January 2014 Edition Vol.11, Issue 1

2014 Forecast Series-A conversation with Nancy Davenport-Ennis

2014 Forecast Series-A conversation with
Nancy Davenport-Ennis

Nancy Davenport-Ennis is the founder of two national nonprofit organizations: The Patient Advocate Foundation (PAF) and the National Patient Advocate Foundation (NPAF). The Patient Advocate Foundation is a 501(c)3 nonprofit direct patient services organization whose mission is to help remove obstacles to the access of healthcare for people with chronic, debilitating, and life threatening conditions. The Foundation seeks to resolve medical debt crisis for patients and works to stabilize job security for people who are diagnosed with a chronic, debilitating, or life threatening condition, so that they don’t lose their jobs once they’re diagnosed. 

The 501(c)4 National Patient Advocate Foundation is a policy organization. The purpose of the NPAF is to take the data collected across every patient served through the Patient Advocate Foundation and use it to support regulatory improvement or legislative reform at the State and the Federal levels. 

OBR: OK. First, I’d like to look back on 2013 before we go forward. From your point of view, would you call 2013 a turbulent year, primarily because of sequester?

NDE: It has been a turbulent year for a number of reasons, one of which is sequester and certainly the rocky rollout of the Affordable Care Act, which many providers and nonprofit groups have spent so much time trying to develop and get passed. Not to mention the new approach in the Senate as they develop a new SGR platform for reimbursement. All three of those have created great turbulence. 

OBR: How do you see those issues translating into 2014?

NDE: Certainly, 2014 is the year for full implementation of the Affordable Care Act. We are curious to see how the program is working out for the uninsured and how is it working in relation to our providers. For instance, will our patients be able to continue to see their providers? Are the networks robust enough? What do the formularies look like in the plans that are part of the exchanges? The law calls for an evaluation in 2016 to answer the basic question: Are the essential health benefits provided by the ACA what they need to be? We need to start collecting that data now to answer that one important question.

OBR: How soon do you think you might be able to gauge if patients are receiving these essential health benefits and then make an assumption about whether the ACA is working for cancer patients? 

NDE: We’ve already begun the process of collecting data. For every patient who calls in, who may be enrolled in an exchange product or marketplace product we are recording what issues they’re facing around access to care. We’re also tracking what we do to resolve the issue and then record how that issue relates to the essential health benefit feature of the caller’s plan. We plan on publishing the findings of our data toward the end of 2014. We are beginning to understand who the people are that are enrolling, their household income, where they live, and employment. I think we’ll be able to be the canary in the coalmine fairly quickly, and be on the front lines in providing the gap services and benefits consumers need.

OBR: Can you give me an idea of how many patients are calling in to PAF to tap into your resources?

NDE: Between October 1st and January 10, 2014, we had 647 people contact us for information about the marketplace plans and how to enroll. Due to the well-known computer glitches, none of them initially could complete the enrollment online, but we were able to move more than 250 through the paper process of filling out the application and submit the application on their behalf. I think it was discouraging for people who were excited about reaching out and re-organizing personal budgets to get health insurance only to be deterred by computer glitches.

Last year, we served over 109,200 patients, 81% of whom were cancer patients. From that number, about 18% were completely uninsured, 38% were Medicare, and about 19% were Medicaid. So I would suspect that this year, a large portion of that uninsured population may have moved into a marketplace or an exchange product. 

OBR: Let me roll into sequester. Do you have hope that we’re going to see it repealed or providers will be given a break on the 2% drug reimbursement cuts?

NDE: With regard to sequester, I think everyone knows that we have to take financial pressure off providers, the research community, and oncology, if we’re going to keep our national framework in place. And when you think about any business in America, any service in America, being hit with a 2% across the board financial cut is serious. Everyone is aware that the 2% drug reimbursement cut needs to end. For us, sequester needs to be removed entirely. The issue is very much at play in Washington, but we also have the added complexity of trying to develop an entirely new platform for physician reimbursement to replace the SGR model.

The sequester remains in place. In fact, recent information notes that Senate Democrats are willing to extend it by one year to pay for an extension of emergency unemployment benefits.  The Bipartisan Budget Act of 2013 doesn’t replace all sequester cuts, but it does provide $65 billion in sequester relief over two years, evenly divided between defense and nondefense programs.

Discretionary spending for defense programs in FY2014 would total $520.5 billion. The nondefense spending level would be $491.8 billion. The lower sequester amount is offset by $65 billion in so-called “deficit reduction provisions,” including a combination spending cuts and higher user fees. The deal also extends the mandatory sequester through 2023, which saves an additional $28 billion that is used for deficit reduction.

Regarding SGR, the December 18 budget agreement also includes a 3-month patch to mid-March 2014. The House Energy & Commerce Committee on July 31 passed H.R. 2810, the Medicare Patient Access and Quality Improvement Act of 2013 to transform the Medicare physician payment system. First and foremost, the bill repeals the flawed SGR system and replaces it with a fair and stable system of payments. Instead of looming annual cuts, physicians will be rewarded for the quality of care they provide to Medicare beneficiaries. On December 12, the Ways & Means passed the Medicare Patient Access and Quality Improvement Act (also HR 2810), and Senate Finance passed the SGR Repeal and Medicare Beneficiary Access Improvement Act. Their respective chambers have not yet considered the bills.

 

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