Medicine & Health articles from January 2006

Medicine & Health archives from January 2006

P4P programs not reaching small physician practices: many physicians don't trust health plan-generated performance data.(Pay for performance)
January 2, 2006... Despite the enthusiasm surrounding pay-for-performance pilot programs in both the public and private sectors, an influential think-tank has revealed a P4P backlash involving quality-measurement disparities and certain physician groups. Although...

Part D contingency plans for dual eligibles still riddled with pitfalls: GAO report questions protections for benes--much to CMS' displeasure.
January 2, 2006... A safety net is in place to ensure comprehensive, uninterrupted drug coverage for dual eligibles during their transition to Medicare Part D--but it contains some significant holes, a new report charges. The contingency plans that are in...

Senate seeks additional funding to improve drug plan education and distribution: more funding for SHIPs, SSA resources could make a difference.(Coverage)
January 2, 2006... Twenty-one senators agree that $1.5 billion isn't enough to get Medicare Part D education and distribution off the ground--but requests for nearly $500 million in additional funding may not be possible. The Centers for Medicare & Medicaid...

Time is running out for outpatient therapy cap moratorium: moratorium is still on the back burner--at least until the budget bill passes.(Brief Article)
January 2, 2006... As the new year rolls in, outpatient therapy caps are likely to go back into effect--but that isn't stopping Congress and other organizations from putting up a good fight. Sen. Charles Grassley (R-IA), Senate Finance Committee Chairman,...

Hospital wage index may not accurately reflect occupational mix: reporting discrepancies could bias wages upward and distort adjustments.(Brief Article)
January 2, 2006... Proposed changes to the occupational mix survey show major idiosyncrasies, according to the Medicare Payment Advisory Commission. The Centers for Medicare & Medicaid Services recently proposed changes to the occupational mix survey, which...

Florida passes managed-Medicaid bill: revamped system signals opportunity for private health plans.(Brief Article)
January 2, 2006... Florida legislators last week approved a plan Gov. Jeb Bush proposed to offer Medicaid beneficiaries more choices in health care coverage. If other states follow this model--and sources suggest that they're watching closely--private plans could...

P4P standardization is key, industry leaders agree: quality reporting won't work unless Congress and CMS develop a national system, IOM says.(Pay-for-performance )
January 2, 2006... Pay-for-performance adoption will accelerate if government programs begin to mandate them, researchers say. Further, if government agencies--such as the Centers for Medicare & Medicaid Services--provide a uniform set of quality reporting...

States chime in with dual eligible transition concerns: focus group fears increased cost obligations and inadequate support.
January 2, 2006... The Centers for Medicare & Medicaid Services is taking its fair share of lumps for the way it's handling dual eligibles' transition from Medicaid to Medicare drug coverage. In a recent focus group, 12 Medicaid officials from 11 states spoke...

Pay-for-performance quality measures may bring Medicare into the 21st Century, and many top agencies are all aboard.(In Other News ...)
January 2, 2006... Pay-for-performance quality measures may bring Medicare into the 21st Century, and many top agencies are all aboard. Fourteen reputable agencies, including AARP, National Business Coalition on Health and National Committee for Quality...

The Institute of Medicine and the Medicare Payment Advisory Commission have endorsed P4P methodology.(.)(Brief Article)
January 2, 2006... The Institute of Medicine and the Medicare Payment Advisory Commission have endorsed P4P methodology. "We believe such improvements will ultimately reduce wasteful expenditures of health care dollars," the agencies say. "There is...

Stalled Deficit Reduction Act thwarts physician payments and program funding: Congress' indecision frustrates industry leaders and threatens coverage for seniors.
January 9, 2006... If the House and Senate can reach an agreement on the Deficit Reduction Act provisions, many health care costs in 2006 could net long-term savings by 2010. The result: Better physician payment and more funding for Medicare and Medicaid...

Congressional delay puts 11 payment changes on hold: reconciliation bill may soon pass, but changes may not be retroactive.(Reimbursement)
January 9, 2006... As health care professionals begin working on their New Year's resolutions, hang-ups in Congress have left Medicare payment provisions in limbo. Until Congress resumes volleying the budget reconciliation bill later this month, proposed...

Industry leaders support LTC reform for flawed system: Medicare LTC coverage, P4P get strong support in a recent survey.(Long-term care )(Pay-for-performance )
January 9, 2006... Long-term care facilities' ears are pricked to a quiet rumbling in the distance--millions of baby boomers are about to cross the retirement threshold, and everyone's worried that the system can't support them. Hundreds of health care and...

FDA joins forces with AHRQ to improve drug safety: plus: massive contractor reforms spark renewed scrutiny of claims processing.(Food and Drug Administration)(Agency for Healthcare Research and Quality)
January 9, 2006... As pharmaceutical companies are marketing more drugs to consumers directly, the Food and Drug Administration is working hard to improve its communications about drug safety and research with the Agency for Healthcare Research and Quality. ...

Health care spending shows signs of slowing: reduced growth stirs up mixed emotions among industry leaders.(Spending)
January 16, 2006... The 7.9 percent rise in health care spending during 2004 offers some consolation--this marks the second straight year that the spending growth rate for health care has been on the decline. Industry leaders, however, have mixed opinions on what...

PVRP revisions help physicians 'test the waters': CMS tries to assuage docs before tying quality reporting to Medicare payments.(Physician Voluntary Reporting Program)(Centers for Medicare and Medicaid Services)
January 16, 2006... Quality improvement initiatives could doctor up the health care industry for patients and providers alike--but only if physicians are willing to participate. The Centers for Medicare & Medicaid Services is changing the way it reports...

Vague claims data challenge therapy trends and coverage: therapy cap controversy renews focus on coverage and spending growth.(Outpatient Therapy)
January 16, 2006... Notable growth in outpatient therapy spending has led providers and physician groups to question just who and what Medicare covers, as well as the effects that coverage has stimulated. The Medicare Payment Advisory Commission defines...

Therapy caps tied to spending, payment update: therapy caps reduce provider spending but threaten to escalate benes out-of-pocket burden.(outpatient care)
January 16, 2006... Upon recommendation from the Government Accountability Office, therapy caps went back into effect Jan. 1, 2006, at $1,740 per bene. The $1,740 limit applies to OT services and to PT and SLP services combined. There are notable ebb-and-flow...

Medicaid, managed care restrictions put the brakes on spending growth: reduced Rx spending wasn't the only factor playing into 2004's declining health care spending growth rate.(Spending)(Brief Article)
January 16, 2006... Prescription drug spending played an integral role in slowing down aggregate health care spending growth in 2004--but that's not the full story. The Centers for Medicare & Medicaid Services also attributes 2004's diminished spending growth to...

CMS confirms retroactive physician payment adjustments: plus: bipartisan bill could extend Part D enrollment deadline.(Centers for Medicare and Medicaid Services)
January 16, 2006... Providers who've been crossing their fingers for retroactive adjustments to the 2006 physician payment update finally have some good news. Upon the Deficit Reduction Act's enactment, the Centers for Medicare & Medicaid Services will...

Part D drug plan participants could see extended enrollment deadline.(Industry Notes)
January 16, 2006... A new bipartisan plan could buy Medicare recipients more time to enroll in a Part D drug plan. Senators Olympia J. Snowe (R-ME) and Bill Nelson (D-FL) recently introduced a bill that could extend the Part D enrollment deadline from May 15 to...

MedPAC: lift Part B CAP for satellite chemotherapy.(Payment Advisory Commission)(Competitive Acquisition Program )(Brief Article)
January 16, 2006... The Department of Health and Human Services should permit drug deliveries to satellite chemotherapy facilities, recommends the Medicare Payment Advisory Commission. Vendors should deliver drugs directly to the facility that plans to...

Four new Medicare DME MACs enter the scene.(Durable Medical Equipment)(Medicare Administrative Contractor)(Brief Article)
January 16, 2006... After a competitive bidding process, four new Medicare administrative contractors will be responsible for handling claims from durable medical equipment, prosthetics and orthotics suppliers, CMS announced Jan. 9. The DME MACs will begin...

Enrollment nightmare forces states to enact emergency drug coverage: Rocky Part D rollout leaves many without prescription drug access.
January 23, 2006... While system glitches leave many Part D beneficiaries without access to their prescription drugs, states are stepping up to protect their own--at considerable cost. In spite of the Centers for Medicare & Medicaid Services' comprehensive...

Baby boomers could be the straw that breaks LTC's back: leaders speak out with aggressive propositions on LTC reform.(long-term care system)
January 23, 2006... Ready or not, over the next 10 years, the aging baby boom population will transform the long-term care system. But will the struggling LTC system be able to ready itself--and repair itself--in time? Most elderly Americans consider health...

Money-saving Medicaid waivers may sacrifice quality-of-care: flexible LTC options could end up costing benes access to Medicaid coverage.(long-term care )
January 23, 2006... Millions of aging baby boomers, combined with escalating budgetary pressures, have federal and state governments trading in long-term care quality-of-care initiatives for cheaper--and controversial--"flexible" coverage options. One of...

Payment fluctuations don't stop physicians from accepting Medicare patients: Medicare acceptance relies on more than physician reimbursements, study suggests.
January 23, 2006... Physician advocates' fears that inadequate reimbursements will force practices to turn away new Medicare patients may not hold water. Physicians' willingness to accept new Medicare patients over the past few years shows insignificant...

IPF payment changes could buy better psychiatric care: plus: generic statins could boost Part D cost savings.(Industry Notes)
January 23, 2006... Inpatient psychiatric facilities may soon receive a significant Medicare payment rate increase for discharges on or after July 1, 2006--if the Centers for Medicare & Medicaid Services passes a new rule. The rate increase--part of a...

Health plans, CMS agree to reimburse states' stopgap drug coverage for dual eligibles: senate keeps reimbursement legislation on 'simmer.'.(Centers for Medicare & Medicaid Services)
January 30, 2006... At least 26 states have stepped up to the plate to provide emergency stopgap prescription drug coverage to dual eligibles facing Part D enrollment problems, with no clear decision whether Medicare would reimburse their efforts--until now. ...

Private sector's administration costs rival medicare: medicare cost reports don't tell the whole story, study reveals.(Reimbursement)
January 30, 2006... Health care policy analysts have for years stood by the axiom that Medicare administrative costs are significantly less than private insurers' administrative costs--but a new study shows a much narrower margin. "There are more costs in...

Private plans to blame for part D's high costs: a 'centrally administered' Medicare drug program could be more cost-efficient.(Coverage)
January 30, 2006... Enlisting private insurers to provide Medicare drug coverage did more than confuse consumers--it also may have resulted in at least $332 billion in unnecessary Medicare drug costs and administrative expenses. An add-on benefit to the...

Prescription drug package inserts get a user-friendly makeover: long-overdue redesign improves information but sparks controversy.(Physicians)
January 30, 2006... Physicians may soon find prescription drug labeling information a much more useful tool--but critics worry that the Food and Drug Administration's package-insert revisions conceal a hidden agenda. The potential revisions, which would take...

Baby boomers buckle under crippling health care costs: without help, older adults may face further financial hardship after retirement.(Coverage)
January 30, 2006... Industry experts fear that the current health care system might not support the millions of baby boomers who will soon reach retirement age--but many older adults who are not yet eligible for Medicare are already facing health care hardships, a...

E-prescribing goes under the microscope: plus: change is in the wings for LTC hospitals' Medicare payments.(Long Term Care)
January 30, 2006... A new pilot program will evaluate e-prescribing software and methodology, helping to catalyze the transition to a universal electronic health records system. The program will measure the impact that e-prescribing data transmission systems...