Dec 02, 2014
More on Policy and Legislation
Federal exchanges top 10 most pressing challenges for HHS in 2015
Management of federal exchanges, drug safety and financial management lead the list.
While the Food and Drug Administration is primarily responsible for the safety of food, drugs, devices and supplements used in healthcare settings, HHS can help establish and enforce rules that require the kind of inspections that can spot problems before they become hazards.
The U.S. Department of Health and Human Services has a full schedule as 2014 ends, especially with the federal health insurance exchanges kicking off their open enrollment period. But great power doesn’t just bring great responsibility -- it also adds a host of new problems, each more imposing than the next.
To put the issues in perspective, the U.S. Office of the Inspector General recently compiled a detailed report highlighting the 10 most pressing challenges facing the organization as it heads into 2015. See the abridged list below, and scroll to the very end to see the entire report.
10. Ensuring the Safety of Food, Drugs, and Medical Devices
While the Food and Drug Administration is primarily responsible for the safety of food, drugs, devices and supplements used in healthcare settings, HHS can help establish and enforce rules that require the kind of inspections that can spot problems before they become hazards. One particular concern is imported, unapproved drugs distributed by providers, as well as new supplements marketed as health aids without demonstrating their safety.
9. Protecting HHS Grants and Contract Funds from Fraud, Waste, and Abuse
The HHS paid out about $389 billion in fiscal 2014, a staggering amount doled out through more than 79,000 grants. That kind of output opens up the possibility for fraud, waste and abuse if not strictly monitored. One issue: Some who received cash may have poorly managed the contracts tied to these grants, which makes it difficult to track how the money was used. One suggestion the report makes is to align HHS and the Office of Federal Procurement Policy on federal contracts, since the OFPP is tasked with monitoring federal contractors.
8. Ensuring Effective Financial and Administrative Management
HHS is responsible for a host of programs related to insurance, public health and research, and must make its financial results public. Unfortunately, auditors found weaknesses in the department’s financial management IT systems, which can delay financial reporting. The HHS also made $65 billion in improper payments in fiscal 2013, the bulk coming from the Medicare program. One suggestion would be for the department to publish an improper payments log, as well as immediately fix weaknesses in its financial monitoring systems.
7. Effectively Operating Public Health and Human Services Programs to Best Serve Program Beneficiaries
The devastation wrought by Hurricane Sandy, as well as the recent outbreak of Ebola in Africa and its effect on the United States, highlight some of the public health problems HHS must manage. Ultimately, swift deployment of resources during these emergencies is paramount, and the department should make sure it has the right plans in place, the report states.
6. The Meaningful and Secure Exchange and Use of Electronic Health Information
The change to electronic systems for managing medical records is one of the biggest shifts facing healthcare providers, and HHS bears much of the responsibility in making sure that rollout is managed efficiently. On one hand, HHS must monitor the payout of incentives given to providers converting to electronic records: Medicare and Medicaid incentives totaled $25.4 billion as of September 2014. HHS also must monitor the interoperability of electronic health records, so data can be shared accurately across providers. While security, interoperability and fraud protection demand the department’s focus, HHS also should make sure it is listening to feedback from providers about the rollout and about EHRs generally.
5. Ensuring Quality in Nursing Home, Hospice, and Home- and Community-Based Care
As the U.S. median age rises and more people require elder care, expect a surge in nursing home populations and people requiring hospice care. The aging of America has contributed to more incidents of poor care, including cases of abuse and neglect. HHS should not only prioritize the care of elderly patients, the report recommends, but also should explore other methods to ensure good care. One idea would be to link provider payments to the quality of care delivered.
4. Fighting Waste and Fraud and Promoting Value in Medicare Parts A and B
HHS must work on reducing waste in Medicare; the system is besieged by improper payments and outright fraud. As it is, the federal government reported a 10 percent error rate in fees paid for Medicaid services, costing $36 billion in 2013. Key to fixing that is the ongoing Medicare transition from a fee-for-service reimbursement model to a value-based system. Another suggestion the report makes: HHS should make sure it is monitoring the performance of contractors hired to find and recover improper payments.
3. Protecting an Expanding Medicaid Program from Fraud, Waste, and Abuse
The number of Americans covered by Medicaid is growing, especially in the 27 states that agreed to expand its coverage provision to more low-income families under the Affordable Care Act. But that growth opens up the possibility for fraud and waste -- something HHS must monitor. To do that, the report suggests that HHS focus on making sure it has a complete national database of Medicaid info, as well as targeting and recovering improper payments. Key to that initiative is HHS making sure states report data in a timely fashion.
2. Ensuring Appropriate Use of Prescription Drugs in Medicare and Medicaid
While Medicaid and Medicare cover nearly 100 million people through their prescription drug programs, the report found a host of questionable utilizations and billing patterns that suggest many people are illegally receiving, and perhaps selling, prescription drugs. For example, Medicaid paid $32 million for HIV drugs to beneficiaries with unusual billing patterns. The Centers for Medicare & Medicaid services must tighten its controls to ensure the abuse of prescription drugs is limited, the report states.
1. Implementing, Operating, and Overseeing the Health Insurance Marketplaces
The top issue facing HHS is the rollout of health insurance marketplaces, including the sign-up and coverage process for the millions of Americans buying insurance on these exchanges set up through the Affordable Care Act. A key concern is managing the flow of payments from taxpayers enrolling, a massive financial endeavor that requires systems designed to handle the flow of data. But HHS must also make sure it’s accurately gauging the eligibility of citizens hoping to use the exchanges, as well as safeguarding their personal information. Key to this is continuing to improve the federal marketplaces, though Healthcare.gov has made huge strides since its initial problem-plagued rollout in 2013.
The full report:
