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Posts Tagged ‘Marilyn Tavenner’

CMS: What Anarchy Looks Like

Posted by J. Paul Spencer, CPC, CPC-H in Industry Updates

Among my many musical areas of interest is punk rock, as performed by the original creators between 1976 and roughly 1984. If music was ever in need of someone stepping to the fore with an airing of grievances, it needed to happen in the middle of the self-indulgent, fashion elitism of the disco era.

One of the founding principles of the punk rock movement was the idea of skipping revolution and going straight to anarchy. In the post-Watergate era in America, and as the post-World War II excesses of the upper economic echelons continued in Great Britain, the idea of being completely leaderless held a certain appeal for many, including me. That personal fascination ended abruptly in 1994, when the events in Rwanda showed the world in stark terms what anarchy actually looks like. Nations, organizations and institutions need stable leaders and a cultural direction, mainly because to leave the human race to their own devices invites the worst of all possible scenarios.

It was with this philosophy in mind that I came across a story this week regarding Marilyn Tavenner, the current Acting Director of CMS. Due to archaic procedural rules in the U. S. Senate (seemingly designed to insure gridlock), it was announced that there would be no confirmation hearings to remove the “Acting” portion from her title. As a reminder, based mostly on political pie fights, CMS has had only acting directors since 2006. Ms. Tavenner is the 5th such temporary director in that time period.

CMS is now deeply submerged in multiple initiatives designed to transform the government health benefit payment model from one of consumption to one based on the quality of the outcomes. Most of these initiatives have come into being with the agency lacking long-term leadership. It has indeed been a difficult task to bring forth such things as ACOs, increased audit initiatives, mandatory medical records and ICD-10 when the average tenure length of leadership at CMS over the past 12 years is one year and 73 days. Looking at that number, it reminds one more of the random length of a prison sentence rather than a legitimate term of leadership.

As the story linked above clearly demonstrates, Ms. Tavenner does not appear to be as polarizing a figure as her predecessor. She has admirers on both sides of the aisle, which is admirable given the rhetorical gulf between the two sides in Congress. On the surface, there is no logical reason why her installation as a “permanent” agency head should be postponed. Given that based on averages, Ms. Tavenner is more than likely just about half way through her term as acting director, the nonsensical nature of the delay is compounded.

By their inaction towards the needs of CMS and the people who rely on the Medicare and Medicaid programs running smoothly, the Senate is giving us another window into the world of anarchy, albeit a less violent example than the streets of Rwanda in 1994. As announcement e-mails from CMS regarding new initiatives slowly fill my inbox, I head into the long holiday weekend wondering who or what will run CMS the next time the Anarchy Train comes to town. As a pointedly-named punk band of yesteryear once put it, “It’s coming some time, maybe”.

Surprise! It’s A Sternly-Worded Letter!

Posted by J. Paul Spencer, CPC, CPC-H in Industry Updates

Another birthday weekend is upon me.

This coming Sunday will mark yet another anniversary of my birth. Coming up on 46, for me birthdays are no longer a celebration of my birth, but rather another mile marker on the (hopefully long) highway leading to my cremation. This is a somewhat dark way of looking at it, but as one of my living musical heroes, Robyn Hitchcock, so eloquently put it, “God finds you naked and he leaves you dying / What happens in between is up to you”.

As I get older, I find that I am making less and less time for politics in my life. There are many reasons for this, but the biggest reason is simply that every politician that I come across on the state and national stage lacks imagination. Just once, I would like to turn on C-SPAN during a Special Orders session in the House of Representatives and see a member of Congress painting a seascape, singing a new song that they’ve written or doing an interpretive dance in honor of the planet Jupiter. It would assure me that at least someone with their hands on the levers of power had the ability to think outside of the box.

In the absence of my grand vision, we are left with the oft-repeated habits of the Beltway Set; grandstanding for the cameras, filling their pockets with lobbying dollars and (my personal favorite in terms of absurdity) taking advantage of Congressional free mail to fill people’s mail boxes with letters that combine the worst of the two previous activities just listed. So much for elected leaders representing “public servants” or the “best of the best”.

If it’s another week in Washington, then someone must have sent a sternly-worded letter, and this week’s is a doozy.

Anyone who reads my missives in this space knows that I have a dim view of government audits, mainly because they are shifting the blame for abuse in the system to the wrong people, namely well-meaning hospitals and physicians who have a hard time understanding federal rules of documentation and reimbursement. We all know who the thieves are when it comes to healthcare delivery, and pelting hospitals with thousands of requests for documentation per year rarely smokes these rats out of their lairs. Claims are paid badly by MACs and subsequently reviewed poorly by RACs based on complexity built into the system by CMS. Shifting the administrative burden of such a system on providers is short-sighted and does nothing to improve the care being administered.

With all of that being said, you would think that I would be in favor of this week’s sternly-worded letter from a subcommittee of the House Ways and Means Committee to Marilyn Tavenner, the Acting Administrator of CMS. After a short preamble, the letter asks for every statement of work, performance report, case referral and contractor fee paid relating to Medicare and Medicaid program integrity efforts for every contractor involved in such activities.

You should all know by now that I’ll sprint to the front of the opinion line to talk about government audits, and I have always been a fan of full disclosure. As it applies to the Recovery Auditor Program, every quarterly report that has been issued by CMS on RAC performance is either a collection of half-truths or (in the case of the first provider accuracy scores issues by the RAC Validation Contractor) bald-faced lies. I am encouraged that CMS will be called onto the carpet regarding RAC appeal rates, as any provider that has been affected by RAC audits can tell you that a look at that aspect of the program is well overdue.

With all of that being said, it helps to consider the source of the letter to CMS. Charles Boustany, the Louisiana Congressman who chairs the oversight committee has quite the revealing report when it comes to an analysis of his biggest campaign donors. The list includes Blue Cross and Blue Shield and an organization known as the LHC Group, a nationwide provider of home health, hospice and long-term acute care services. That list of LHC’s services looks a lot like the list of the types of providers often caught in the HEAT team net. In all, Congressman Boustany has taken in over $350,000 in campaign contributions from entities involved in health care, including nearly $170,000 from various factions of the insurance industry.

Whenever a legislative opponent mugs for the camera, they do so hoping for a knowledge vacuum by the viewer. This latest in a string of sternly-worded letters that bounce back and forth within the Beltway is part of the never-ending gamesmanship that has led to the system we currently have in place. If I believed that anyone in Washington, DC cared for my opinion, I would issue my own correspondence to those in power. I can guarantee that there would be just enough in every letter to anger everyone on both sides. I can also promise you that unlike this blog, it would be unexpurgated.

I am happy with the long-overdue demands made in this letter, but I simply know better than to trust this particular messenger. It takes no imagination whatsoever to take action simply because someone pays you to do so. Sometimes, you have to do it because no one else will and it is the right thing to do. By this standard, the letter is a failure.

So if you want an uncensored and uncompensated opinion, and you’re not doing anything tomorrow night, come out and celebrate my birthday at 7:30 and I’ll be happy to impart some wisdom, but take this latest sternly-worded letter with a grain of salt until we see a response from CMS.

Goodbye, Dr. Berwick (And With Him PPACA?)

Posted by J. Paul Spencer, CPC, CPC-H in Industry Updates

The final day of any job is a challenge.

I’ve been a bit of an occupational nomad in my life, so in looking back on instances when  I’ve left one job for another, the only feeling I have is an awkward one. I can remember being given cards that everyone in the office signs saying “Good Luck” or “Best Wishes”, followed by a drink or two after work, accompanied by hollow promises of keeping in touch that never come to pass. Given where I have landed in my life, none of these memories fill me with any sense of regret.

Today, someone in Washington, DC is experiencing one such last day of work. Donald Berwick, the head of CMS, leaves his post today. In his brief time as the appointed head of the agency, Dr. Berwick attempted, against nonsensical political headwinds, to reshape the future of health care delivery in the United States. Based on his impressive resume of accomplishments, we shall more than likely here from him again in the future in a capacity outside government.

Dr. Berwick’s brief time period in his post had to do neither with his abilities for the task nor on-the-job failures during his tenure. The reason Dr. Berwick is suddenly seeking other employment is that he committed the sin of voicing publicly that maybe , just maybe, there are other health care delivery systems in the world that do a better job in certain areas than the United States in the realm of promoting the general welfare. For daring to study the American health care problem with an academic’s path of contrasting, comparing and then arriving at a solution, he is being sacrificed at the chest-beating alter of American Exceptionalism.

Attempting to move the conversation forward, attention is now being focused on Dr. Berwick’s replacement. Marilyn Tavenner has  been nominated to the job having followed a much different occupational path. She worked her way forward in her career solely as an employee of HCA, a for-profit hospital chain with a checkered history with CMS, from a hospital nursing position to their national head of outpatient services. She left the company in 2006 to be the head of Health & Human Resources in the state of Virginia. She is known mostly for her pragmatism, which given the enmity in the current configuration of Congress is a virtue that one side of the aisle will promote while the other side will do everything in its power to exploit.

Provider organizations are falling all over themselves praising Tavenner as an able replacement for Berwick and urging her confirmation by the Senate, something Dr. Berwick never attained because he dared to express an educated opinion.

Ms. Tavenner is left with multiple initiatives created during Dr. Berwick’s tenure that have caused equal parts consternation and confusion within the hospital community. Given her background, a number of these initiatives will more than likely see extensive revision as part of a “pragmatic” approach to satisfy that constituency.

Hanging like the Sword of Damocles above this news is the fact that the Supreme Court has promised a ruling on the constitutionality of the Patient Protection and Affordable Care Act by May of 2012. Ms. Tavenner, in a very short time. could find herself going from the inheritor and fine-tuner of the status quo to the person guiding the transition of CMS right back to the place it occupied in 2008. In either case, the task in front of her is not enviable. Perhaps she and Dr. Berwick can talk about it all over drinks later this afternoon before they never see each other again.