On May 10th a Joint Hearing of House Committee on Public Health and Appropriations Subcommittees on Health & Human Services and General Government was held regarding the factors influencing health care cost trends in Texas.
During the hearing some witnesses argued for a pay for performance program. John Holcomb with the Texas Medical Association (TMA) argued for “bundled payments” for episodes of care. Holcomb also cautioned that a decrease in physician rates under Medicaid would negatively affect provider participation.
Commissioner Tom Suehs with Texas Health and Human Service Commission (HHSC) stated the total caseload and cost per client are the primary cost drivers in the Medicaid Program.
Suehs then noted the following cost containment initiatives that have been implemented:
- Increase efficiencies and reduce cost for Managed Care Organizations
- High cost imaging management (prior authorization required)
- New drug classes added to the Preferred Drug List
- Billing Coordination System expanded to pharmacy claims
- Women’s Health Program (reduced pregnancies)
He followed up his comments with highlighting cost containment initiatives that are under development:
- National Corrective Coding Initiative (NCCI) – Implement standard codes for claims payment
- Diagnosis Related Group (DRG) Recovery – Ensure the diagnosis and procedure codes that generate the DRGs, and thus the hospital invoice, are accurate, valid and sequenced in accordance with national coding standards
- Ultrasound Utilization Project – Obstetric ultrasounds limited 3 per client, unless prior authorization
- Enhanced Third Party Recovery Efforts
- Additional Administration Cost Containment Initiatives including: Discontinue mailing paper Medicaid bulletins & Discontinue printing of remittance and status reports
A quality improvement initiative pointed out by Suehs was the Department of State Health Services (DSHS) development of the Healthcare-Associated Infections (HAI) Reporting System and establishment of the HAI Advisory Panel.
The HAI reporting component is under development and will being in 2011. Additionally, DSHS is planning the expansion of the HAI reporting initiative to include reporting of Preventable Adverse Events (PAEs). Reportable PAEs will include 28 events identified by the National Quality Forum.
Other developed quality initiatives pointed out include the Frew Strategic Initiatives, nursing facility incentive payment program, potentially preventable readmissions, and Medicaid payment reductions for PAEs.
In addition to the various initiatives that HHSC is currently exploring, there are some options aimed at quality improvement available to states under the Patient Protection and Affordable Care Act (PPACA) which include various demonstration projects.
A copy of Suehs’ testimony can be found by visiting: http://www.hhsc.state.tx.us/news/presentations/2010/Joint_House_0510.pdf