January 19, 2011 was the day that the U.S. House of Representatives voted  245 to 189 in favor of repealing health care reform, but most agreed that this was symbolic only.

Weeks after that, the U.S. Senate voted down a Republican attempt to repeal reform.   The news of this domestic development which impacts hundreds of millions of Americans and $ Billions in U.S. spending disapeared with a whimper.

As of February 11, 2011 the international news of Mubarek resignation is the most popular topic on the Internet.   A peaceful transition will keep the suez canal open and avoid a spike in oil prices, but likely will have little impact on our domestic situation.  Lady Gaga’s new song Born this Way is the top tune on iTunes.

Sensationalism creates a sense of temporary urgency to know more.  Mubarek steps down, Lady Gaga has a new hit.  However, in health care reform more than 50% of all health care companies in the U.S. are not prepared for a new reimbursement system called ICD-10.  This is a slow steady march to what could be a sensational event in the future.  If a large percentage of health insurance firms and hospitals cannot submit or process claims in the new medical coding system, then it could lead to the next Federal bailout – but this time in health care not financial services.   There is immediate gratification in reading headlines, but long term the diffcult situation that many firms are having trouble facing is that the future of the entire health care payment system is in jeopardy because a large portion of all companies are behind.  This is due in part to complexity, part due to cost, and part due to distraction with other regulations that also must be met.

So, while the world searches and reads about Mubarek stepping down today and Lady Gaga, we think more of the U.S.  should be searching for information on whether their hospital or insurance company are on target to achieve health care standards.  Some of these standards, by the way, are completely separate from health care reform and were actually mandated in 2008 before Obamacare.

These are:

1. Meaningful Use – ensuring that hospitals, physicians and others are ready to go electronic with “E.H.R.”

2. Ability to property enter a diagnosis as well as a medical procedure code using the new ICD-10 system by October 1, 2013

3. Ability to properly send or receive a claim for health care services via a new EDI standard, HIPAA 5010 by January 1, 2012.

4. Ability to create the systems that ensure better coordination of care and quality measures – key to moving from a reimbursement focused health care system to one where outcomes – “quality” are the drivers, and where a patient can move from one medical center to another knowing their entire medical record will be accessable by health care providers at any point of care.

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The recent passage of national health care reform legislation is an important milestone in the process of moving toward providing millions of Americans with access to health insurance. However, significant steps must still be taken in order to achieve the goals established in the legislation.

Specifically, greater clarification is needed to determine how reform will be implemented and, just as important, there is the challenge of effectively dealing with the critical issue of affordability. Health plans and providers have received many questions regarding how they will make the necessary changes within their business to help employers and trading partners comply with the new law.

While most answers are still unclear, we have developed initial comments to many of the questions dealing with the 2010 provisions, including:

Health care business, process, people and technology changes for payor and provider firms:

We will cover these topics in subsequent releases of our blog. We will continue to monitor the detailed discussions during the lengthy implementation process.  Our focus will be on taking the time to make sure we help our clients get the implementation of reform right and addressing the most significant issue facing our industry – affordability.

It is important to remember that most of the provisions in the legislation will not go into effect until 2014 or later.  The details of implementing legislation can take months, even years to work through the regulatory process.  Much of what Congress has passed will require additional regulations to bring further clarity to this new law, and those regulations will truly shape the impact on consumers and employers.

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