Medicare Part D

CMS makes Part D data available for patient-safety efforts

Fri, 23 May 2008 06:59:58 -0400

CMS has issued final regulations that will make Medicare Part D claims data available to the FDA and other agencies, as well as academic researchers, for use in patient-safety initiatives. The FDA has said that it will use the data to pilot-test its Sentinel Initiative, a new electronic system that will let the agency query a large number of health information databases in an effort to more effectively detect post-market adverse events resulting from use of approved drugs and medical devices. This program won't only detect the events, it will allow the agency to monitor the performance of drugs and devices in real time, said FDA and CMS officials. The Sentinel program links claims data from 25 million beneficiaries with prescription drug coverage to other Medicare claims information, including diagnoses, treatments, hospitalizations and physician services.

To learn more about this announcement:
- read this Modern Healthcare article (reg. req.)

Related Articles:
CMS approves Part D e-prescribing standards
Error in Medicare Part D handbook could cause trouble
Medicare Part D, healthcare play out in an election year

UnitedHealth suffers financial setback

Wed, 23 Apr 2008 06:59:58 -0400

After years of allegations that management engaged in financial manipulations to feather their own nest, some might see this as a bit of karma. Having already missed its first quarter financial targets, UHG has had to cut its full-year profit outlook. The company, which expects 2008 revenue around $82 billion, lowered its profit outlook by 40 cents a share to about $3.60. While UHG faces some unique challenges, this mirrors losses posted by other health plans, many of which seem likely to kick up premiums substantially at their next opportunity.

One major factor in UHG's adjusted prediction was customer losses. The company lost 530,000 commercial members during Q1 of this year, including 250,000 from its PacifiCare unit. Meanwhile, enrollment in its Medicare Part D program fell by 290,000. To boot, medical costs went up faster than income, despite raised premiums in 2006 and 2007.

This comes just as the air has started to clear from its former CEO's departure. Less than 18 months ago, former CEO William McGuire left the company with a mindbogglingly-golden parachute, options worth $1.78 billion at the time. Since then, McGuire has been forced to give up at least $400 million in assets, after regulators concluded that the options were back-dated to give him the highest possible value.

To learn more about UHG's financial picture:
- read this Modern Healthcare piece (reg. req.)

Related Articles:
Doctors angered by proposed UnitedHealth fines
AMA tries to block UnitedHealth acquisition
NY hospitals sue UnitedHealth, claim racketeering

HHS: Medicare pharmacy pay lower than Medicaid

Mon, 14 Jan 2008 06:59:55 -0500

A new report from the HHS Office of Inspector General has given pharmacies ammunition in their fight for better reimbursement under the Medicare prescription drug benefit. According to the report, which was requested by 33 senators in response to pharmacy industry complaints, pharmacies charge health insurers an 18 percent surcharge on the cost of medications, and get a dispensing fee of about $2.27 per prescription under the Medicare drug benefit system. That's about $2 less than what they get in dispensing fees for Medicaid prescriptions, the OIG report concluded. The Association of Community Pharmacists says that this level of reimbursement is inadequate, as it doesn't cover all of its members' costs. The ACP says that pharmacies would have to charge a premium of more like 20 percent to 21 percent to stay in business.

At this stage, it's not clear what will happen next, as the report doesn't make any specific recommendations. But it seems likely that the senators will seek to gather more information, perhaps at a future hearing.

To learn more about this issue:
- read this Kaiser Daily Health Policy Report item

Related Articles:
Medicare Part D, healthcare play out in an election year. Report
'Mixed successes' of Medicare Part D. Report

Medicare marketing, claims handling problems abound

Mon, 08 Oct 2007 06:59:57 -0400

Misbehavior and administrative problems are surprisingly common within Medicare contractors, according to a new review of federal audits by The New York Times. In particular, plans are having problems in marketing the Medicare Advantage product appropriately and in responding to consumer challenges related to quality of care issues.

CMS has been cracking down on violations by Medicare plan operators of late, and has handed out $770,000 in fines to 11 companies since March. Violators have included big names like UnitedHealth, Humana and WellPoint.

UnitedHealth, for example, was accused of failing to supervise marketing representatives and improperly denying claims without giving proper explanations to beneficiaries. Humana has failed to keep up with complaints about marketing and has not handled claims denials appropriately, the agency says. And WellPoint's UniCare subsidiary had a backlog of about 354,000 claims and took nearly 16 minutes to answer provider phone calls.

To find out more about the investigation:
- read this article from The New York Times

Related Article:
Medicare Part D marketing not going well. Report

Read more on: Medicare l CMS

ALSO NOTED: Medicare changing hospital reimbursement; Bill would speed up Part D reimbursement; and much more...

Mon, 13 Aug 2007 06:59:50 -0400

> Brace yourself: it looks like Medicare is about to change the way it pays hospitals. Blog

> On another Medicare note, senators are continuing to consider a bill requiring prompt payment of Medicare Part D claims. Go Baucus and Grassley! Article

> The center of Massachusetts health plan is that everyone in the state gets health insurance. The problem is, the state can't cope with the volume of applications for the subsidized programs. Article

> It's almost a given that rural hospitals struggle. But one Pennsylvania health system seems to be defying the conventional wisdom. Article

And Finally... For better or worse, it seems the days of Studio 54-style partying are long gone. Press release

Healthcare industry leads in campaign contributions

Thu, 21 Jun 2007 20:01:36 -0400

A new study released by the California Nurses Association/National Nurses Organizing Committee suggests that the healthcare industry is taking a leading role in funding the campaigns of this season's crop of presidential hopefuls. The CNA/NNOC analysis concludes that healthcare industry players contributed $3.7 million to current candidates during the first quarter of 2007. It also notes that the industry--which it defines as including drug and insurance companies, doctors, hospitals, dentists and nursing homes--spent more than $2.2 billion on federal lobbying over the past decade. By CNA/NNOC calculations, Sen. Hillary Clinton (D) and Sen. John McCain (R) got the lion's share of healthcare contributions of all presidential candidates, collecting 40 percent of the overall total.

To find out more about this trend:
- read this CNA/NNOC release

Related Articles:
Medicare Part D triggers lobbying boom. Report
Drug companies biggest spenders on lobbying. Report

ALSO NOTED: PA health reforms held up; FL hospital succeeds with "bloodless" surgery; and much more...

Sun, 22 Apr 2007 20:01:30 -0400

> A Pennsylvania health reform plan backed aggressively by Gov. Ed Rendell (D) may not pass this year. Article

> Following peers elsewhere, a Jacksonville, FL hospital has developed a bloodless medicine and surgery program aimed at patients who reject transfusions. Article

> Dallas-area hospitals have decided to cut trans fats from their menus. Article

> A California nonprofit focused on quality improvement is working to get doctors on board with EMRs and other health IT tools. It's dangling Medicare pay-for-performance options as an incentive. Article

> A new federal bill is now under consideration which would help physician practices afford the cost of implementing more sophisticated health IT tools. Article

> New York City plans to distribute EMR software at no cost to physicians with large Medicaid caseloads. Article

> CMS has put its stamp of approval on three e-prescribing standards for use in Medicare Part D transactions, after testing them jointly with the Agency for Healthcare Research and Quality. Article

> Promoting PHR use: Is it a good idea? One critic offers a resounding "no." Article

> Red Hat strikes a healthcare research deal with the University of North Carolina. Article

And Finally... A physician critique in rhyming couplets. Blog

GAO says U.S. can't afford more healthcare

Tue, 06 Mar 2007 19:01:37 -0500

While it's all well and good to expand health coverage to more uninsured Americans, doing so would impose an untenable burden on the federal budget, according to a top government official. Government Accountability Office head David Walker says that existing federal government commitments such as Social Security and Medicare are already breaking the federal bank. While some have suggested that economic growth--and a corresponding rise in tax revenues--can solve the problem, Walker says that it just can't happen.

GAO research concluded that federal liabilities have climbed 150 percent over the last six years alone, hitting $50 trillion in 2006. The Medicare Part D prescription drug benefit alone accounts for about $8 trillion of these expenses. Proposals for expanding federal health coverage--which, for example, grow the Medicaid program--can't work, he suggested. Instead, the U.S. government may have to impose austerity measures such as limiting eligibility for Medicaid by raising the income level at which people qualify.

To get more of Walker's comments:
- read this article from The Atlanta Journal-Constitution

Related Articles:
GAO finds Part D info inaccurate. Report
GAO report details problems at FDA. Report
GAO calls Louisiana hospitals "unsalvageable." Report

ALSO NOTED: Medicare program helps slow rate of drug spend; Bush stumps for healthcare proposals; and much more...

Wed, 21 Feb 2007 19:01:30 -0500

> Federal analysts say that the government's new Medicare Part D drug program has slowed the rate of growth in the amount of money being spent on therapeutics as insurers negotiate lower prices for members. But the trajectory of spending on healthcare in the U.S. will continue to arc upwards, leading to 2016 when the federal government will cover the cost of 50 percent of all care provided. Report

> President Bush continues to travel around the country plugging his healthcare reform proposals, landing yesterday in Tennessee. Article

> The EPA has issued guidelines patients should follow when they're getting rid of drugs they don't use. Article

> The state of Pennsylvania has won $7.8 million in a settlement with Schering-Plough over improper drug marketing and pricing practices. Release

> Air ambulances may be necessary at times, but they're far more expensive than most people realize, and may not be covered by "air evacuation" clauses in travel insurance. Release

And Finally... Who would have thought you could fight childhood obesity by having kids play another video game? Article

House passes Medicare drug negotiation bill

Mon, 15 Jan 2007 19:01:37 -0500

The new Democrat-controlled House followed through on a campaign promise--and ignored a presidential veto threat--by passing legislation requiring the federal government to negotiate bulk drug purchases for Medicare Part D. The Friday vote then set the Washington spin machine into a pre-holiday frenzy, and the Capitol Hill press corps took full advantage of the rhetorical flourishes. "Those who insist that the sky will fall if drug companies negotiate lower prescription prices are arguing that those companies should continue to skin a fat hog at the expense of taxpayers and beneficiaries," Michigan Democrat John Dingell, the bill's lead sponsor, told the New York Times.

However, White House Press Secretary Tony Snow made clear the Bush administration's opposition to the legislation by saying, "If this bill is presented to the president, he will veto it." According to the Associated Press, Dingell was ready with a response: "The president and his Republican allies have argued that this bill would do nothing. Then why, I must ask, would he bother to veto it?"

Rep. Tom Price (R-GA,) called the bill "a solution in search of a problem," and fellow GOP Rep. Joe Barton of Texas predicted that the plan would not survive the Senate. "It'll probably die there, which will be a nice benign death. And then we can get back to being responsible," Barton said, apparently believing that Congress had in fact been responsible prior to Friday.

For details
- see the New York Times report
- read the AP account of the same story

PLUS: Canadian pharmacists want health minister to ban Rx exports to the U.S. Report

Related Articles:
Dems tackle Medicare drug costs. Report
Critics question Democrats' Part D plans. Report