Health reform tasks could overwhelm agencies, former federal official says

Washington -- Federal employees responsible for drafting and enforcing health reform regulations have an enormous task ahead of them, according to Gail Wilensky, PhD, an economist and former director of the agency now known as the Centers for Medicare & Medicaid Services.

The Patient Protection and Affordable Care Act contains a daunting list of tasks that will overhaul how health care is delivered in the U.S., Wilensky said at a July 9 Alliance for Health Reform event on implementing the act.

The national health reform law includes the phrase "the secretary shall" more than 1,000 times, each of which refers to a new task for the Health and Human Services secretary. "The secretary is going to be very, very busy," said Linda E. Fishman, the American Hospital Assn.'s senior vice president for public policy, analysis and development.

HHS, CMS and other agencies must finalize more than 40 rules mandated by the health reform law, including standards for how health insurance exchanges will operate, how much health insurance coverage is required to satisfy the individual coverage mandate, and how tighter restrictions on health insurance plans will roll out, according to a report released on April 13 by the Congressional Research Service, Congress' research arm.

CMS and HHS also are experiencing a wave of retirements, which means they are losing important institutional knowledge, said Wilensky, now a senior fellow with Project HOPE, an international health foundation. "That makes all of this much more challenging."

Simply implementing the health reform law's hospital value-based purchasing program by 2012 -- which will establish Medicare incentive pay for hospitals -- will be difficult, Wilensky said. The forthcoming rule will compare in complexity and controversy to the rule implementing Medicare's resource-based relative value system in the early 1990s, which now governs Medicare pay. The RBRVS rule drew more than 100,000 comments from stakeholders, and the Medicare agency had to respond to each issue raised in the comments.

"What is going on now is so much more complicated," Wilensky said.

The Congressional Research Service report is available online (link).