From the providers’ point of view, CMS by any other name still smells the same, regardless of the media spin

In July 2001, the entity formerly known as the Health Care Financing Administration (HCFA) officially became the Centers for Medicare & Medicaid Services (CMS). The name change is an attempt to repackage the agency into a more consumer-friendly association. Although the media spin says the name change is an increased emphasis on the responsiveness to beneficiaries and providers, insiders are whispering about the real reason behind the new facade. One rumor is that the name change was slated to become MOM (Medicare Offices with Medicaid)—an acronym just a little too homegrown to be taken seriously.

Spin City

Reportedly, the name Centers for Medicare and Medicaid Services is based on the results from extensive focus groups with beneficiaries and other interested parties and is intended to increase consumers’ understanding of the government’s role in health care. It is also a public awareness campaign to change the image and negative feelings experienced when anyone associated with health care thinks of HCFA.

According to a June 14, 2001, press release by the US Department of Health and Human Services (HHS), "Changing the agency’s name is the first, visible sign of the many steps being taken to change the agency and drive it to be the responsive and effective agency that it should be."

Tommy G. Thompson, HHS secretary, said that the reform of HCFA will be restructured around three centers that reflect the agency’s major lines of business.

1) The Center for Medicare Management will focus on management of the traditional fee-for-service Medicare program, which includes development of payment policy and management of Medicare fee-for-service contractors.

2) The Center for Beneficiary Choices will focus on providing beneficiaries with information on Medicare, Medicare Select, Medicare+Choice, and Medigap options. It also includes management of the Medicare+Choice plans, consumer research and demonstrations, and grievance and appeals functions.

3) The Center for Medicaid and State Operations will focus on programs administered by states. This includes Medicaid, the State Children’s Health Insurance Program (SCHIP), insurance regulation functions, survey and certification, and the Clinical Laboratory Improvements Act (CLIA).

"We’re making quality service the number one priority in this agency," Thompson said, "These sweeping reforms will strengthen our programs and enable our dedicated employees to better serve Medicare and Medicaid beneficiaries as well as health care providers. We’re going to encourage innovation, better educate consumers about their options, and be more responsive to the health care needs of Americans."

To that end, CMS is implementing a number of new and expanded services including:

• Expanded call center services—effective October 1, 2001. Customer service representatives at 800-MEDICARE will be available 24 hours a day, 7 days a week, to respond to questions from beneficiaries and their caregivers. Callers will receive access to information on the choices that best meet their needs immediately and can receive a copy of the information in the mail for further discussion and review.

• Development of a web-based decision tool—The Decision Support Tool will enhance the suite of consumer information databases on www.medicare.gov, which will allow users to narrow down health plan choices (available in their zip code) based on what is most important to them; offers a direct, out-of-pocket cost comparison between all health insurance options; and has detailed information on plans that meet their needs. This will be implemented on October 1, 2001.

Nominal Changes

However, as anyone who has ever been put on hold knows, part of the image problem with HCFA is trying to get a straight answer from a knowledgeable person. HHS is keenly aware of this impression and addresses this problem in a press release: "Timely, consistent communication is the hallmark of an effective organization." Therefore, they are making communications and public relations a major focus of the new and improved agency. Key issues of concern include:

• Appoint senior staff members to serve as the primary contacts, and strengthen all lines of communication.

• Assign individual contact persons to work with states. One Medicaid/SCHIP contact person will work with each state at both regional and central office levels.

• Set a goal of responding not only to beneficiaries and providers in a more timely manner, they have also set a 14-day response deadline for congressional inquires. Even Congress used to wait months for a response!

• Plan on revitalizing the professional relations staff to develop better partnerships with providers, health practitioner associations, and health plans.

• Expand the physicians’ regulatory issues team’s, which is an agency-wide group led by a physician, role to help identify workable solutions for Medicare requirements.

• Improve the website for physicians to access the Internet for the latest Medicare information changes. Although the website remains: www.hcfa.gov, the site itself has been updated and includes the CMS banner. Users can also find the site by visiting: www.cms.gov or www.hhs.gov.

• Improve provider training and problem resolution by enhancing its system with formal training on new requirements, as well as offer web-based information and learning.

• Release data and information in a timely manner, which includes confidentiality of data and new HIPPA requirements.

A Rose is a Rose is a Rose

Whether these changes truly improve provider and beneficiary services remains to be seen. However, the most bitter pill to swallow from this reform package is the government’s $35 million national advertising campaign, which will educate beneficiaries in choosing a Medicare plan.

This comes in a year when chiropractors will see the first decrease in Medicare reimbursement in many years. The decrease is an across-the-board reduction in all physician fee services, which will total a 4% to 5% decrease from 2001 fees. CMS says that although physician reimbursement is reduced for 2002, it is still expected to payout an increase in benefits from $41.2 billion to $41.7 billion under part B.

How much of the budget will be used for DCs? Chiropractic services under Medicare, are limited to the reduction of a subluxation by manual manipulation. Until the adoption of the Chiropractic Manipulative Treatment Codes in 1998, reimbursement was limited to one CPT code. Since then, DCs have three CPT codes (98940, 98941, and 98942). However, on average, reimbursement for the middle-of-the-road code (98941) is approximately $30 to $35. And in most states, the number of visits is limited to 12 to 18 per patient, per year.

Although these figures appear to be inconsequential to the half-billion-dollar increase, consider this: In a November 17, 1999, memo from June Brown, Inspector General at the Office of Inspector General (OIG), stated that by developing utilization parameters for chiropractic treatments, Medicare could save between $19.4 and $30.2 million per year just by lowering (limiting) chiropractic review claims to 12 to 18 visits. This recommendation must have been adopted by most Medicare carriers since in 2000, most chiropractors began having more denials. In the big scheme of things, chiropractic is doing its part to "Restore Medicare Trust"—the government’s title to save Medicare.

The politicians can change the name of HCFA to CMS, and the government can color the budget woes of agencies with euphemisms of restoring trust, but there is no significant interior change. More money seems to be spent on the administrative side of Medicare and its commercials, than on the benefits.

About the Author

Ces Soyring, CA, is a cofounder of the National Academy of Chiropractic Assistants (www.naca-online.com)   and a chiropractic consultant. She can be reached at: 888-218-7757 or via email: naca_csoyring@yahoo.com.