President's budget said to reduce healthcare spending by revamping system.
In a front-page story, the Washington Post (2/22, A1, Montgomery, Connolly) reported that "President Obama is putting the finishing touches on an ambitious first budget that seeks to cut the federal deficit in half over the next four years." However, "Obama faces the long-term challenge of retirement and health programs that threaten to bankrupt the government years down the road, as well as the more immediate problem of deficits bloated by spending on the economy and financial system bailouts." The Post notes, "Administration officials and outside experts say the most likely path to revamping the health system is to begin with" Medicare and Medicaid. Reforms "such as rewarding physicians who computerize their medical records or paying doctors for results rather than procedures -- could improve care while generating long-term savings, experts say."
The Wall Street Journal (2/21, A2, Weisman) notes that the "upcoming budget is likely to call for the elimination of subsidies to" Medicare Advantage, "a savings of as much as $7 billion a year. He is also expected to make good on a promise to propose allowing the federal government to negotiate for lower drug prices for Medicare." The New York Times (2/22, A20, Stolberg) also covered the story.
Obama turns focus to affordable healthcare for all. Bloomberg News (2/23, Marcus) reports, "With the economic stimulus package signed, President Barack Obama this week will outline how he plans to provide affordable medical coverage for all Americans, an administration official said." On Monday, Obama "will tell a joint meeting of the House and Senate that revamping the US health system is a priority, according to the official, who spoke on condition of anonymity. The President will outline how he plans to pay for it when he submits his budget to Congress on Feb. 26, the official said in a telephone interview yesterday." As a possible solution, "the president may look to reduce payments to private Medicare Advantage plans," according to the official. During the presidential campaign, "Obama said...that he wanted to cut $15 billion in government payments to the plans, which private insurers such as UnitedHealth Group, Inc., of Minnetonka, Minnesota, offer to seniors in place of the government's Medicare insurance program for the elderly."
Consensus on health reform breaks down on details. The AP (2/22, Alonso-Zaldivar) reported that "President Barack Obama and Congress are plunging ahead with a healthcare overhaul." In doing so, Obama is expected to "start the dialogue on how to increase coverage, restrain costs, and improve quality" this week followed by "a budget that includes a commitment to expand coverage for the uninsured." Sen. Ron Wyden (D-OR) noted that although "there are areas in which there is going to be spirited debate...there are four or five major areas where there's a lot of common ground." In fact, data indicate that "consensus starts to break down once thorny details such as costs and the government's influence on the doctor-patient relationship come into the picture." And, "potential dealbreakers lurk at every turn." Among "conservatives and insurance companies," a "public plan offered to workers and their families" is perceived as "the gateway for Canada-style government healthcare." Meanwhile, "employers, hospitals, doctors, and drug companies worry that the government's already pervasive influence in healthcare will become stifling."
Fraud and Abuse
DOJ says Community Health Systems may face False Claims suit for fraudulent Medicaid payments.
Modern Healthcare (2/21, Galloro) reported that, according to Community Health Systems, "the US Justice Department has advised the company that a civil False Claims Act lawsuit in federal court is likely in a dispute regarding Medicaid payments received by three of its New Mexico hospitals." Wayne Smith, chairman, president, and CEO of Community, noted that "the government is not alleging any willful coding violations." Rather, "the matter comes down to alleged improper transfers between the state and the counties," which the three hospitals claim "were ineligible for $27.5 million in federal participation payments they received between 2000 and 2006," he added.
Federal Agency News
Sebelius offers no indication about possible HHS nomination.
In an article published on the websites of at least 50 media outlets, the AP (2/23) reports Kansas Gov. Kathleen Sebelius (D) "said Sunday she has not talked with President Barack Obama about joining his Cabinet." In an interview Sebelius said, "There really isn't anything to tell. I haven't had any meetings about the position."
The Kansas City Star (2/23, Goldstein) emphasizes that while attending the National Governors Conference in Washington, Sebelius has been "busily dodging THE QUESTION." Sebelius has "said nothing was shaking. 'I've had no meetings on HHS,'" and when asked "Sunday morning if she's sure she even wants to be a part of the Washington fishbowl, Sebelius said, 'No.'" Sebelius "did offer what she thought the new head of HHS should focus on, though, and listed the priorities that candidate Barack Obama laid out during the campaign: health insurance coverage for all American, improved healthcare technology to lower costs and monitor quality, and better preventive care."
In a brief story The Politico (2/23, Brown) notes that "there are growing signs that Obama is still casting about for options. The White House reached out Thursday to Nancy-Ann DeParle...to consider serving as both the health czar and the secretary of health and human services, according to a source familiar with the process."
In a brief story, the Topeka Capital Journal (2/23) notes that in its coverage of the NGA's conference the Washington Post (2/22, A02, Rucker) reported, "Sebelius was hounded with questions about her prospects to become" HHS Secretary. Modern Healthcare (2/23) reports similar details.
FDA releases guidelines to clarify when drugmakers can distribute reprints of articles about off-label drug use.
American Medical News (2/23, Landers) reports that "physicians may see an uptick in the number of journal reprints coming their way from pharmaceutical firms interested in alerting them to information about an off-label use of one of their drugs or devices," as the Food and Drug Administration has released guidelines "to clarify when this approach is permissible." Ken Johnson, senior vice president of the Pharmaceutical Research and Manufacturers of America, said, "The FDA guidance supports the public health by helping to assure that medical professionals receive timely and accurate medical information prior to the lengthy process for inclusion in the FDA-approved labeling." But, "some physicians argue the FDA has blurred the line between what is promotional and what is not." Bruce Psaty, M.D., Ph.D., professor of medicine, epidemiology and health services at the University of Washington in Seattle, said, "The idea that industry would be permitted to use their scientific literature for off-label promotion is distressing."
FDA advisory committee to examine quality of information on pharmacy pamphlets.
The Atlanta Journal-Constitution (2/23, Young) reports, "Whether consumers get critical information about the medications they take varies greatly depending on the pharmacy they use, according to research commissioned by the US Food and Drug Administration (FDA)." The issue will be taken up on Thursday by an FDA advisory committee, which "will begin examining how the pharmacy pamphlets can be improved and whether their content should be regulated." According to Janet Woodcock, M.D., director of the FDA's Center for Drug Evaluation and Research, "the current voluntary system has failed to provide consumers with the quality information they need." But, Alan Goldhammer, vice president of science and regulatory affairs for the Pharmaceutical Research and Manufacturers of America (PhRMA), said the industry's goal "is to make sure that patients have as thorough an understanding as possible."
General Health Law
Suit alleges San Francisco overcharging poor, indigent who seek care through safety-net services.
American Medical News (2/23, Sorrel) reports that, according to a lawsuit filed Dec. 30, 2008, in San Francisco Superior Court, city "officials are overcharging poor and indigent patients who seek care through safety-net services," thereby sparking "more controversy over" Healthy San Francisco, "the city's unique universal health-coverage program." A group of patients "sued the city's Dept. of Public Health and other city and county officials, alleging that they violated a state law requiring such public programs to base co-payments for medically necessary services on patients' ability to pay," alleging that "poor and indigent patients who otherwise would qualify for discounted or free care are being unfairly charged for emergency department visits, primary-care visits, hospitalizations and medications," including "some fees charged under Healthy San Francisco." The complaint also alleges that "city and county officials have failed to conduct needs-based assessments to help determine an individual's ability to pay for such fees, instead relying solely on strict income requirements."
Health Business
J&J CEO declines merit raise for this year.
The Wall Street Journal (2/23, Wang) reports, "Johnson & Johnson Chief Executive William Weldon declined a merit raise for this year from his 2008 salary because of the current global economic situation, according to a regulatory filing Friday." Although Johnson & Johnson's board "voted to give Mr. Weldon an increase, he asked to remain at his 2008 salary of $1.8 million. He was paid an additional $2,500 for a benefit from the previous year that was discontinued."
Healthcare Policy/Legislation
Wyoming House passes two bills to modify health insurance.
The AP (2/20, Korn) reported, "The Wyoming House passed two bills that aim to give health insurance holders more leverage when negotiating disputes with insurance companies. One bill would establish independent review boards to conduct hearings for policyholders to appeal claims that insurance companies have denied." The "second bill would remove so-called discretionary clauses, which can allow insurance companies to deny procedures even if they're covered in individuals' policies." Lawmakers "speaking in favor of the bills, which were approved Thursday, said policyholders are typically at a disadvantage if they have conflicts with insurance providers. They said doctors and patients -- not insurance companies -- should decide whether medical procedures are necessary." Meanwhile, "opponents of the bills said the changes could hurt consumers by limiting their coverage and driving up the cost of insurance."
Bill would require public disclosure of payments to physicians of $100 or more from drugmakers.
American Medical News (2/23, O'Reilly) reports, "Physicians who receive $100 or more from drugmakers or device manufacturers over the course of a year would have those payments posted to the Web under bipartisan Senate legislation introduced in January." The bill, "known as the Physician Payments Sunshine Act, came amid another round of disclosure and conflict-of-interest policies announced by doctors and academic health systems." It "requires reporting of virtually every kind of industry compensation to doctors, ranging from small gifts to royalties and consulting income. Drug samples and short-term device loans would not be reported." In addition, it "would require drug companies or device makers that are not publicly traded to disclose any ownership interest held by physicians or their immediate family members."
New Jersey's Legislature approves measure to allow certain self-referrals to physician-owned ambulatory surgery centers.
American Medical News (2/23, Sorrel) reports, "A bill headed to New Jersey Gov. Jon S. Corzine's desk aims to reverse a court decision that threatened to put the roughly 200 physician-owned ambulatory surgery centers there in violation of the state's anti-self-referral law." Under the legislation, physicians who meet certain exemptions would be allowed "to refer patients to surgery centers in which they have a financial stake." A 2007 trial court ruling deemed "such referrals illegal despite conflicting regulations by the state medical board." Physicians "lobbied to undo the court decision, fearing it would threaten access to care." Medical Society of New Jersey board member John W. Poole, M.D., noted that "smaller centers can offer patients improved quality and convenience over traditional hospital settings." Meanwhile, "hospitals viewed the bill as an important step toward leveling the playing field," citing "instances where surgery centers have been siphoning off paying patients for service lines that could help support the drawdown hospitals have from insufficient charity care and Medicaid patients."
Health Information Technology
California health information exchange to launch in July.
Government Health IT (2/20, Robinson) reported, "The development of a statewide health information exchange in California will formally begin in July with the launch of an electronic medical record service that will provide critical patient information to 23 Orange County emergency departments." This "is the first step in a possible expansion of similar services early next year to other populous areas" within the state. The exchange "will at first provide emergency physicians with medical record information on some 360,000 patients enrolled in CalOptima," a program that "provides coverage for people on Medi-Cal, the state's version of Medicaid, as well as Medicare and the Healthy Kids program."
Healthcare IT News (2/20, Merrill) added that the system "is a collaboration between the statewide California Regional Health Information Organization (CalRHIO) and the Orange County Partnership Regional Health Information Organization (OCPRHIO)." The exchange is also expected to "provide additional data to emergency physicians including medical history, laboratory data and clinical claims data for patients with commercial insurance" by 2010.
CCHIT to expand health-IT certification programs.
Healthcare IT (2/20, Monegain) reported, "The Certification Commission for Healthcare Information Technology (CCHIT) plans to expand its certification activities," according to Chairman Mark Leavitt, who "said the panel would, at the same time, remain flexible and responsive as the impact of the American Recovery and Reinvestment Act emerges." Leavitt called the act "the most important turning point in the history of health IT," and said that CCHIT's "nine new programs for launch in 2010 and beyond will extend certification to new specialties, settings, and populations, while also opening the door to labeling that recognizes advanced capabilities in electronic health records as users become ready to adopt them." The organization has begun "development of four programs -- clinical research, dermatology, advanced interoperability, and advanced quality -- for launch in 2010. These are in addition to two areas previously scheduled for a 2010 launch -- behavioral health and long-term care." In 2011, certification programs for "eye care, oncology, advanced security, and advanced clinical decision support" are planned to launch.
Insurance and Managed Care
CMS orders WellCare to halt new Medicare enrollment.
The Wall Street Journal (2/21, Brin) reported, "WellCare Health Plans Inc., already burdened by a Medicaid-fraud probe, said Friday it would suspend new enrollment in its Medicare health plans after the US imposed sanctions on it." Among the allegations against the insurer are claims of "noncompliance, deficiencies in Medicare prescription-drug contracts and misleading beneficiaries." The Centers for Medicare & Medicaid Services (CMS) noted that "WellCare has the highest number of beneficiary marketing complaints among large Medicare Advantage plans." In addition, the agency's "secret shoppers found evidence that WellCare misled and confused beneficiaries at December sales events." The company released a statement that "it is working with CMS to address the issues."
Health-plan executives make case for long-term success despite dismal economy.
American Medical News (2/23, Berry) reports that despite the fact that "the seven largest publicly traded health plans saw their earnings slide in 2008," health-plan "executives tried to make the case for their own long-term success by emphasizing how they are taking advantage of the weak economy and planning for future health system reform." Some plans "said they would step up efforts in products that those members were potentially turning to for insurance," such as "Medicaid and individual coverage." Meanwhile, "other health plans already in the managed Medicaid field are...promising" investors "that despite state budget constraints, running Medicaid programs is a good way to make money in the midst of the recession," while "positioning themselves to be ready for national health-system reform." Another "common strategy is establishing a sales network and customer base for individual insurance, in case the government establishes an individual health insurance mandate or subsidies to pay for health insurance."
Patient Rights/Quality of Care
Study indicates patients rely heavily on physicians' recommendations in making medical decisions.
In the USA Today (2/23) Your Health column, Kim Painter writes that, according to a study conducted at the University of Michigan, medical decisions are typically made "after a much more one-sided process," rather than based on shared information among physicians and patients. The researchers found that "as a result...too many people get care they don't want or need and miss out on options that make more sense for them." The survey of "3,010 people over 40" revealed that "doctors initiate the discussion in 93 percent of talks about taking cholesterol or blood pressure drugs and in a majority of talks about cancer screening and elective surgery." In addition, "doctors are much more likely to mention the pros of taking action than the cons." In fact, "69 percent of men heard about the advantages of taking a blood test that screens for prostate cancer, and just 18 percent heard about the downside." The researchers also discovered that "doctors almost always give their opinion but are much less likely to ask about a patient's view." Meanwhile, "patients rely heavily on doctors' recommendations," the study showed.
Physicians and Practice
Research indicates many states allow license renewal without considering physicians' clinical activity status.
American Medical News (2/23, Hedger) reports, "Many state medical boards don't ask physicians about their clinical activity status, allowing license renewal even though a doctor may not have treated a patient in years, according to a report in the February Pediatrics." A separate report published in the same issue "showed that roughly one in eight pediatricians has put his or her practice on hold for a year or longer." In the first study, researchers surveyed "64 state boards in allopathic and osteopathic medicine," while the second study included "4,600 pediatricians 65 or younger." Gary L. Freed, M.D., M.P.H., lead author of both studies and chief of the division of general pediatrics and director of the Child Health Evaluation and Research Unit at the University of Michigan Health System, noted that "specialty boards are ahead of state medical boards in assuring physician competency." He added that "the states could take a bit of a lesson from the specialty boards and...begin to work with them more effectively."
Pharmaceuticals
Special court and law shields vaccine makers from lawsuits faced by drugmakers.
The Wall Street Journal (2/23, Johnson) reports, a special 'vaccines court' "and a law that established it more than two decades ago -- buffers...makers of childhood-disease vaccines from much of the litigation risk that dogs traditional pill manufacturers." The legal shield was created because "a spate of lawsuits against vaccine makers in the 1970s and 1980s had caused dozens of companies to get out of the low-profit business, creating a public-health scare." According to the Journal, "the strategy worked and the public-health implications have been sizable. Vaccines have driven huge reductions -- and in the case of smallpox, for instance, complete eradications -- of major childhood diseases." The strategy has also allowed vaccines to "become big business." Their "transformation into a lucrative business has some observers questioning whether the shield law is still appropriate. The vaccine court's ruling this month that routine childhood immunizations aren't linked to autism underscored the limited recourse families who claim injury from vaccines have, critics say."
International News
UK group urges businesses, government to do more to protect workers against RSI.
BBC News (2/23) reports that, according to the UK's Chartered Society of Physiotherapy, "businesses and the government need to do more to protect workers from repetitive strain injury (RSI)." As "official figures" show that "the rate of RSI has hardly changed in the past six years, with more than 200,000 sufferers a year in the UK," the group "wants employers to be compelled to provide occupational health services." Specifically, "an analysis of figures from the Health and Safety Executive (HSE)" by the society "found that injuries were most common in building trades, health and social care, and among factory workers," and "estimated that RSI costs businesses £300 million [$438,400,000] a year in lost working time, sick pay, and administration." The society said that people with RSI "take an average of 13 days off work each year, meaning that overall nearly three million working days are lost annually in the UK."
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