After an 80-day extension costing taxpayers well over $1 million, the North Carolina House and Senate chambers have finally reached a tentative budget agreement with a price tag of roughly $22 billion — a fiscally conservative budget considering that spending increased by only 3.1 percent which equates to less than the combined growth of population and inflation. For overall budget highlights, you can peruse what my JLF colleagues have to say about it here, here, and here.
A few items of interest in the Health and Human Services portion:
Price Transparency
Promoting price transparency in health care has been tried for over a decade, and it’s not uncommon for non-governmental agencies to beat state policymakers to the punch. Blue Cross and Blue Shield of North Carolina (BCBSNC) released its publicly accessible cost estimator tool back in March for anyone interested in obtaining average cost information for the most common surgeries and procedures.
However, state lawmakers did begin to push for more price transparency when they passed the Health Care Cost Reduction and Price Transparency Act in 2013. Unfortunately, this statute has not been enforced as intended.
Nevertheless, lawmakers have reinstated this transparency measure. The language states that the Department of Health and Human Services (DHHS) will post on its website total charges and reimbursement data submitted by hospitals and ambulatory surgery centers (ASCs) for their most popular inpatient, surgical, and imaging services:
Let’s hope that this policy leverages a stronger ‘transparency race,’ even more now that Obamacare’s pricey regulations are driving employers to either push more benefit cost sharing onto employees or release them to find coverage from a plethora of high deductible health plans in the individual marketplace.
Accountability
Funds totaling $750,000 over the biennium will be dedicated to establishing the Office of Program Evaluation, Reporting, and Accountability (OPERA). The program will be charged with evaluating whether government programs such as those within the public health sphere effectively quantify service outputs and improve patient health outcomes. OPERA could also justify not expanding Medicaid since there are numerous existing organizations funded by competitive state grants and federal funds that specifically cater to low-income populations who are uninsured and underinsured.
Innovation
Big data is all the rage in health care nowadays, and the legislature is setting aside $24 million to continue statewide implementation of the North Carolina Health Information Exchange (HIE). Launched in 2011, the HIE’s mission is to collect and store secured patient data to aid clinical research and allow providers among multiple health facilities to provide seamless care for a patient navigating the system. Policymakers and supportive stakeholders are also aiming to link HIE with Medicaid reform — the idea being that identifying beneficiary health risks and pinpointing medical expense trends can help reduce government spending long-term.
Change
One of the big changes coming over the next few years is reform of the state’s Medicaid program. Final legislation on this will be released within the next week or so, and the budget allocates $225 million to start the process.
And, if Washington doesn’t delay ICD-10 implementation for another year, it’s supposed to go live this fall at a total cost of $60 million. Formally known as the International Classification of Diseases (ICD), the ICD is the most widely used index of medical diseases and injuries, dating back to the late 1890’s. The updated, more detailed coding system will grant providers access to a more accurate index of diagnoses before submitting claims to the government or other third-party payer. The number of codes will exponentially increase to 155,000 from 17,000.
Now, new codes certainly are necessary due to medical innovation and discovery. But after reading Stephen Hayes’s "Code Chaos" in the Weekly Standard, some are just laughable. Others make you wonder why they even made the book:
Ever considered suicide by jellyfish? Have you ended up in the hospital after being injured during the forced landing of your spacecraft? Or been hurt when you were sucked into the engine of an airplane or when your horse-drawn carriage collided with a trolley?
Chances are slim.
But should any of these unfortunate injuries befall you after October 1, 2015, your doctor, courtesy of the federal government, will have a code to record it.
For more information on HHS spending, see here and here.
Click here for the Health Care Update archive.
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