Senate HELP Committee Hearing on Costs

This week, on June 27, 2018, the Senate Health, Education, Labor, and Pensions (HELP) Committee hosted a hearing on the high costs of healthcare. Four panelists gave brief testimony, which included their analyses of the issue, as well as potential solutions. Then the floor was open for senators’ statements and questions to the panel.

 

One area for improvement identified by several panelists, was reducing the administrative costs and provider burden in the healthcare industry. Some of the panelists emphasized that there are benefits to collecting cost, pricing, and quality measurement data. However, many clinicians are faced with the choice of hiring staff to assist with these administrative tasks or being acquired by another entity. These mergers and acquisitions also lead to anti-competitive and opaque pricing structures, further increasing costs, in many cases.

 

One way to address this issue is for the federal government to consider centralizing and distributing data that is needed for these operations. The status quo is that healthcare providers are often duplicating processes and data comply with each payer’s requirements — this includes Medicare, Medicaid, the Veterans Administration, private carriers for employer sponsored insurance, and other payers. One panelist, Asish Jha, MD, MPH, noted that credentialing requirements alone consume too many administrative personnel hours.

 

There is great opportunity for the Centers for Medicare and Medicaid Services (CMS) to leverage systems such as:

• Provider Enrollment, Chain, and Ownership System (PECOS) to enroll and pay Medicare providers
• National Plan and Provider Enumeration System (NPPES) for unique identifier and enumeration registration for National Provider Identifiers (NPI)
• Various program integrity databases

 

CMS could extend its practice of building APIs on large datasets to include these databases. This could allow payers to leverage the federal CMS source as the singular source of truth, rather than asking providers to update multiple payers with credentialing information, quality measurement data, and basic demographics.

 

Until this issue is resolved, states are spending money creating similar systems that uniquely identify, enumerate, and pay providers. Greater efficiency, accuracy, and reliability can be achieved and enforced when this process is centralized.