MEDICARE: Can HCFA Handle Program Changes?

      The Health Care Financing Administration most likely will be unable "to meet statutory deadlines for many of the changes scheduled to take effect over the next two years," the front page of yesterday's New York Times reported. "Overwhelmed with new responsibilities," HCFA officials said "they will miss deadlines for some of the changes" mandated in last year's balanced budget law. Some members of the bipartisan Medicare reform commission have expressed fears that "some attractive policy options under consideration may prove unworkable for a similar reason: the cannot be carried out in a timely way." HCFA is "severely behind schedule" in trying to fix its computers to deal with the Year 2000 problem, according to a General Accounting Office report due out next month. "In any event," the Times reported, "it is clear that Congress overestimated the agency's ability to make hundreds of complex changes" to the Medicare program. William Scanlon, the GAO's director of health care studies, said HCFA's new tasks "appear to be outstripping its capacity to managed its existing workload." The GAO report says it is "highly unlikely" that the computer systems will be fixed "in time to insure the delivery of uninterrupted benefits and services into the year 2000." Rep. Pete Stark (D-CA) said, "It is incomprehensible to me how this year 2000 problem has gotten so far out of hand. [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." Nancy-Ann Min DeParle, head of HCFA, conceded that her agency "got a late start" on the Y2K problem, but said the agency has made "credible progress."

What's The Hold-Up?
      The Times noted that in addition to the Y2K problem, "Medicare officials have never had so many changes to make" at one time. In addition to the new Medicare+Choice program, HCFA has the new Children's Health Insurance Program to run and is "struggling" to enforce the 1996 Kassebaum-Kennedy portability law. "It was naive for Congress to think that it could load a huge number of tasks on this agency and expect the work to be completed in a timely way," said health care attorney Joel Hamme. Health care lawyer Steven Epstein defended HCFA's work ethic but said it has "been overwhelmed with the tasks that have been given to them." The Times reported that other factors contributing to the delays include the agency's just-completed "major reorganization," which "disrupted the work of many offices"; the retirement of many experienced workers; the cancellation of "a huge computer project" that was to have streamlined the administration of the Medicare program; and the agency's sluggishness in adopting a more market-based approach to heath care. Bruce Fried, a lawyer who used to be with HCFA, said, "The agency has a tendency to be mistrustful of health care providers, especially investor-owned organizations. Few people at the agency have had experience in the private sector. Officials do not fully appreciate the power of the market, and the innovation that takes place in a market-driven economy." The Times reported that HCFA officials said earlier this summer they would introduce legislation to change the deadlines for the Medicare changes, "but so far they have not submitted such proposals to Congress" (Pear, 9/27).

Hoping For The Best
      In yesterday's Washington Post, former Post financial writer Stan Hinden recounted some of the concerns he and his wife face as the well-being of the Medicare system becomes increasingly uncertain. He wrote: "[T]he bottom line is that we, like millions of other Americans, now depend on Medicare for our primary health care coverage. So when we hear that Medicare is in financial trouble, we feel as if we're in trouble. And we wonder whether Medicare will still be around in the future when we're sure to need it." Hinden noted that while he believes the program will survive, he is "worried about how well the program will meet our needs" (9/27). Click here to read the article.