Hospital Practices Cause 340B Drug Program Investigation

Are hospitals hording hard-to-get drugs using the 340B program? That’s what Congress wants to know. It came to light last week that members of Congress in April escalated their inquiry into the program, which was created in 1992. Click here for the congressional letter that focused the investigation on a specific hospital’s activities. Click here for a summary of the ongoing 340B congressional review.

Five New MedPAC Members Announced

The Medicare Payment Advisory Commission (MedPAC) has five new members. They start immediately and their terms run for three years. They are Alice Coombs, MD, South Shore Hospital, Weymouth, MA; Jack Hoadley, Ph.D., Georgetown University, Washington, DC; David Nerenz, Ph.D., Director of the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI; Rita Redberg, MD, Professor, University of California at San Francisco Medical Center; and Craig Samitt, MD, President and CEO, Dean Health System, Inc., Madison, WI. MedPAC advises Congress on Medicare policy. Click here for more information on the appointees.

New Report Details States’ Medicaid Reform Efforts

Most states are moving forward with significant Medicaid reform, according to a Kaiser report out last week. Under the Affordable Care Act there are five key Medicaid options for states. As of May 2012, nearly every state (48 states and DC) has taken steps forward with at least one of the five options. To date, most state participation has been in funding to upgrade Medicaid eligibility systems (28 states and DC) and test integrated care models for dual eligible beneficiaries (26 states). The very good complete 12-page report is available here.

Hospitals’, Insurers’ Have Creative Cost Cutting Efforts

This is no surprise to you, but hospitals and insurers are pushing hard to find new ways of cutting health care costs. The NY Times ran an interesting article last week providing some creative examples. Click here for the story.

Less Tobacco Money Going for Cessation and Prevention

State tobacco settlement funds and higher taxes on tobacco appear to be used less and less for tobacco cessation and other related health programs, says a new CDC report. The CDC report shows that between 1998 and 2010, states collected $243.8 billion from the settlement and tobacco taxes but spent only $8.1 billion of it — one dollar out of 30 — on smoking prevention and cessation. That’s  less than one-third of what the CDC recommended at the time.  Click here for the CDC report and see how your state compares.

Radiology Use Declining: New Report

A new report on healthcare utilization at private U.S. insurance companies indicates that radiology use is declining while many other healthcare services are growing. The drop mirrors similar findings in the Medicare system, leading radiology backers to repeat charges that imaging is being singled out unfairly for cuts. Click here for the story.

$120 Million to be Awarded for Comparative Research: Ready to Apply?

The Patient-Centered Outcomes Research Institute (PCORI) last week released its first primary research funding announcements to support comparative clinical effectiveness research. PCORI will award $120 million this year for innovative projects that effectively incorporate patients and stakeholders in research teams and address the areas of focus of PCORI’s National Priorities for Research and Research Agenda. Click here for details.  If interested, Strategic Health Care’s research development team can help you to develop programs and applications. Contact Gwen Mathews (gwen.mathews@shcare.net) for more information.

Study: New Summary of Benefits and Coverage Will Help Millions Make Better Choices

The 173.5 million Americans who have private health individual and employer-sponsored insurance will be helped by a health care reform requirement that insurers provide plain-language descriptions of plans’ benefits and costs, according to a report released last week. By requiring uniform descriptions, the Summary of Benefits and Coverage will help consumers make comparisons among plans, and choose plans based on value rather than cost alone said Families USA, which produced the report. Click here to see the report.

2.2 Million Vets and Families Uninsured

An estimated 1.3 million veterans and nearly 950,000 members of their families are uninsured, together making up 4.8 percent of the nation’s 47.3 million uninsured in 2010, according to a new report from the Urban Institute. Forty-one percent of uninsured veterans report having unmet medical needs, while nearly 34 percent have delayed care due to cost. Click here for the full report.

VA, DoD Health Records to be Merged

The departments of defense and veterans affairs plan to fully merge their health care records systems in the next five years, with the goal of giving troops and veterans a single, seamless system to track medical care throughout their lifetime. The announcement came late last week. Click here for the story.

CMS Posts New Answers to Questions on Insurance Exchanges

Having some trouble in figuring out the approval process for state insurance exchanges? CMS last week posted 16 answers the most commonly asked questions on this issue. It does help clarify the agency’s draft blueprint that was released two weeks ago. Click here.

As ACO Deadline Approaches, Milliman Outlines Differences Between Types

June 15 is the deadline to file a letter of intent with CMS if you want to start a Medicare Shared Savings Program ACO on January 1, 2013. Click here for more information. To help clarify the differences between an MSSP ACO and a Pioneer ACO (also a CMS creation), Milliman has put together a very helpful and detailed summary. Click here.

Non-Facility Based Care Givers Now 31% of Healthcare Workforce

As more care moves from inpatient to outpatient, “direct-care” workers will outnumber healthcare facility workers more than two-to-one by 2020, according to a report last week from the Paraprofessional Healthcare Institute. In 2011, there were at least 4 million nursing assistants, home health aides and personal care aides, with most working in home and community-based settings. Those direct-care workers represented almost 31 percent of the entire U.S. healthcare workforce, according to the analysis. Click here for the report.

Don’t Screen Low-Risk People for Lung Cancer — Ever: New Report

Screening lower-risk individuals snuffs out the benefit of CT lung cancer screening while multiplying the costs and risks of the technology, according to a presentation last week at the American Thoracic Society meeting. Click here for details.

Medicare Saves Seniors Billions in Drug Costs

Medicare beneficiaries have save about $3.5 billion in drug costs since the Affordable Care Act became law in 2010, according to a new analysis from HHS.  Additionally, In the first four months of 2012, more than 416, 000 Medicare beneficiaries saved an average $724 on prescription drugs and 12.1 million used a free preventative service. Click here for a detailed summary.

Senate Passes Major FDA Reform Bill; House Bill Pending

In a rare show of bipartisanship, the US Senate last week passed comprehensive reform legislation (96 to 1) designed to prevent drug shortages and to speed federal approval of lifesaving medicines, including lower-cost generic versions of biotechnology products. The House could approve similar legislation as early as this week. Click here for a good NY Times summary.

Medicare Overpayments to Providers Targeted by OIG

CMS may be stepping up efforts to collect on overpyaments to providers following last week’s release of an OIG report.  The OIG’s review showed that CMS failed to collect $332 million of $418 million in Medicare overpayments identified by 154 OIG audit reports released in fiscal years 2007 and 2008 and the first six months of 2009. The OIG said CMS should push for legislation to extend the statute of limitations for collecting Medicare overpayments (a Medicare contractor with good cause can reopen a claim within four years of the original payment). Click here for the OIG report.

Death Rates for Diabetics Dropping: CDC

Death rates for people with diabetes dropped substantially from 1997 to 2006, especially deaths related to heart disease and stroke, according to researchers at the CDC and the National Institutes of Health.  Deaths from all causes declined by 23 percent, and deaths related to heart disease and stroke dropped by 40 percent. Click here for the report.