With Liberty and Access for All

The Hospitalist. 2007 May;2007(05):

May 1, 2007|The Hospitalist

The latest estimates from the National Coalition on Health Care (www.nchc.org/facts/coverage.shtml) show that 46 million Americans—nearly 16% of the population—have no health insurance, and those numbers are increasing. The federal government has been flirting with addressing this growing problem for years, but 2007 may be the turning point, when key legislation may help turn the rising tide of uninsured and underinsured patients.

“A couple of things create a more favorable milieu for this,” explains Eric Siegal, MD, regional medical director, Cogent Healthcare, Madison, Wis., and chair of SHM’s Public Policy Committee. “The first is that Massachusetts did it on their own—states are no longer waiting for Congress to do something. The second is that, with every passing year, there’s increased pressure to do something.”

Regardless of why this is happening now, some promising legislation has been introduced in Congress that may provide the beginnings of a solution.

Policy Points

Deadline Approaching for Obtaining Your NPI

The deadline for obtaining a National Provider Identifier (NPI) is May 23. An NPI is required for use in standard health transactions, as mandated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA-covered entities, such as providers completing electronic transactions, healthcare clearinghouses, and large health plans, must use only the NPI to identify covered healthcare providers in standard transactions. For more information on the NPI, visit the Centers for Medicare and Medicaid Services NPI page at www.cms.hhs.gov/NationalProvIdentStand. You can apply for an NPI online at https://nppes.cms.hhs.gov, or you can call the NPI enumerator at (800) 465-3203.

Get the Facts with CMS Medicare Physician Fee Schedule Fact Sheet

The latest Medicare Physician Fee Schedule Fact Sheet is available online from the Centers for Medicare and Medicaid Services. It includes information about how payment rates for individual services are calculated. Factors influencing 2007 payment rates, including the effects of the Five Year Review of physician work relative value units (RVUs) and other refinements, and specifies that the new conversion factor for 2007 is $37.8975 as a result of the SHM-supported Tax Relief and Health Care Act of 2006.

To download the fact sheet, visit www.cms.hhs.gov/MLNProducts/downloads/MedcrePhysFeeSchedfctsht.pdf.

Get a Tdap Vaccine

Have you gotten a Tdap vaccine yet? The CDC now recommends that all hospital and ambulatory care workers who have direct contact with patients should consider receiving a single dose of the tetanus, diphtheria, and pertussis (Tdap) vaccine, which was licensed in 2005. A survey of infection-control practitioners in pediatric hospitals shows that 90% of them had been exposed to pertussis over a five-year period.

The Health Partnership Act

Perhaps the most promising legislation on healthcare access is an innovative, bipartisan, bicameral effort known as the Health Partnership Act, which proposes a federal-state partnership to address the issue.

Identical bills have been introduced in each house. The Health Partnership Act (S. 325) was introduced in the Senate by Jeff Bingaman (D-N.M.) and George Voinovich (R-Ohio), and the Health Partnership Act through Creative Federalism (HR 506) was introduced in the House by Tammy Baldwin (D-Wis.), Tom Price (R-Ga.), and John Tierney (D-Mass.). Similar legislation was introduced by some of these same parties in the last Congress; though the bill died before action was taken, it was immediately reintroduced in the new Congress this January.

If enacted, the Health Partnership Act would give state and local governments the opportunity to implement their own solutions for providing coverage to uninsured populations, allowing them to address the unique needs that exist within their boundaries. Interested states, groups of states, or even parts of states would apply for five-year federal grants by submitting proposals that demonstrate how their plans would reduce the number of uninsured and improve healthcare quality. Each plan would include information on the appropriate use of information technology to improve the availability of evidence-based medical and outcomes data to providers and patients.