneficiaries." Panel Chair Paul Ginsburg, president of the Center for Studying Health System Change, said, "Medicare's fee-for-service program is responsible for serving some of the sickest and most vulnerable people in our society, but it is unfortunately behind the times in organizing services for those people. It needs to test and adapt new ways of organizing, delivering, monitoring and paying for services, while preserving a broad choice of providers, especially for people with special health needs." Other panel members included Powers, Pyles, Sutter and Verville's Janet Shikles, a former GAO health policy analyst; Lynn Etheredge, a health care consultant and Judith Moore, of HCFA (release, 1/29).