American Recovery & Reinvestment Act

"You never want a serious crisis to go to waste" ~ Rahm Emanuel

 

Authors:

Grace Anglin Ben Evans Evelyn Lucas-Perry Andy Pritchard Henry Stabler

Health Spending in the ARRAHealth Spending in the ARRA

"create jobs, support the states, and invest in our country’s future"

"create jobs, support the states, and invest in our country’s future“

Health Spending in the ARRA

Do we have a new health system post-ARRA?

Recovery and Reinvestment    

 

79.3%

15.6%

5.1%

recoveryreinvestmentboth

COBRA

Medicare at a Glance

Eliminate proposed reductions in Medicare reimbursements --Cost $191 million

Eliminate proposed reductions in wage-index payments –Cost $134 million

Adjustments to Medicare reimbursements for long-term care hospitals--Cost $13 million

Medicaid at a Glance Temporary increase in Medicaid payments to

hospitals -- Cost $460 million Acceleration of Medicaid reimbursements--

Cost $680 million Extension for low-income Medicare

beneficiaries –Cost $550 million Eliminate out-of-pocket costs for enrolled

American Indians and Alaska Natives --Cost of $134 million

Disproportionate Share Hospitals (DSH) –Cost of $268 million

COBRA Intentions

“A valuable first step towards helping people maintain coverage.”

Yet an area of concern…cost

COBRA at a Glance

Federal subsidy for 65% of the premium for nine months for qualified workers.

Subsidy applies to workers who lose their jobs between Sept. 1, 2008, and Dec. 31, 2009.

Subsidy available for up to 9 months. Workers who may have pre-existing

conditions must maintain coverage to protect insurability.

COBRA

COBRA Beneficiary ExampleCOBRA Beneficiary Example

NIH Appropriations

• $10 billiono $1.8 billion for constuction and renovation of NIH

facilities, extramural facilities, and research equipment

o $8.2 billion for new grants $7.2 billion for the Common Fund (CF) $800 million overseen by the Office of the Director

NIH Appropriations• Poor support from Bush Administration• Will substantially increase grant funding for clinical,

biomedical, and health systems research

NIH Appropriations: Challange Grants

• Challenge Topicso Behavior, Behavior Change, & Preventiono Bioethicso Biomarker Discovery & Validationo Clinical Researcho CER o Enabling Technologieso Enhancing Clinical Trialso Genomicso Health Disparitieso IT for Processing Health Care Data o Regenerative Medicineo STEMo Theranosticso Stem Cellso Translational Science

NIH Appropriations: Why Research Funding?

• Economic Benefit: Families USA studyo 7 jobs per granto $2.21 return for every $1 investment

• Social Benefit

HRSA Allocation

• $500 million to HRSAo $300 million to NHSCo Will substantially increase medical school scholarships,

salary support, and student loans to public health practitioners willing to work in under-served rural areas 

Broadband Allocation

• $2.5 billion for broadband expansion into remote areas to improve and promote:o Distance Learningo Telemedicine

 • Have been found to be effective method of

removing barriers to access while delivering specialty care to remote, under-served areas

HITECH

• Provision A, Title 13 and Provision B, Title 4 make up the "HITECH Act" 

• Under HITECH:o Development of a national HIT systemo HIT incentives through Medicare/Medicaido Increased privacy/security regulations

• $21 billion allocated to development and promotion of HIT

HITECH

Development of a national HIT system: •  Expanded role of ONCHIT

o Promote use of HITo Identify measurable outcome goalso Evaluate and report on progresso Matching funds for state investments

beginning in 2011 - 10:1, 7:1, 3:1• NIST charged with testing, R, & D

o Researching technology improvementso Improve inter-hospital connectivityo Develop new security softwareo Use HIT to reduce error

HITECH

HIT incentives through Medicare:• "eligible professionals" can receive incentive payments for

implimenting HIT/EHR systemso $18,000 in 2011, decreasing to $2,000 in 2013

• Hospitals using HIT are eligible for incentive paymentso $2,000,000 base grant;o $0 for the first through 1,149th discharge;o $200 for the 1,150th through the 23,000th discharge;o $0 for any discharges after the 23,000th

  

HITECH

HIT incentives through Medicaid:• Providers that implement HIT/EHR will be eligible for up to

100% of the amount of Medicaid payments. • Miscellaneous items are also included

o Hospiceo SCHIPo long-term care providers

HITECH

Increased privacy & security:•  Increased enforcement under HIPAA•  Required notification in case of security breach

o If breach involves the records of 10 or more individuals, they must be notified

o If breach involves 500 or more people, the individuals, ONCHIT, and a media outlet must be notified

•  Specifies penalties for security breaches

HITECH

Impact of HIT changes: • CBO estimates that over the next 10 years:

o HIT investment will cost $32.7 billiono will save $12.5 billiono 70% of hospitals will adopt HIT

• Obama admin. cites a RAND study reporting that savings from large-scale use of HIT could reach $77 billion

• HIT can reduce admin. costs:o as low as 2-5% in some countrieso 25% of health spending in the US

HITECHImpact of HIPAA changes:• HIPAA changes may have unforeseen

consequenceso HIPAA will apply to many more workerso Changes add to an already complex set of regulationso No funding to meet these new requirementso AAFP reports changes will, "increase the uncertainty,

complexity, cost and risk for anyone or any organization who collects, stores, manages or transmits personal health information."

HITECH

Tie-ins with other ARRA and Obama Admin. priorities:• Research:

o Data from HIT will facilitate research into quality, comparative effectiveness, small area variation, medical error, etc.

o NIH challenge grants will exploit this new source of data • HITECH dovetails with broader health reform goals:

o campaign promise to invest $10 billion a year in HITo Admin. states that, "strengthening privacy and security in the

digital age" is a top priority

Comparative Effectiveness Research

$1.1 billion total appropriations $700 million to the Agency for Healthcare Research and Quality - $400 million transfered to the National Institute of Health $400 million to the Secretary of Health and Human Services - $1.5 million to IOM study

Comparative Effectiveness Research

NIH Challenge Grants• 69 separate headings• Common themes:  Substance Abuse Treatment, Diagnostic

Biomarkers, Aging Related Illness, Cancer Treatment, Cardiovascular Treatment, Diagnostic Testing

 IOM Study• Form to hospitals

What Will This DO?

• Improve health delivery in rural areas by increasing personnel and communication abilities of rural clinics

• Reduce barriers between remote populations and clinicians, researchers, etc.

Comparative Effectiveness

Sec 804:  Establishes the Federal Coordinating Council for Comparative Effectivness Research  Purpose:  "The council shall foster optimum coordination of comparative effectiveness and related health services research conducted or supported by relevant Federal deparments and agencies, with the goal of reducing duplicative efforts and encouraging coordinated and complementary use of resources"

Comparative Effectiveness

Council - 15 members including senior officials from:•  Agency of Healthcare Research and Quality•  Centers for Medicare and Medicaid•  National Institute of Health• Office of the National Coordinator for Health Information

Technology•  The Food and Drug Administration•  The Veterans Health Administration•  Department of Defense Military Health Care System• At least 8 member have to be physicians or have

significant clinical experienceChaired by the Secretary of HHS

Comparative Effectiveness Research

Rules of Construction Sect 804 (g)(1&2) "Nothing in this section shall be construed to permit the Council to mandate coverage, reimbursement or other policies for any public or private payer" "None of the reports submitted under the section or recommendations made by the Council shall be construed  as mandates or clinical guidelines for payment, coverage or treatment"

Do we have a new health system?

No, but we do have a base for health reform• Framing the problem• Framing the soultion • Media attention    Is the window open?  

Where should you work?

• NIH • Federally qualified health centers

Questions and Comments

Credits:

Grace Anglin Ben Evans Evelyn Lucas-Perry Andy Pritchard Henry Stabler