HR3962 : Division B

So far we have learned that HR 3962 brings the single payer health care system to America along with health care rationing, special end-of-life care, and federally funded abortions. Along with all of those headaches it also brings a dictionary full of new taxes, and all of that was written into Division A. Let’s start a quick review of Division B.

Section 1111 starts off by regulating non-therapy ancillary services. It appears that payment for these services will be based on the patients age, physical and mental status, ability to perform activities of daily living, and other information.

The Secretary of Health and Human Services shall analyze payments for non-therapy ancillary services under a future skilled nursing facility classification system to ensure the accuracy of payment for non-therapy ancillary services. Such analysis shall consider use of appropriate predictors which may include age, physical and mental status, ability to perform activities of daily living, prior nursing home stay, diagnoses, broad RUG category, and a proxy for length of stay.

Why should non-medical staff have the authority to decide what type of non-therapy ancillary service you may require? Shouldn’t your doctor, or at least a health care professional be the one choosing your medical treatment?

Payments for stays in skilled nursing facilities will be based on the aggregate costs during that stay and not on the number of days in that stay.

Outlier adjustments or additional payments described in subparagraph (A) shall be based on aggregate costs during a stay in a skilled nursing facility and not on the number of days in such stay.

but

The Secretary shall reduce estimated payments that would otherwise be made under the prospective payment system under this subsection with respect to a fiscal year by 2 percent. The total amount of the additional payments or payment adjustments for outliers made under this paragraph with respect to a fiscal year may not exceed 2 percent of the total payments projected or estimated to be made based on the prospective payment system under this subsection for the fiscal year.

So rather than base the payment on the number of days a patient stays in the facility, the payments will now be based on aggregate costs minus 2 percent. In other words, facilities will not even be paid for their actual costs for providing treatment.

Section 1112 establishes the standard by which Medicare DSH payments will be reduced to hospitals and service providers based on the “significant” decrease in the numbers of those who are uninsured. A significant decrease will be measured only if there is an 8% decrease in the number of those uninsured. I thought the purpose of this bill was to insure all of the uninsured people in America. Isn’t setting a target goal of only 8% rather lame?

There is a lot more to this bill than I am covering, but like I said when I started, I am trying to cover some of the more important sections of the bill before the debate on the bill begins. You can be sure of one thing. If you followed my review of HR 3200, which was much more in-depth, almost every provision of that bill also exists in this bill.

Section 1156 prohibits the expansion of hospitals without the approval of the Secretary of Health and Human Services. The expansion of facility capacity is completely prohibited.

PROHIBITION ON EXPANSION OF FACILITY CAPACITY- Except as provided in paragraph (2), the number of operating rooms, procedure rooms, or beds of the hospital at any time on or after the date of the enactment of this subsection are no greater than the number of operating rooms, procedure rooms, or beds, respectively, as of such date.

But the Secretary can determine the process in which those facilities can apply for an exception and be allowed to expand.

The Secretary shall establish and implement a process under which a hospital may apply for an exception from the requirement under paragraph (1)(C).

While these exceptions may be approved and facilities will be allowed to expand, they won’t be allowed to expand to a size which is double the size they were when the bill takes affect.

PERMITTED INCREASE-

(i) IN GENERAL- Subject to clause (ii) and subparagraph (D), a hospital granted an exception under the process described in subparagraph (A) may increase the number of operating rooms, procedure rooms, or beds of the hospital above the baseline number of operating rooms, procedure rooms, or beds, respectively, of the hospital (or, if the hospital has been granted a previous exception under this paragraph, above the number of operating rooms, procedure rooms, or beds, respectively, of the hospital after the application of the most recent increase under such an exception).

(ii) 100 PERCENT INCREASE LIMITATION- The Secretary shall not permit an increase in the number of operating rooms, procedure rooms, or beds of a hospital under clause (i) to the extent such increase would result in the number of operating rooms, procedure rooms, or beds of the hospital exceeding 200 percent of the baseline number of operating rooms, procedure rooms, or beds of the hospital.

(iii) BASELINE NUMBER OF OPERATING ROOMS, PROCEDURE ROOMS, OR BEDS- In this paragraph, the term ‘baseline number of operating rooms, procedure rooms, or beds’ means the number of operating rooms, procedure rooms, or beds of a hospital as of the date of enactment of this subsection.

Expansions will be limited only to those hospitals and facilities which have experienced population increases, increased patient admissions in their respective counties, and a higher bed occupancy rate within their state.

In other words, Section 1156 will hasten the end of quality medical care in rural America. If the population isn’t there, it won’t be cost effective to expand (or even build) medical facilities.

Section 1161 gives the Secretary authority to cut payments and even make the determination if Medicare Advantage Plans are qualified health plans.

AUTHORITY TO DISQUALIFY DEFICIENT PLANS- The Secretary may determine that a Medicare Advantage plan is not a qualifying plan if the Secretary has identified deficiencies in the plan’s compliance with rules for Medicare Advantage plans under this part.

The entire section is much longer, but in essence, $150 billion could be cut from Medicare Advantage Plans, which would reduce or eliminate the coverage for millions of senior citizens.

If it wasn’t enough to put their health coverage plans in jeopardy, Section 1236 authorizes the Secretary of Health and Human Services, acting through the Center for Medicare and Medicaid Innovation established under section 1115A of the Social Security Act, to establish a decision making program under the Medicare program using patient decision aids to meet the objective of improving the understanding of medical treatment options in a “shared decision making” process using those patient decision aids.

This section will also waive requirements of the Social Security Act Titles XI and XVIII, seniors will be required to meet attend counseling on Medicare services, and compensation will be granted to providers who generate less cost for care.

Read that last paragraph again people. Compensation if you generate less cost for care. Exactly how do you generate less cost for care with a “patient decision aid”? What decision could a senior citizen possibly make that would reduce the cost for their care? You get the point.

Section 1401 creates the “Center for Comparative Effectiveness Research”. The what? Comparative effectiveness?

The Center shall–

(A) conduct, support, and synthesize research relevant to the comparative effectiveness of the full spectrum of health care items, services and systems, including pharmaceuticals, medical devices, medical and surgical procedures, and other medical interventions;

(B) conduct and support systematic reviews of clinical research, including original research conducted subsequent to the date of the enactment of this section;

(C) continuously develop rigorous scientific methodologies for conducting comparative effectiveness studies, and use such methodologies appropriately;

(D) submit to the Comparative Effectiveness Research Commission, the Secretary, and Congress appropriate relevant reports described in subsection (d)(2);

(E) not later than one year after the date of the enactment of this section, enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences shall conduct an evaluation and report on standards of evidence for highly credible research;

(F) encourage, as appropriate, the development and use of clinical registries and the development of clinical effectiveness research data networks from electronic health records, post marketing drug and medical device surveillance efforts, and other forms of electronic health data; and

(G) appoint clinical perspective advisory panels for research priorities under this section, which shall consult with patients and other stakeholders and advise the Center on research questions, methods, and evidence gaps in terms of clinical outcomes for the specific research inquiry to be examined with respect to such priority to ensure that the information produced from such research is clinically relevant to decisions made by clinicians and patients at the point of care.

How long until the “Center for Comparative Effectiveness Research” begins to deny access to necessary, life saving treatments because the comparative costs of providing them no longer shows effectiveness in reviews by the center staff?

Again, there is a lot more in this bill. I feel like I haven’t even scratched the surface yet. It’s not that I feel I am missing information, I just don’t feel the need to regurgitate all of the text from HR 3200 that still exists in this bill.

Section 1416 with authorize the all powerful Secretary of Health and Human Services to maintain specific information on all direct care staffing at each and every medical facility in the country.

SUBMISSION OF STAFFING INFORMATION BASED ON PAYROLL DATA IN A UNIFORM FORMAT

On and after the first day of the first calendar quarter beginning after the date that is 2 years after the date of enactment of this subparagraph, and after consulting with State long-term care ombudsman programs, consumer advocacy groups, provider stakeholder groups, employees and their representatives, and other parties the Secretary deems appropriate, the Secretary shall require a skilled nursing facility to electronically submit to the Secretary direct care staffing information (including information with respect to agency and contract staff) based on payroll and other verifiable and auditable data in a uniform format (according to specifications established by the Secretary in consultation with such programs, groups, and parties). Such specifications shall require that the information submitted under the preceding sentence–

(i) specify the category of work a certified employee performs (such as whether the employee is a registered nurse, licensed practical nurse, licensed vocational nurse, certified nursing assistant, therapist, or other medical personnel);

(ii) include resident census data and information on resident case mix;

(iii) include a regular reporting schedule; and

(iv) include information on employee turnover and tenure and on the hours of care provided by each category of certified employees referenced in clause (i) per resident per day.

Nothing in this subparagraph shall be construed as preventing the Secretary from requiring submission of such information with respect to specific categories, such as nursing staff, before other categories of certified employees. Information under this subparagraph with respect to agency and contract staff shall be kept separate from information on employee staffing.’.

What purpose would the government have for keeping track of every member of the direct care staff, unless they’re just preparing for the new single payer system where every member of the medical community works for the federal government anyway?

Section 1802 establishes the funding for the aforementioned “Center for Comparative Effectiveness Research”, which will be funded by taxes on certain insurance policies. Yes. In addition to the bakers dozen of new taxes already mentioned, Nancy Pelosi intends to tax some specific health care plans in order to fund their comparative effectiveness research.

Back on July 9th, 2009, Speaker of the House Nancy Pelosi pledged that the House would not leave for the August recess without passing a health care overhaul bill, and she promised that any bill from the House would not tax health benefits.

Pelosi said that any bill the House passes will not tax employee health care benefits and will include a robust public insurance option.

We will not be taxing benefits in any bill that passes the House,” she said.

She lied. Section 1802 of HR3962, the bill she herself helped craft and announced last Thursday, clearly states otherwise. So much for the promises of the Speaker of the House. The same can be said for President Obama. He promised not to raise taxes on any family making less than $250,000. Section 1802 breaks that promise as well. I wonder if HR3962 contains a provision for comparative mental health treatment for dilusional politicians who lack effectiveness?

That’s it for Division B. Tonight, I will tackle the remainder of HR 3962, “Affordable Health Care for America Act”. For those of you keeping track, we’ll pick up on page 1209.