I Didn’t Get a Harumph Outta That Guy…

Good morning, ProviderNation.

If you missed it yesterday, CMS took a chunk out of the long term care industry. Testifying before the Senate Finance Committee, Melanie Bella, director of CMS’ dual-eligibles effort, took aim at rehospitalizations, which she said “could be disruptive, dangerous, and costly.”

Sen. Max Baucus, D-Montana, had a follow-up. “What are you doing to help minimize providers gaming the system?” he asked Bella. “There’s a lot of gaming going on, I suspect.”

“It is part of the problem, and what we’re trying to do is establish accountability for the dollars,” she replied. “Today, they might be able to play Medicaid and Medicare against each other … but when they’re responsible … you take away some of those incentives for gaming those two payers.”

This didn’t sit well with industry types. “There’s no question that dual eligibles are a cost driver in today’s system,” said Jeff Myers, AHCA’s top lobbyist. “But we need solutions and are committed to helping find them. Unfair accusations serve no one, especially those elderly who need this care the most.”

Sen. Jay Rockefeller, D-W.Va., also wasn’t hip to CMS’ vibe. He said he didn’t trust CMS’ assurances that they were merely testing “proposals” for managed care. “This is a losing situation for dually eligible beneficiaries as well as federal and state programs trying to deliver the effective, high-quality care they need and deserve,” Rockefeller said.

There are a lot of subtexts here. The Obama administration won a decisive victory, but the Affordable Care Act remains its most unpopular piece of legislation. And Republicans, though wounded by last month’s elections, aren’t dead. What better way, then, to reassure the budget conscious, than with a good, old-fashioned harrumph against “gaming?”

Meanwhile, industry is fighting a multi-front battle against further spending cuts. To some insiders we’ve spoken to, these accusations of gaming—are, shall we say, curiously timed.

1 Comment

Filed under health care, Long term care

One response to “I Didn’t Get a Harumph Outta That Guy…

  1. Your style is unique compared to other people I’ve read stuff from. I appreciate you for posting when you have the opportunity, Guess I’ll just book mark this blog.

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