dagblog - Comments for "U.S. Proposes Cuts to Rates in Medicare Payments"

There is also lots of news

artappraiser — Sat, 22 Feb 2014 16:57:49 +0000

In reply to U.S. Proposes Cuts to Rates in Medicare Payments

There is also lots of news about Medicare and painkillers owing to a new Harvard study that says 1/3 of Medicare patients are being prescribed them by multiple doctors. (Thereby also bringing up the topic of lack of managed care of prescriptions with Medicare fee-for-service, where patients can visit many doctors without anyone but the patient coordinating treatments):

Study: 1 in 3 Medicare patients prescribed painkillers from multiple doctors
By Deborah Kotz, Boston Globe, Feb. 20, 2014

With the steep rise in prescription narcotics and deaths from unintentional overdose of these drugs, a Harvard Medical School study found a wide-scale problem that could be contributing to the dangerous trend: One in three Medicare patients who fill prescriptions for narcotics like opioids get them from multiple doctors who were unaware that their patients were already prescribed these drugs.

In the study published Wednesday in the British Medical Journal, researchers reviewed more than 1.2 million medical records of Medicare patients who received a prescription for an opioid— such as hydrocodone, fentanyl, morphine, and oxycodone—and found that nearly 35 percent had received a prescription from more than one doctor. One-third of this group got their prescriptions from four or more doctors [....]

The following article used data from a Pro Publica study of all Medicare prescriptions to apply it to the state of Nevada on the topic of pain killers (lots of charts @ the link) but also gets at the link between the feature/bug of fee-for-service that it encourages "money-driven-medicine," in this case, selling drugs to the Medicare public:

Painkillers Mean Big Business For Medicare in Nevada
By Steve Kanigher, I-Team Reporter, KLAS TV, Updated: Feb 19, 2014 3:23 PM EST

LAS VEGAS -- Statistics compiled by the nonprofit newsroom ProPublica show Nevada medical professionals prescribed more than $14.5 million worth of major pain relievers oxycodone, OxyContin and hydrocodone to Medicare patients in 2011, the latest year data is available.

The recipients of these Medicare Part D drug prescriptions included not only patients 65 and older, but also younger disabled individuals.

In a project called Prescriber Checkup, ProPublica reported that a relatively small number of physicians nationwide were responsible for a disproportionately large share of the Medicare cost absorbed by taxpayers for expensive name-brand drugs. Nevada medical professionals in 2011 wrote $390 million worth of prescriptions on behalf of Medicare patients for the 500 most popular drugs.

While much of that expense was absorbed by taxpayers, patients also shared in the cost through copayments. In many cases the retail costs were also reduced through rebates drug companies passed on to Medicare recipients.

ProPublica ranked all drugs prescribed under Medicare so the focus of the news organization wasn't only on painkillers. But because of widespread concerns about abuse of painkillers in Southern Nevada, 8 News NOW wanted to examine ProPublica data [....}

Is Medicare drug coverage in

artappraiser — Sat, 22 Feb 2014 16:38:06 +0000

In reply to Plan to Limit Some Drugs in

Is Medicare drug coverage in jeopardy?
By Elise Viebeck, "Healthwatch" blog @ The Hill, Feb. 20, 2014

Republican committee leaders are pushing the Obama administration to call off proposed changes to the Medicare prescription drug program, arguing the overhaul would jeopardize seniors' plans and raise premiums.

The charges pertain to recent regulations proposed by the Centers for Medicare and Medicaid Services (CMS). The rules would allow the agency to participate in negotiations between insurance companies and pharmacies in Medicare Part D for the first time out of concerns over cost and access.

Supporters of the change argue the CMS needs new authority to ensure the market for prescription drugs in Part D works for patients. But Republicans said the proposal will allow the agency to unnecessarily interfere with existing drug plans, potentially forcing millions of seniors out of their coverage [....]

Medicare Advantage Faces Rate

artappraiser — Sat, 22 Feb 2014 16:12:25 +0000

In reply to U.S. Proposes Cuts to Rates in Medicare Payments

Medicare Advantage Faces Rate Cut
Some 30 percent of seniors in the Medicare program get health insurance through the private option.

By Clara Ritger and Sam Baker, National Journal, Feb. 21, 2014

Medicare Advantage plans are facing a payment cut next year, the federal Medicare agency said Friday.

The administration's planned cut into Medicare Advantage—privately administered plans that serve about 30 percent of seniors—defies a months-long lobbying campaign from insurers. The industry has marshalled bipartisan support in Congress for their effort to block the payment cut. They argue that the Affordable Care Act—which imposes roughly $150 billion in cuts over 10 years—has already jeopardized the benefits the 16 million seniors in the program receive [....]

The cuts imposed by the health care law were aimed at stopping historic overspending in the program, which cost about 14 percent more than traditional Medicare coverage, according to reports. Policymakers approved the cuts in an effort to increase efficiency in providing Medicare coverage through private plans, but insurers say those cuts will be passed down to seniors.

Insurers have the support of a growing coalition in Congress; 40 senators sent a letter to the Centers for Medicare and Medicaid Services, the Health and Human Services agency that oversees the Medicare program, asking for payment rates to be kept level.

AHIP is using its "Seniors Are Watching" campaign to remind the Beltway audience that beneficiaries will see the effects of payment cuts in late October—just before the midterm elections. The lobbying and public-relations blitz will likely last through April, when CMS must finalize next year's payment rates.

There's a chance CMS could backpedal [....]

U.S. health insurers brace for new steep Medicare cuts
By Caroline Humer, Reuters, Feb 20, 2014

The U.S. government is expected to announce this week the proposed payment rates for insurer-run Medicare plans in 2015, but industry officials say the anticipated cuts will mean higher co-pays and fewer benefits for seniors.

Of the more than 50 million older Americans who receive coverage through Medicare, about 15 million are enrolled in Medicare Advantage plans offered by companies such as UnitedHealth Group Inc, Humana Inc and Aetna Inc. The rest use Medicare fee-for-service programs, in which doctors are reimbursed by the government for patient visits and procedures.

Each February, the Centers for Medicare and Medicaid Services proposes reimbursement rates that it agrees to pay insurers for managing the privately run programs. It publishes a final rate 45 days later [....]

Plan to Limit Some Drugs in

artappraiser — Sat, 22 Feb 2014 15:29:43 +0000

In reply to U.S. Proposes Cuts to Rates in Medicare Payments

Plan to Limit Some Drugs in Medicare Is Criticized
By Katie Thomas and Robert Pear, New York Times, Feb. 22, 2014

An alliance of drug companies and patient advocates, joined by Democrats and Republicans in Congress, is fiercely opposing an Obama administration proposal that would allow insurers to limit Medicare coverage for certain classes of drugs, including those used to treat depression and schizophrenia.

Opponents warn that the proposal, if enacted, could harm patients. Federal officials say it would lower costs and reduce overuse of the drugs.

The proposed rule, which would lift a requirement that insurers cover “all or substantially all” drugs in certain treatment areas, is just one of a series of changes to the drug program that are being opposed by the unlikely alliance. Even insurers and drug benefit managers, who have previously supported added limits on drug coverage, oppose the rule. They object to provisions including changes to so-called preferred pharmacy networks, where consumers are steered toward a limited network of pharmacies, and to reducing the number of plans that insurers can offer in any one region.

A House subcommittee plans to hold a hearing on the proposal next week, and the rule is open for public comment until March 7 [....]