There is talk that the Congress could attach a health care overhaul package to one of the tax bills before Thanksgiving. Of course, nobody knows if that would include a public health insurance option or not.
In addition, eight moderate Democrat senators sent a letter to congressional leadership asking them to present the health care bill at least 72 hours before a vote. They include: Bayh, Lincoln, Pryor, McCaskill, Landrieu, Ben Nelson, Lieberman and Webb.
Saturday, October 10, 2009
Friday, October 9, 2009
Powerchair Registration Forms in a Dallas Hospital Waiting Room
I am sitting in a Dallas hospital and there is a box where you can place registrations for a powerchair from Nationalwide Medical Equipment, Inc. "Register for a free evaluation." I wonder if the hospital realizes that this registration box is here.
Tuesday, October 6, 2009
WSJ Article Examines Pennsylvania Health Care Outcomes System
Today's Wall Street Journal examined Pennsylvania's extensive health care outcomes reporting system for Pennsylvania health care facilities. "Hospitals Find Way to Make Care Cheaper - Make It Better" looked at the death and complications rates that are reported to the state.
Texas will soon enforce its own health-care associated infections (HAI) in health care facilities. Regulators will hold a meeting in Austin later this month to examine reporting requirements.
The article can be viewed by clicking here: http://online.wsj.com/article/SB125478721514066137.html
Texas will soon enforce its own health-care associated infections (HAI) in health care facilities. Regulators will hold a meeting in Austin later this month to examine reporting requirements.
The article can be viewed by clicking here: http://online.wsj.com/article/SB125478721514066137.html
Monday, October 5, 2009
Corrections to Senate Finance Committee CBO Score
The Senate Finance Committee made a few corrections to the Chairman's Mark. The Congressional Budget Office (CBO) requested this so that they could score the bill. They are mostly technical in nature.
CORRECTIONS
Page 56, Children’s Health Insurance Program
The maintenance of effort requirement for children in Medicaid and for CHIP expires on September 30, 2019, not on December 31, 2019 as the document indicates.
Page 116, CMS Innovation Center
Strike the sentence beginning with “To be approved for expansion” and ending with “individualized care plans.
Page 126, Redistribution of Unused Graduate Medical Education Slots
The GME redistribution pool was reduced to 65% in the Modification to the Mark.
The implementation date for the redistribution of residency slots should be July 1, 2011 rather than July 1, 2010.
Page 252, Review and Report by the U.S. Department of Veterans Affairs
The review and report by the Secretary of the U.S. Department of Veterans Affairs shall review and report to Congress on the effect of the fees outlined in Title VI of the Chairman’s Mark not just the fees on branded drugs and medical devices.
CLARIFICATIONS
Page 12, Grandfathered Plans
Any individual or group with existing coverage would be able to keep this plan through the grandfather policy – not just those with a policy equal in value or greater than the “young invincible” plan.
Page 23, Deductible for Small Employer Plans
The deductible amounts for small employer plans ($2,000/$4,000) are indexed to premium growth.
Page 35, Penalty Amount in 2017 and Beyond
The penalty amount of $750 is indexed to CPI-U after 2017.
Page 35, Threshold for Affordability Exemption
The 8% threshold for the affordability exemption is indexed in the same manner as the income caps in the exchanges.
Page 38, Cap on Employer Penalty
The $400 cap on the employer penalty is indexed to premium growth. Page 2
Page 116, CMS Innovation Center
The list of potential opportunities for improving quality and reducing costs are intended to be illustrative not binding; the Secretary would have authority to focus on identifying, designing, testing, and evaluating models that would be expected to reduce program costs while preserving or enhancing the quality of care received by individuals receiving benefits.
Page 128, Promoting Greater Flexibility for Residency Training Programs
Hospitals and eligible training sites participating in a jointly operated residency training program will receive GME payments proportional to the resident costs incurred at each facility.
Page 164, MA Coding Intensity
The policy to transition current MA benchmarks to competitively bid benchmarks from 2011 through 2013 also includes the current law coding intensity adjustment over that time frame.
Page 168, Grandfather Policy for MA Plans
The grandfather policy applies only to beneficiaries enrolled in MA on the date of enactment and excludes rebate payments or performance bonus payments under competitive bidding.
The Secretary shall review the utilization factor for grandfathered plans and only allow factors that reasonably capture added use of care from the extra benefits allowed by the grandfather provision based on historical bids.
Page 174, MA Private Fee-for-Service Plans
The waiver for employer-based PFFS plans only applies to employer-sponsored plans (as defined in 1857(i)(2)) that have enrollment as of the date of enactment.
Page 176, Provider-Specific Cap on Home Health Outlier Payments
The Secretary would continue to withhold 5% from episode payments for the outlier pool, with payouts capped at 2.5%.
Page 183, Extension of Section 508 Reclassifications
In implementing this provision, the Secretary shall use the hospital wage index promulgated in the Federal Register on August 27, 2009 (74 Fed. Reg. 43754) and any subsequent corrections.
Page 187, Medicare Market Basket Cuts
The first paragraph should read: “For hospitals, the provision would require a market basket minus 0.25% reduction in 2010 (effective January 1, 2010) and 2011 for inpatient and outpatient hospitals, inpatient psychiatric facilities, inpatient rehabilitation and long term care hospitals.”
Page 187, Productivity
The first sentence should read: “The provision would provide for updates based on the MB or CPI minus full productivity for all Parts A and B providers, except for Graduate Medical Education, who are subject to a MB or CPI update.”
Page 188, Clinical Labs
Add to the fifth year of the 1.75% reduction x percentage point additional reduction to equal $100 million in additional savings.
CORRECTIONS
Page 56, Children’s Health Insurance Program
The maintenance of effort requirement for children in Medicaid and for CHIP expires on September 30, 2019, not on December 31, 2019 as the document indicates.
Page 116, CMS Innovation Center
Strike the sentence beginning with “To be approved for expansion” and ending with “individualized care plans.
Page 126, Redistribution of Unused Graduate Medical Education Slots
The GME redistribution pool was reduced to 65% in the Modification to the Mark.
The implementation date for the redistribution of residency slots should be July 1, 2011 rather than July 1, 2010.
Page 252, Review and Report by the U.S. Department of Veterans Affairs
The review and report by the Secretary of the U.S. Department of Veterans Affairs shall review and report to Congress on the effect of the fees outlined in Title VI of the Chairman’s Mark not just the fees on branded drugs and medical devices.
CLARIFICATIONS
Page 12, Grandfathered Plans
Any individual or group with existing coverage would be able to keep this plan through the grandfather policy – not just those with a policy equal in value or greater than the “young invincible” plan.
Page 23, Deductible for Small Employer Plans
The deductible amounts for small employer plans ($2,000/$4,000) are indexed to premium growth.
Page 35, Penalty Amount in 2017 and Beyond
The penalty amount of $750 is indexed to CPI-U after 2017.
Page 35, Threshold for Affordability Exemption
The 8% threshold for the affordability exemption is indexed in the same manner as the income caps in the exchanges.
Page 38, Cap on Employer Penalty
The $400 cap on the employer penalty is indexed to premium growth. Page 2
Page 116, CMS Innovation Center
The list of potential opportunities for improving quality and reducing costs are intended to be illustrative not binding; the Secretary would have authority to focus on identifying, designing, testing, and evaluating models that would be expected to reduce program costs while preserving or enhancing the quality of care received by individuals receiving benefits.
Page 128, Promoting Greater Flexibility for Residency Training Programs
Hospitals and eligible training sites participating in a jointly operated residency training program will receive GME payments proportional to the resident costs incurred at each facility.
Page 164, MA Coding Intensity
The policy to transition current MA benchmarks to competitively bid benchmarks from 2011 through 2013 also includes the current law coding intensity adjustment over that time frame.
Page 168, Grandfather Policy for MA Plans
The grandfather policy applies only to beneficiaries enrolled in MA on the date of enactment and excludes rebate payments or performance bonus payments under competitive bidding.
The Secretary shall review the utilization factor for grandfathered plans and only allow factors that reasonably capture added use of care from the extra benefits allowed by the grandfather provision based on historical bids.
Page 174, MA Private Fee-for-Service Plans
The waiver for employer-based PFFS plans only applies to employer-sponsored plans (as defined in 1857(i)(2)) that have enrollment as of the date of enactment.
Page 176, Provider-Specific Cap on Home Health Outlier Payments
The Secretary would continue to withhold 5% from episode payments for the outlier pool, with payouts capped at 2.5%.
Page 183, Extension of Section 508 Reclassifications
In implementing this provision, the Secretary shall use the hospital wage index promulgated in the Federal Register on August 27, 2009 (74 Fed. Reg. 43754) and any subsequent corrections.
Page 187, Medicare Market Basket Cuts
The first paragraph should read: “For hospitals, the provision would require a market basket minus 0.25% reduction in 2010 (effective January 1, 2010) and 2011 for inpatient and outpatient hospitals, inpatient psychiatric facilities, inpatient rehabilitation and long term care hospitals.”
Page 187, Productivity
The first sentence should read: “The provision would provide for updates based on the MB or CPI minus full productivity for all Parts A and B providers, except for Graduate Medical Education, who are subject to a MB or CPI update.”
Page 188, Clinical Labs
Add to the fifth year of the 1.75% reduction x percentage point additional reduction to equal $100 million in additional savings.
Thursday, October 1, 2009
Kidney Dialysis Payment Changes
Several weeks ago, CMS proposed a new payment system for renal dialysis facilities - bundled payments. It is expected to hurt some drug makers. However, the verdict is out as to how it could impact facilities.
Meanwhile, the Office of Inspector General, in its FY 2010 Work Plan, included a few renal issues in its items to be analyzed. Among them:
Medicare Payments for End-Stage Renal Disease Drugs
We will review dialysis facilities’ fourth-quarter 2008 average acquisition costs for selected ESRD drugs and compare these to fourth-quarter 2008 Medicare payment amounts. Medicare bases payment on 106 percent of the drugs’ ASPs. However, effective January 1, 2011, MIPPA will change payments for ESRD items and services by bundling ESRD drugs, which are currently billed separately, with all of the other costs of ESRD care. Previous OIG reviews have found that Medicare payments for the majority of separately billable ESRD drugs are consistently higher than average acquisition costs reported by dialysis facilities and prices paid by the Department of Veterans Affairs (VA). We will also compare facilities’ 2008 fourth-quarter average acquisition costs to the costs that facilities reported for these drugs in previous quarters.
(OEI; 03-09-00280; expected issue date: FY 2010; work in progress)
Renal Dialysis Facilities’ Dosing Guidelines for Erythropoiesis-Stimulating
Agents
We will review whether protocols used by renal dialysis facilities for erythropoiesis-stimulating agents (ESA) adhere to FDA labeling recommendations. In response to research published in 2007, FDA approved revised labeling for ESAs, including a “black box” warning recommending that ESAs be dosed to maintain a hemoglobin value of less than 12 g/dL. According to the revised labeling for ESAs, maintaining hemoglobin levels above 12 g/dL can adversely affect a patient’s health, possibly resulting in death. There are concerns that dialysis facilities may be using dosing guidelines, standards, and protocols that are not consistent with the revised labeling
recommendations. We will determine the extent to which renal dialysis facilities’ protocols for administering ESAs are consistent with CMS’s monitoring policy for ESA claims.
(OEI; 03-09-00010; expected issue date: FY 2010; work in progress)
Ambulance Services Used To Transport End-Stage Renal Disease Beneficiaries
We will review the extent to which ambulance services are used to transport ESRD beneficiaries to and from dialysis facilities. CMS’s “Medicare Benefit Policy Manual,” Pub. No. 100-02, ch. 10, § 10.3, describes coverage of ambulance services to and from renal dialysis facilities for ESRD patients who require dialysis. Furthermore, section 623(f) of the MMA requires the Secretary to develop a report on a bundled PPS for ESRD services. The bundled PPS for ESRD services generally does not provide for ambulance services. In CY 2005, payments for ambulance services between beneficiaries’ residences and hospital-based or freestanding ESRD facilities were approximately $262 million. We will examine factors such as the percentage of
the population using ambulance services, the feasibility of contracting by freestanding facilities with ambulance suppliers, and the coverage policies of other health insurance programs.
(OAS; W-00-10-35417; various reviews; expected issue date: FY 2010; new start)
Meanwhile, the Office of Inspector General, in its FY 2010 Work Plan, included a few renal issues in its items to be analyzed. Among them:
Medicare Payments for End-Stage Renal Disease Drugs
We will review dialysis facilities’ fourth-quarter 2008 average acquisition costs for selected ESRD drugs and compare these to fourth-quarter 2008 Medicare payment amounts. Medicare bases payment on 106 percent of the drugs’ ASPs. However, effective January 1, 2011, MIPPA will change payments for ESRD items and services by bundling ESRD drugs, which are currently billed separately, with all of the other costs of ESRD care. Previous OIG reviews have found that Medicare payments for the majority of separately billable ESRD drugs are consistently higher than average acquisition costs reported by dialysis facilities and prices paid by the Department of Veterans Affairs (VA). We will also compare facilities’ 2008 fourth-quarter average acquisition costs to the costs that facilities reported for these drugs in previous quarters.
(OEI; 03-09-00280; expected issue date: FY 2010; work in progress)
Renal Dialysis Facilities’ Dosing Guidelines for Erythropoiesis-Stimulating
Agents
We will review whether protocols used by renal dialysis facilities for erythropoiesis-stimulating agents (ESA) adhere to FDA labeling recommendations. In response to research published in 2007, FDA approved revised labeling for ESAs, including a “black box” warning recommending that ESAs be dosed to maintain a hemoglobin value of less than 12 g/dL. According to the revised labeling for ESAs, maintaining hemoglobin levels above 12 g/dL can adversely affect a patient’s health, possibly resulting in death. There are concerns that dialysis facilities may be using dosing guidelines, standards, and protocols that are not consistent with the revised labeling
recommendations. We will determine the extent to which renal dialysis facilities’ protocols for administering ESAs are consistent with CMS’s monitoring policy for ESA claims.
(OEI; 03-09-00010; expected issue date: FY 2010; work in progress)
Ambulance Services Used To Transport End-Stage Renal Disease Beneficiaries
We will review the extent to which ambulance services are used to transport ESRD beneficiaries to and from dialysis facilities. CMS’s “Medicare Benefit Policy Manual,” Pub. No. 100-02, ch. 10, § 10.3, describes coverage of ambulance services to and from renal dialysis facilities for ESRD patients who require dialysis. Furthermore, section 623(f) of the MMA requires the Secretary to develop a report on a bundled PPS for ESRD services. The bundled PPS for ESRD services generally does not provide for ambulance services. In CY 2005, payments for ambulance services between beneficiaries’ residences and hospital-based or freestanding ESRD facilities were approximately $262 million. We will examine factors such as the percentage of
the population using ambulance services, the feasibility of contracting by freestanding facilities with ambulance suppliers, and the coverage policies of other health insurance programs.
(OAS; W-00-10-35417; various reviews; expected issue date: FY 2010; new start)
Tuesday, September 29, 2009
Comparative Effectiveness Amendment Failed
Another amendment that would prevent the federal government from using certain data for comparative effectiveness data research.
The amendment and vote:
KYL-ROBERTS-CRAPO-CORNYN AMENDMENT #D8 America’s Healthy Future Act of 2009
Short Title: The PATIENTS Act Description: The amendment would add
the “Preserving Access to Targeted, Individualized, and Effective New
Treatments and Services (PATIENTS) Act of 2009” (S.1259).
SECTION 1. SHORT TITLE.
This Act may be cited as the `Preserving Access to Targeted,
Individualized, and Effective New Treatments and Services (PATIENTS)
Act of 2009' or the `PATIENTS Act of 2009'.
SEC. 2. PROHIBITION ON CERTAIN USES OF DATA OBTAINED FROM COMPARATIVE
EFFECTIVENESS RESEARCH; ACCOUNTING FOR PERSONALIZED MEDICINE AND
DIFFERENCES IN PATIENT TREATMENT RESPONSE.
(a) In General- Notwithstanding any other provision of law, the
Secretary of Health and Human Services--
(1) shall not use data obtained from the conduct of comparative
effectiveness research, including such research that is conducted or
supported using funds appropriated under the American Recovery and
Reinvestment Act of 2009 (Public Law 111-5), to deny coverage of an
item or service under a Federal health care program (as defined in
section 1128B(f) of the Social Security Act (42 U.S.C. 1320a-7b(f)));
and
(2) shall ensure that comparative effectiveness research conducted or
supported by the Federal Government accounts for factors contributing
to differences in the treatment response and treatment preferences of
patients, including patient-reported outcomes, genomics and
personalized medicine, the unique needs of health disparity
populations, and indirect patient benefits.
(b) Rule of Construction- Nothing in this section shall be construed
as affecting the authority of the Commissioner of Food and Drugs under
the Federal Food, Drug, and Cosmetic Act or the Public Health Service
Act.
Offset: None
Republicans
CHUCK GRASSLEY -yes
ORRIN G. HATCH -yes
OLYMPIA J. SNOWE- yes
JON KYL -yes
JIM BUNNING -yes
MIKE CRAPO -yes
PAT ROBERTS -yes
JOHN ENSIGN -yes
MIKE ENZI -yes
JOHN CORNYN -yes
Democrats
MAX BAUCUS -no
JOHN D. ROCKEFELLER -no
KENT CONRAD -no
JEFF BINGAMAN -no
JOHN F. KERRY -no
BLANCHE L. LINCOLN -no
RON WYDEN -no
CHARLES E. SCHUMER -no
DEBBIE STABENOW -no
MARIA CANTWELL -no
BILL NELSON -no
ROBERT MENENDEZ -no
THOMAS CARPER -no
Not Agreed to (10-13)
The amendment and vote:
KYL-ROBERTS-CRAPO-CORNYN AMENDMENT #D8 America’s Healthy Future Act of 2009
Short Title: The PATIENTS Act Description: The amendment would add
the “Preserving Access to Targeted, Individualized, and Effective New
Treatments and Services (PATIENTS) Act of 2009” (S.1259).
SECTION 1. SHORT TITLE.
This Act may be cited as the `Preserving Access to Targeted,
Individualized, and Effective New Treatments and Services (PATIENTS)
Act of 2009' or the `PATIENTS Act of 2009'.
SEC. 2. PROHIBITION ON CERTAIN USES OF DATA OBTAINED FROM COMPARATIVE
EFFECTIVENESS RESEARCH; ACCOUNTING FOR PERSONALIZED MEDICINE AND
DIFFERENCES IN PATIENT TREATMENT RESPONSE.
(a) In General- Notwithstanding any other provision of law, the
Secretary of Health and Human Services--
(1) shall not use data obtained from the conduct of comparative
effectiveness research, including such research that is conducted or
supported using funds appropriated under the American Recovery and
Reinvestment Act of 2009 (Public Law 111-5), to deny coverage of an
item or service under a Federal health care program (as defined in
section 1128B(f) of the Social Security Act (42 U.S.C. 1320a-7b(f)));
and
(2) shall ensure that comparative effectiveness research conducted or
supported by the Federal Government accounts for factors contributing
to differences in the treatment response and treatment preferences of
patients, including patient-reported outcomes, genomics and
personalized medicine, the unique needs of health disparity
populations, and indirect patient benefits.
(b) Rule of Construction- Nothing in this section shall be construed
as affecting the authority of the Commissioner of Food and Drugs under
the Federal Food, Drug, and Cosmetic Act or the Public Health Service
Act.
Offset: None
Republicans
CHUCK GRASSLEY -yes
ORRIN G. HATCH -yes
OLYMPIA J. SNOWE- yes
JON KYL -yes
JIM BUNNING -yes
MIKE CRAPO -yes
PAT ROBERTS -yes
JOHN ENSIGN -yes
MIKE ENZI -yes
JOHN CORNYN -yes
Democrats
MAX BAUCUS -no
JOHN D. ROCKEFELLER -no
KENT CONRAD -no
JEFF BINGAMAN -no
JOHN F. KERRY -no
BLANCHE L. LINCOLN -no
RON WYDEN -no
CHARLES E. SCHUMER -no
DEBBIE STABENOW -no
MARIA CANTWELL -no
BILL NELSON -no
ROBERT MENENDEZ -no
THOMAS CARPER -no
Not Agreed to (10-13)
2nd Public Option Senate Finance Amendment Dead
The second shot at a public health insurance option died in the Senate Finance Committee. It was offered by Senate Chuck Schumer (D-NY):
Schumer Amendment #C1 to Title I, Subtitle E-
Short Title: Level Playing Field Public Option
Description of Amendment:
Strike Title I, Subtitle E, Health Care Cooperatives and replace with a national ―level playing field‖ public health insurance option with negotiated reimbursement rates to enhance competition for consumers within the Exchange.
The new national level playing field public option must adhere to the same rules (actuarial reporting, community rating and guaranteed issue) as all other plans in the Exchange and must be self-sustaining with premiums and copayments covering claims. Like private plans, the ―level playing field‖ public option would also be required to establish a reserve fund. Aside from covering some initial start-up costs, general revenues or annual appropriations may not support the ongoing operation of the plan.
The government must not use existing programs like Medicare as a stick to compel providers to participate in the public option. Instead, doctors and hospitals should be able to voluntarily opt-in to participate in the public option.
Offset:
Increase annual fee on for-profit health insurance providers by amount necessary to offset the increase in spending.
Republicans
CHUCK GRASSLEY -no
ORRIN G. HATCH -no
OLYMPIA J. SNOWE -no
JON KYL -no
JIM BUNNING -no
MIKE CRAPO -no
PAT ROBERTS -no
JOHN ENSIGN -no
MIKE ENZI -no
JOHN CORNYN -no
Democrats
MAX BAUCUS -no
JOHN D. ROCKEFELLER -yes
KENT CONRAD -no
JEFF BINGAMAN -yes
JOHN F. KERRY -yes
BLANCHE L. LINCOLN -no
RON WYDEN -yes
CHARLES E. SCHUMER -yes
DEBBIE STABENOW -yes
MARIA CANTWELL -yes
BILL NELSON -yes
ROBERT MENENDEZ -yes
THOMAS CARPER -yes
Not Agreed to (13-10)
Schumer Amendment #C1 to Title I, Subtitle E-
Short Title: Level Playing Field Public Option
Description of Amendment:
Strike Title I, Subtitle E, Health Care Cooperatives and replace with a national ―level playing field‖ public health insurance option with negotiated reimbursement rates to enhance competition for consumers within the Exchange.
The new national level playing field public option must adhere to the same rules (actuarial reporting, community rating and guaranteed issue) as all other plans in the Exchange and must be self-sustaining with premiums and copayments covering claims. Like private plans, the ―level playing field‖ public option would also be required to establish a reserve fund. Aside from covering some initial start-up costs, general revenues or annual appropriations may not support the ongoing operation of the plan.
The government must not use existing programs like Medicare as a stick to compel providers to participate in the public option. Instead, doctors and hospitals should be able to voluntarily opt-in to participate in the public option.
Offset:
Increase annual fee on for-profit health insurance providers by amount necessary to offset the increase in spending.
Republicans
CHUCK GRASSLEY -no
ORRIN G. HATCH -no
OLYMPIA J. SNOWE -no
JON KYL -no
JIM BUNNING -no
MIKE CRAPO -no
PAT ROBERTS -no
JOHN ENSIGN -no
MIKE ENZI -no
JOHN CORNYN -no
Democrats
MAX BAUCUS -no
JOHN D. ROCKEFELLER -yes
KENT CONRAD -no
JEFF BINGAMAN -yes
JOHN F. KERRY -yes
BLANCHE L. LINCOLN -no
RON WYDEN -yes
CHARLES E. SCHUMER -yes
DEBBIE STABENOW -yes
MARIA CANTWELL -yes
BILL NELSON -yes
ROBERT MENENDEZ -yes
THOMAS CARPER -yes
Not Agreed to (13-10)
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