health policy report

Study: Wellness programs common despite lack of savings

Thu, 05 Jun 2008 06:59:54 -0400

According to a new study, health and wellness initiatives seem to be a matter of faith among big employers. According to research by the Center for Studying Health System Change, many employers are adopting such programs, despite the fact that there's currently little evidence such programs actually save money. The researchers, who studied 12 nationally-representative metropolitan communities, concluded that large employers are looking for long-term strategies to address their rising healthcare costs. The large employers also see wellness programs as a means of giving their employees more responsibility for their health care decisions and costs.

For more information:
- read this Kaiser Daily Health Policy Report brief

FTC: Pharmas cut 14 deals to delay generic sales in '07

Tue, 27 May 2008 06:59:57 -0400

Makers of brand-name prescription drugs reached 14 agreements with makers of generic drugs to delay the generic drug makers entry into the market, according to a new report released by the Federal Trade Commission. The FTC says these deals, which it has dubbed 'pay-for-delay,' are harmful to consumers, but it hasn't been very successful in blocking them to date. The agency is on record as supporting legislation that would ban such deals, but such measures haven't made much progress on the Hill due to opposition from both brand-name and generic drug makers.

The 14 deals discussed were part of a total of 33 deals between brand-name and generic drug makers for FY 2007 reported to the agency (as required by 2003 Medicare legislation). In each of the 14 deals, the generic maker got some kind of compensation to delay the market entry of their generic product, and in 11 of the agreements, the brand-name drug maker agreed not to sell its own generic when its patents expired.

To learn more from the report, and get more context:
- read this Kaiser Daily Health Policy Report item

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Merck agrees to $58M settlement on Vioxx ads

Wed, 21 May 2008 06:59:58 -0400

Merck has agreed to a $58 million settlement with 29 states and the District of Columbia to settle allegations that it downplayed heart risks created by Vioxx in direct-to-consumer advertising. Under the terms of yesterday's agreement, Merck will submit all new TV ads for its drugs to the FDA for seven years, and follow all agency-suggested changes before airing the ads. Merck also agreed to end its practice of "medical ghostwriting," in which paid consultants or employees, rather than physicians listed as lead authors, wrote studies on Vioxx.

The agreement follows a $4.85 billion settlement, which is still pending, that ended most lawsuits resulting from findings that the drug doubled risks of heart attack and stroke. Merck withdrew Vioxx from the market in 2004.

To learn more about the new agreement:
- read this Kaiser Daily Health Policy Report item

Related Articles:
Despite safety issues, Vioxx still in demand
Vioxx defense dealt a blow by new study results
Vioxx lawsuits continue to multiply

Health plans drop out of CT Medicaid over disclosure rules

Tue, 13 May 2008 06:59:57 -0400

Connecticut's Medicaid program is struggling to regain its equilibrium after a standoff over new provider contracting disclosure rules prompted a handful of health plans to jump ship. In 2007, Gov. Jodi Rell (R) demanded that HMOs participating in Husky, the state's Medicaid program, share information on the details of their contracts with providers. Her position was that since they contracted with the state, they were, in essence, acting as public agencies for the purposes of participating in Husky.

The plans disagreed, however, arguing that they couldn't disclose proprietary contracting information. Two HMOs pulled out of Husky in April, leaving 120,000 Medicaid beneficiaries to transfer to other forms of coverage. A third will leave on July 1, bringing the total to 226,000 beneficiaries. Meanwhile, two participants, Anthem Health Plans and Health Net of Connecticut, are challenging the disclosure requirement in the Connecticut Supreme Court.

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

Related Article:
CT court makes Medicaid plans disclose MD pay

Study: Acute shortage of adult primary care MDs coming

Thu, 01 May 2008 06:59:54 -0400

A new study appearing in the journal Health Affairs attaches some numbers to a problem we all see coming--the growing U.S. shortage of primary care physicians. According to the study, by 2025 the U.S. will see a shortage of 35,000 to 44,000 family or general internal medicine physicians who care for adults. Worse, with population growth and an aging population figured in, existing family physicians and general internists will see their workloads grow by a substantial 29 percent by 2025 (versus 2005 levels) if nothing is done.

To learn more about the study:
- read this Kaiser Daily Health Policy Report item
- check out the study abstract

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Primary care shortage blocks healthcare reform
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Hospitals requiring upfront cash payments

Tue, 29 Apr 2008 06:59:57 -0400

Of late, a growing number of hospitals--including not-for-profits--have been insisting on cash payments before they offer services to non-emergency patients. While it may not generate the best PR, it's a matter of survival, hospitals say. Uncompensated care has been flattening hospitals nationwide, with the burden climbing 44 percent in 2006, to $31.2 billion, from $21.6 billion in 2000. Hospitals are being sapped by care for growing numbers of uninsured patients, and say that unless they get tough on patients with some means, some of them simply won't survive. However, such a strategy can rebound when not-for-profits take this stand. For example, this week the Wall Street Journal brought some unflattering attention to the M.D. Anderson Cancer Center, which in late 2006 asked a leukemia patient for $105,000 up front because it wasn't satisfied with her insurance coverage.

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

Related Articles:
In 2007, bad debt rising for hospitals
In 2006, uncompensated care costs level out
Bad debt savages HCA, LifePoint profits
HCA sees debt rising until patients get insured

GA minorities suffer big health disparities

Mon, 21 Apr 2008 06:59:55 -0400

A new report concludes that Georgia's minorities suffer significantly worse health than non-minority citizens, with the report awarding an "F" to 16 Georgia counties on scores of minority care. The grades, which were issued by the state's Department of Community Health, reflect the serious differences found in death rates before age 75. (Another report, by the United health Foundation, ranked Georgia 40th in health status overall, with African-Americans there experiencing 44 percent more premature deaths than whites.)

The disparities come, in part, from structural problems faced by the state's healthcare system as a whole. Of the state's 159 counties, 118 are rural, and have roughly half as many doctors per capita as, say, metro Atlanta, in addition to major shortages of nurses, therapists and nutritionists, the report said. However, minorities generally seem to face bigger obstacles to getting care than non-minority citizens.

To learn more about Georgia's health disparities:
- read this Atlanta Journal-Constitution article
- read this Community Health press release

Related Articles:
Racial disparities persist in health outcomes
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Study: Hispanics get lower-quality medical care
CMS hopes to close Medicare race, ethnicity gap

Healthcare industry top spender on federal lobbying in '07

Wed, 16 Apr 2008 06:59:56 -0400

It's good to get attention from federal legislators, but it's going to cost you. That's no mystery to some key healthcare groups, who collectively spent $445 million on federal lobbying during 2007, according to new research from the Center for Responsive Politics. That's more than any other sector of the economy, and tops on the list for the second year in a row, according to the CRP. This number includes 20 industry subsectors, including pharmaceutical and medical products companies ($227 million), health insurance companies ($138 million), hospitals and nursing homes ($91 million) and health professionals ($70 million.) Among those who follow lobbying, it will come as no surprise that leading spenders included the Pharmaceutical Research and Manufacturers of America ($22.1 million) and the American Medical Association (another $22.1 million).

To learn more about CRP's research on lobbying:
- read this Kaiser Daily Health Policy Report item

Related Articles:
Pharmas, device firms spend $182M on lobbying
Merck stops lobbying for mandated HPV vaccine
Healthcare industry leads in campaign contributions
Providers dished out the lobbying bucks

MA may limit Boston metro hospital expansion

Thu, 10 Apr 2008 06:59:57 -0400

Now here's something you don't see every day. Rather than simply letting market forces prevail, Massachusetts health authorities proposed this week to protect suburban hospitals from competitive intrusions by the big Boston medical centers like Brigham and Women's and Mass General. Officials are worried that such expansions could duplicate services, but also that it could put community hospitals at financial risk, said Paul Dreyer, director of healthcare safety and quality at the state's Department of Health. Dreyer's concerned about cases like that of Children's Hospital Boston, which has opened 11 overnight beds at a satellite facility in nearby Waltham. Right now, moves like the one made by Children's don't require state approval, but that would change under new rules proposed by Dreyer's office.

To learn more about Boston's competitive situation (and state plans):
- read this piece in The Boston Globe

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Competitive DME bidding could save CMS $1B

Mon, 24 Mar 2008 07:59:57 -0400

A new CMS analysis suggests that its new competitive bidding program for Medicare DME suppliers might save $1 billion in 2009 alone. Right now, CMS pays for DME under a listed price, but under the program, DME companies will be required to submit bids, allowing CMS to choose based on cost and volume, or on potential savings. The program was mandated by the 2003 Medicare law. So far this year, the program is operating in 10 of the largest metro areas, and applies to 10 of the top DME, prosthetics, orthotics and supplies product categories. However, next year, CMS expects to expand to an additional 70 metro areas, and will add additional product categories to the competitive bidding list.

Critics say the program potentially could put too much of a squeeze on suppliers, possibly limiting patient access to equipment. They're also arguing that such bidding could eliminate smaller suppliers from the game. However, CMS Acting Administrator Kerry Weems says that small suppliers with gross annual revenue of $3.5 million or less accounted for 64 percent of companies winning contracts. Weems didn't address whether such a program would cut down on Medicare fraud, but that might be on his mind too.

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

Related Articles:
FL DME companies named in $142M fraud. Report
Medicare fraud costs CMS billions. Report