Physicians shed the kid gloves, come out swinging against HCFA
April 1, 1999
Physicians shed the kid gloves, come out swinging against HCFA
AMA pushes complaints to the forefront
Dropping the public niceties like a prizefighter shedding his robe, the American Medical Association has aimed a punch squarely at the jaw of the Health Care Financing Administration.
In written comments to the House Ways & Means health subcommittee, the AMA told Congress HCFA is so mismanaged and overloaded with work that it is the verge of a crisis — if not a total administrative meltdown. The problems already are "beginning to spill over into the actual delivery of health care to our nation’s Medicare patients," the AMA said.
An "ill-advised" reorganization and a heavy workload caused by requirements of the Balanced Budget Act of 1997 have overwhelmed the agency, the AMA said. It called on Congress to intervene immediately and correct the "management problems" at the agency.
"We believe that HCFA’s problems will only get worse as the number of Medicare patients, claims, and health care delivery systems increase. To say that HCFA’s current problems could lead to a crisis is an understatement," the AMA wrote.
Drawing a connection between HCFA and the IRS, the AMA also wants Congress to take the agency to task for what it feels have been overbearing and intimidating tactics and attitudes towards providers.
"Just as the IRS is struggling to reinvent itself into a customer’ friendly agency, HCFA must, with a push from Congress and the Administration, reassess its role and relationships with medical professionals who care for Medicare patients," the AMA said.
The AMA wants Congress to investigate these specific areas of HCFA’s operations:
• the regulatory requirements HCFA places on physicians, hospitals, and other health care providers;
• the rule-making process;
• an alleged failure to distinguish inadvertent billing errors from intentional acts to defraud the government;
• ongoing implementation of the Medicare+Choice program;
• oversight of Medicare carriers and other contractors.
The General Accounting Office (GAO) also has criticized HCFA’s operations. However, it placed most of the onus on the Y2K computer bug.
"Year 2000 computer compliance efforts have put a tremendous burden on HCFA that has affected the timing and quality of its work on many other projects," William Scanlon, director of health, education and human services studies at the GAO told a March 2 House Ways & Means health subcommittee hearing.
According to Scanlon, HCFA "has delayed needed systems modernization and computer changes that implement new payment systems intended to slow program cost growth. It has also slowed efforts to improve the oversight of ongoing operations, such as financial management and Medicare fee-for-service claims administration, which desperately need attention."
While noting that HCFA’s attempt to manage the many new responsibilities given it in recent years has been "impressive," Scanlon said "measured against the magnitude of challenges it faces, HCFA’s progress seems modest."
The GAO official also said HCFA’s efforts to address Y2K problems are counterproductive because many of its computer systems will need to be replaced soon after the year 2000. "Y2K presented an immediate problem with an inflexible endpoint, which has forced HCFA to shelve efforts to consolidate its Medicare claims processing systems and modernize other systems," Scanlon says.
HCFA also suffers from a lack of "tactical" planning that could allow it to identify desired outcomes and assign deadlines and responsibilities for completing specific tasks. Instead, the agency often operates in "crisis mode," with staffers constantly being pulled from one hot project to another, according to the GAO.
Subcommittee member Rep. Pete Stark (D-CA) agreed with the GAO’s assessment, saying recent reorganizations at HCFA have "demoralized the staff and largely failed to improve its operations."
Stark partly blames this on an administrative and staffing budget too anemic to support the duties HCFA has been assigned. "No business — no insurance company and no managed care plan — would even consider trying to operate with an administrative overhead of less than 2%," says Stark. "And no business would be required to operate under the management constraints that have been placed on HCFA" by Congress.
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