Key radiation stakeholders were caught off-guard by a pay cut
to a high-cost stereotactic radiosurgery instrument -- called Gamma Knife -
that sources say was quietly tucked into the fiscal cliff deal at the last minute
as a way to offset the one-year "doc fix" and they are urging lawmakers to get
CMS to re-examine the payment rates through the regulatory process. The
provision gleans at least $300 million by lowering payments for the Gamma Knife
technology -- which is manufactured by Sweden's Elekta and widely used in brain
cancer treatment -- to put them in line with payments for linear
accelerator-based (or LINAC) stereotactic radiosurgery (SRS) instruments, many
of which are produced by California-based Varian Medical Systems.1395 words
Hospitals are appealing to Congress' Medicare payment
advisors to rethink draft payment proposals they plan to take up Thursday (Jan.
10), saying the proposals when taken in conjunction with the $11billion hit to
hospitals in the fiscal cliff law's "doc fix" and upcoming sequestration cuts
would be an unwarranted payment cut across the industry. In a letter to the
commissioners, the American Hospital Association and the Federation of American
Hospitals say hospitals need much bigger payment updates than called for by the
draft recommendations.791 words
In a decision that surprised health care stakeholders, Sen.
Tom Coburn (R-OK) will not sit on the powerful Senate Finance Committee in the
113th Congress, a change that comes as lawmakers are expected to tackle deficit
reduction and reforms to the tax code and federal health care programs -- which
all fall under the committee's jurisdiction -- over the coming year.573 words
California, the state proposing to cover by far more dually
eligible beneficiaries than any of the CMS demonstrations approved to date, is
poised to release its agreement with the agency, a Medicaid beneficiary
advocate says, and beneficiary advocates are eagerly awaiting the details as an
indicator of how far CMS is willing to let the state demos go. Some lawmakers
have raised concerns that CMS' duals demonstrations cover too many
beneficiaries, which they say could threaten the quality of care for the poor,
but others say CMS and states should use the demos to more aggressively move duals
into managed care.353 words
Rep. James Lankford (R-OK) will chair a reconfigured energy,
health care and entitlements subcommittee within the House Oversight Committee,
the committee announced Wednesday (Jan. 2). Previously, the Oversight health
subcommittee did not have "entitlements" in its title, and the change could
suggest that the issue will be a high-profile subject in 2013.216 words
UnitedHealth Group is touting a new proposal to reduce health
spending that calls for Medicare and Medicaid to be updated to include
strategies already successfully implemented by health plans, employers and
states -- including use of "administrative services organizations" in
fee-for-service Medicare to manage beneficiaries' health benefits and increased
reliance on managed care for dual eligibles beyond current CMS demonstrations.815 words
While the overall growth in health care spending remained at
historically low levels in 2011, according to a CMS analysis of national health
expenditures, Medicare spending grew faster than other health sectors areas and
one expert says that could become a rallying cry for entitlement reform in the
coming months.705 words
PCORI plans to announce this year specific, and larger,
research projects that it will fund, breaking from a more general research
agenda for which it has been criticized, said Joe Selby, executive director of
the Patient-Centered Outcomes Research Institute. The shift might allow PCORI
to give more money for individual projects, he said, and PCORI also would like
to help fund a national research database.636 words
A new broad-based stakeholder commission, chaired by two
former governors, held a conference call Tuesday (Jan. 8) as it works to put
together a blueprint by November on practical ways for states to control health
care spending. Reviewing scope of practice, encouraging implementation of
state-based delivery and payment reforms and helping residents become wiser
health care consumers were among the list of ideas commissioners discussed.579 words
Proponents of the health reform law's voluntary long-term
care insurance program that was repealed in the recently enacted "fiscal cliff"
legislation say they are hopeful a new long-term care commission created by
that same bill will provide another opportunity to move forward on a long-term
care plan, sources tell Inside Health Policy, though an alternative to
the CLASS program is far from clear.616 words
The National Association of Insurance Commissioners says CMS
should give states flexibility to phase in the health reform law's new 3:1 age
rating restrictions that apply in 2014, echoing the concerns raised by insurers
that immediately enacting a 3:1 age rating could result in rate shocks that
would result in younger individuals dropping coverage. The stance seems to be
at odds with that of some of the commission's own consumer representatives, who
say that any move to phase in the law's age rating restrictions would have to
be enacted through a legislative change as CMS does not have the regulatory
authority to make the move on its own.570 words
Therapist advocates complain that fiscal cliff negotiators'
decision to cut $1.8 billion in payments for therapy multiple procedures, an
offset for the one-year Medicare physician payment patch, is blatantly unfair
as it cuts across therapy disciplines that are normally paid separately, and
some advocates say they will seek to have the cuts eliminated or at least to
lessen their impact on therapists. The newly enacted fiscal cliff bill reduces
payments for subsequent therapies when therapies are provided on the same day.572 words
Medicaid tops the list of fiscal issues for state
legislatures in 2013, according to a survey of state legislative fiscal
officers by the National Conference of State Legislatures, and more than half
of the states are gearing up to address rising health care costs and ACA
implementation issues in the new year. The survey offers a snapshot of Medicaid
funding issues facing dozens of states as they decide whether to expand the
program or reshape it in other ways to cut back costs.866 words
State health cooperatives were "blind-sided" by Congress'
11th-hour decision in fiscal cliff talks to strip nearly all remaining funding
from the health reform law's Consumer Oriented and Operated Plans (CO-OP) and
plan to mount an aggressive lobby to get the funding restored, National
Association of State Health Cooperatives (NASCHO) President John Morrison tells
Inside Health Policy. Morrison points out that the lawmakers' decision
came just hours after the December round of applications was submitted, calling
the move a "tragic" deal that will result in only half the country having
access to CO-OP plans and, as a result, bolster large insurance.798 words
The Supreme Court scheduled oral arguments in two
highly-watched drug preemption and patent settlement cases for March. The high
court will hear Mutual Pharmaceutical Co. v Bartlett, a generic
drug preemption case, March 19, followed by oral arguments in a case examining
the legality of patent settlements, FTC v. Watson Pharmaceuticals, et al., March
25.189 words
The head of CMS' Center for Consumer Information and Insurance
Oversight said Thursday (Jan. 3) that Mississippi's application to have a
state-based exchange has neither been approved nor denied by the administration
because there is disagreement in the state about whether it can oversee all
exchange activities. The move comes despite the fact that HHS is required by
the health reform law to certify state-based exchanges by Jan. 1, 2013, and if
by that date the HHS Secretary determines that the state will not have an
exchange operational by 2014, HHS must run a federal exchange.645 words
Hospitals are deeply disappointed in Congress' decision to
offset the one-year Medicare physician payment patch by recouping $10.5 billion
in coding adjustments from the providers, a move fiscal cliff negotiators
appear to have taken in lieu of cutting hospital evaluation & maintenance
funding, cuts also vehemently opposed by the industry. One hospital association
official said that in the wake of $95 billion in hospital cuts over the past
three years it's time for legislators to look elsewhere for healthcare savings
during debt limit talks in February.701 words
Consumer advocates met with White House officials Dec. 27 to
urge them to quickly review the long-overdue physician-payment disclosure
regulation and reject several revisions sought by the American Medical
Association, according to consumer representatives who attended the meeting.
CMS officials last year said they hoped to release the regulation by the end of
2012, and a couple of physician groups pointed out to the agency last week that
it missed that goal.716 words
While the "fiscal cliff" and a one-year "doc fix" are behind
them, health care stakeholders are bracing for lawmakers to again go after the
sector in the coming weeks as a part of larger deficit reduction efforts,
especially now that Congress has less than two months to figure out how to stop
the automatic spending cuts called for by sequestration as well as raise the
debt ceiling, sources tell Inside Health Policy.1012 words
Nearly four out of 10 physicians surveyed said they
"sometimes or often" prescribe brand-name drugs over generics because patients
ask them to, and drug company relationships with physicians exacerbate the
trend, according to a study published Monday (Jan. 7) by JAMA Internal
Medicine. Generic drugmakers said the study shows there are savings to be
achieved by turning to generics, while Pharmaceutical Research and
Manufacturers of America countered that physician prescribing decisions are
influenced by a slew of factors such as formularies, clinical guidelines and
continuing education.766 words
FDA's first biosimilar approval is not expected this year,
but debate is anticipated at the federal and state level over substitution
policies, including naming, interchangeability and automatic substitution
standards, according to industry sources following the new pathway. Sources
also said 2013 will be a critical year for smoothing out kinks in the
biosimilar review process to determine whether the health reform-created
pathway will prove lucrative to drug makers and provide health care savings.1063 words
Massachusetts Gov. Deval Patrick (D) on Friday (Jan. 4)
unveiled a legislative proposal and additional measures to beef up his state's
oversight of pharmacy compounding by enhancing inspections and reforming the
state board of pharmacy -- a proposal that builds on recommendations released
the same day by Massachusetts' newly formed pharmacy compounding commission.
Rep. Ed Markey (D-MA) said the proposal is a "robust state complement" to a
bill he plans to re-introduce in the new Congress to beef up federal oversight
of large-scale compounding pharmacies.797 words
Vertex Pharmaceuticals this week said it received FDA's first
two breakthrough drug designations and will use the designations to expand uses
for its landmark cystic fibrosis drug Kalydeco, ending widespread speculation
about which company received the initial designations enacted by the FDA Safety
and Innovation Act. The drug, although approved before the new program existed,
was seen as an example of the type of product that could be a breakthrough
candidate, according to a stakeholder who backed the program's inclusion in
FDASIA.781 words
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