Consumer And Patient Groups Support Bipartisan Bill, H.R. 1041, To Repeal Controversial Medicare Bid Program For Home Medical Equipment And Services

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Caregivers / Homecare
Article Date: 01 Apr 2011 – 2:00 PDT

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Citing reduced access to care and higher costs, two dozen consumer and patient advocacy organizations sent a letter of thanks this week to Reps. Glenn Thompson (R-Pa.) and Jason Altmire (D-Pa.) for introducing H.R. 1041, a bipartisan bill to repeal the controversial Medicare “competitive” bidding program for home medical equipment and services (HME). To read the full letter and to see the full list of supporting organizations, visit here.

Among the groups signing the letter are the Muscular Dystrophy Association, the American Association of People with Disabilities, and the National Family Caregivers Association. Titled the “Fairness in Medicare Bidding Act,” H.R. 1041 was introduced on March 11 and has already gained 53 cosponsors, including 30 Republicans and 23 Democrats.

The Medicare bidding program applies to home medical equipment and services, such as medically required oxygen therapy, enteral nutrients (tube feeding), continuous positive air pressure (CPAP) and respiratory assistive devices, power wheelchairs, walkers, hospital beds and support surfaces, and mail-order diabetic supplies. The bidding program was implemented on January 1, 2011 in nine metropolitan areas including Charlotte, Cincinnati, Cleveland, Dallas-Fort Worth, Kansas City, Miami, Orlando, Pittsburgh, and Riverside, California. The program is scheduled to expand to an additional 91 areas later this year.

The letter underscores the challenges that Medicare beneficiaries and homecare providers face as a result of Medicare’s controversial bidding program. The letter states:

“The competitive bidding program is a fundamentally flawed pricing mechanism that will create significant obstacles to quality patient care and needed services while threatening the homecare infrastructure for our nation’s seniors and persons with disabilities. Competitive bidding restricts access to, and choice of, HME items and services by forcing consumers to use certain home medical equipment providers whether they furnish the products and services that provide the most benefit to patients or not. In addition, rather than lowering costs, competitive bidding is increasing them.”

The organizations signing the letter in support of H.R. 1041 include:

– ALS Association,

– AlphaOne (Maine Center for Independent Living),

– American Association of People with Disabilities,

– American Foundation for the Blind,

– American Sleep Apnea Association,

– American Therapeutic Recreation Association,

– Association of Assistive Technology Act Programs,

– Association of Programs for Rural Independent Living,

– Association of University Centers on Disabilities,

– Brain Injury Association of America,

– Christopher and Dana Reeve Foundation,

– International Ventilator Users Network,

– Long Island Center for Independent Living,

– Muscular Dystrophy Association,

– National Association of the Deaf,

– National Council on Independent Living,

– National Emphysema/COPD Association,

– National Family Caregivers Association,

– National Spinal Cord Injury Association,

– Post-Polio Health International,

– Statewide Independent Living Council of Georgia,

– Three Rivers Center for Independent Living,

– UCP/CLASS (formerly UCP Pittsburgh), and

– United Spinal Association.


In addition to the patient groups listed, several medical and long-term care groups support H.R. 1041, including the American Association for Homecare, the National Association for Home Care and Hospice, the National Association for the Support of Long Term Care, and UPMC (University of Pittsburgh Medical Center).

By design, this new Medicare program severely restricts the number of companies that are allowed to provide the equipment and services that are subject to bidding. Since the bidding program began in the initial nine areas on January 1, 2011, patients, clinicians, and homecare providers have reported:

– Difficulty finding a local equipment or service provider;

– Delays in beneficiaries obtaining medically required equipment and services;

– Longer than necessary hospital stays due to trouble discharging patients to home-based care;

– Far fewer choices for patients when selecting equipment or providers;

– Reduced quality; and

– Confusing or incorrect information provided by Medicare.

In November, 2010, 167 leading economists including two Nobel laureates and auction experts who have experience in the design and application of auctions around the world warned Congress that Medicare’s bidding design for medical equipment will fail. Those experts, who design market-based auction systems and do not oppose the concept of using a competitive bidding system to set Medicare prices, found that this particular bidding program has irreparable flaws that will prevent it from achieving its objectives of low cost and high quality equipment and services.

Tyler J. Wilson, president and CEO of the American Association for Homecare, commented, “Homecare is already the most cost-effective setting for post-acute care, and total Medicare spending on home medical equipment and services has dropped severely in recent years. This bidding system is merely a badly designed solution in search of a problem.”

Source:

American Association for Homecare



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AARP Welcomes New Rules To Encourage Higher Quality And Savings For People In Medicare

Main Category: Medicare / Medicaid / SCHIP
Article Date: 01 Apr 2011 – 2:00 PDT

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AARP today responded to new rules announced by the Centers for Medicare and Medicaid Services regarding a new delivery system of health care called accountable care organizations (ACOs). A statement from Nora Super, AARP Director of Federal Government Relations for Health, follows:

“AARP believes accountable care organizations hold great promise for giving people in Medicare better, more coordinated care while reducing health care costs and we welcome the chance to review these new regulations. We know when providers work together they can avoid costly and burdensome duplication and confusion that too often results in poorer health, preventable hospital readmissions, and higher costs for people in Medicare.

“We are pleased CMS recognizes the need to inform patients about ACOs so that people in Medicare can choose whether or not to participate. However, we are concerned that the draft regulation may not provide patients with timely information, leading some to learn about an ACO only after arriving at a doctor’s office. We look forward to working with CMS to ensure that patients are fully aware of their health care options before joining an ACO.”

“Our focus remains on making sure people not only have the right to decide for themselves if they will participate in an ACO, but also have the full and clear information they’ll need to make those decisions.”

Source:

AARP



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Statement By Blair Childs, Senior Vice President Of Public Affairs, Premier Healthcare Alliance, On ACO Proposed Rule

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Public Health
Article Date: 01 Apr 2011 – 2:00 PDT

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The Premier healthcare alliance supports CMS in its efforts to develop people-centered, sensible regulations for accountable care organizations (ACOs). This new model of care delivery represents one of our best hopes for overcoming fragmentation in care delivery. In forming ACOs, we believe that we will achieve greater clinical integration and collaboration among doctors, hospitals and other care providers, and foster alignment of accountable care principles across public and private payors. The end result will be better, safer and more convenient care delivered at a lower cost for the benefit of healthcare consumers nationwide.

Based on our experience with the Accountable Care Collaboratives, Premier believes it is critical that government regulations do everything possible to remove impediments that could derail ACO development, as well as select ACOs and structure the program to maximize the potential for success. With this in mind, Premier offers reactions to several key provisions in the rule.

Beneficiary opt-out, transparency and inducements

Requiring that beneficiaries are made aware of their participation in the ACO will ensure transparency and provide consumers with appropriate, fact-based information on their healthcare choices. We also support CMS’ decision to allow ACOs to not only contact, but also provide additional benefits and services to beneficiaries, including disease management programs and condition-specific education. These services will provide tremendous value to beneficiaries, and will give the ACO the flexibility needed to direct and improve care. However, in the final rule, we will urge CMS to be more expansive in allowed communication and services provided to beneficiaries to include pay for travel, technologies, seminars, co-pay waivers, etc. These services do not serve a marketing function, and are essential to improve care quality, provide convenient choices and enhance overall compliance with recommended care.

Timely access to A, B D claims data and beneficiary list

Since ACOs can’t effectively manage and improve care without timely access to relevant data, we are extremely pleased that CMS will make data from Medicare Parts A, B and D available. As we learned in the Physician Group Practice demo, it is essential that providers know the services beneficiaries are receiving outside the ACO, in order to customize care and avoid duplicative work with other providers. However, in its final rule, we urge CMS to provide this data monthly, rather than quarterly. Without monthly access to this data, providers may not have adequate information to ensure they are meeting targets and appropriately directing care.

Payment models

We are extremely pleased that CMS will allow multiple payment models within the ACO program from the start. As we have learned from members of the Accountable Care Collaboratives, different ACOs are at different points in their journey to deliver accountable care, with some prepared to participate in a one-sided shared savings program, while others are able to accept downside risk. As ACOs are local and subject to regional market conditions, multiple payment models will allow a variety of approaches to be tested, as well as a broader scope of learnings for CMS. However, noticeably absent from the rule are partial and full capitation payment models. We hope such options will be considered either in the final rule or through the CMS Innovation Center.


Measures

As we have learned through the Hospital Quality Incentive Demonstration (HQID) and the QUEST: High Performing Hospitals Collaborative, measures are the key to assessing performance and evaluating improvements over time. Given that the measurement requirement for ACOs is a significant undertaking, and one that should not be discounted due the need for sophisticated informatics capabilities, CMS has taken a wise step in structuring year 1 of the program as a pay for reporting year. This will give providers adequate time to demonstrate capacity to improve care and health of their ACO population. We are also pleased that CMS has chosen population-based quality measures that are standardly-defined, tested and in use today, as well as those that overlap with other requirements, including patient experience, hospital and physician quality, and meaningful use of electronic health records. This will support efficiencies, as providers will be able to collect and submit data once, avoiding duplicative or conflicting reporting obligations.

Savings splits

CMS should reconsider its savings split with providers and instead share back at least 70 to 80 percent of the total in preliminary years of the program. In addition, we are concerned about CMS’s application of a payment withhold. Shared savings payments are critical, and are necessary to make the technology and other infrastructure investments needed to transform care delivery and processes. Without adequate investment capital, accountable care organizations will struggle to provide care and services needed to appropriately manage the health of the population. Short changing ACOs now will make the program less attractive to applicants and could stifle future innovations.

Legal (anti-trust, anti-kickback….) “safe harbors”

Legal barriers traditionally have prevented innovative care delivery models from taking root. We believe CMS’s decision to grant waivers for the division of shared savings bonuses and a “safe harbor” for other payments provides a greater level of legal assurance, and will allow a variety of ACO models to be tested over time, both in the Medicare program and among private payors. We also strongly agree that ACOs that meet CMS’ criteria for clinical integration are in compliance with antitrust laws overseen by the Department of Justice and the Federal Trade Commission. Assuming that the final rule is substantially similar to the proposed regulations, providers will have confidence in the legality of ACOs, and an efficient, expedited review process for antitrust questions. This should permit hospitals to collaborate with non-owned providers, share data across the continuum and financially reward physicians for improved outcomes and reduced costs. These new abilities are foundational to the ACO, and will allow for improved care coordination, greater provider cooperation and enhanced services for consumers.

Medicaid ACOs

We were disappointed that the regulation did not adequately address the interaction between the Medicare and Medicaid programs. Our initial impression is that shared savings will only be determined based on Medicare savings, although savings to the Medicaid program may also be attained due to efforts of the ACO. We would encourage CMS to provide states with specific guidance for establishing Medicaid ACO programs and demonstrations, and ideally, that CMS will structure the Medicare application process in such a way that states could rely on it to determine eligibility for Medicaid ACO program.

Payment adjustments

We believe that a critical fix that CMS must make in the final rule is to exclude disproportionate share hospital (DSH), indirect medical education (IME) and direct graduate medical education from the calculation of spending and the associated targets. These payments are made to account for higher program costs that are outside of the services provided to ACO beneficiaries, such as teaching residents or higher proportions of uncompensated care. These costs will not affected by care improvements or other quality interventions initiated by the ACO. Hospitals with a higher proportion of these payments will be at a disadvantage, because their spending will look artificially higher than others, yet they have no ability to affect these costs. As these are both key constituencies for the ACO program, CMS should consider including a policy to mitigate this disincentive for participation among teaching hospitals, as well as those that serve low-income patients.

Source:

Premier healthcare alliance



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AIDS Virus Blocked From Entering Cells By Engineered Protein Fragment

Main Category: HIV / AIDS
Also Included In: Immune System / Vaccines;  Arthritis / Rheumatology;  Lupus
Article Date: 01 Apr 2011 – 2:00 PDT

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In what could be a potential breakthrough in the battle against AIDS and a major development in the rational design of new drugs, scientists have engineered a new protein that prevents the virus from entering cells. This protein is based on a naturally occurring protein in the body that protects cells from viruses, except the man-made version does not cause inflammation and other side effects at the dosages needed to inhibit AIDS. This discovery was published in the April 2011 issue of The FASEB Journal.

“This is science fiction made reality. These researchers took a protein apart and removed the portion that causes harm, then stabilized and modified the section that has a therapeutic effect,” said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal. “Not only is this good news for people with AIDS, it’s good news for all of us as this research paves the way for similar work for many, many other illnesses.”

The protein fragment is based on a naturally occurring protein called RANTES, which is part of the body’s immune system. RANTES naturally defends the body against HIV/AIDS, but cannot be used as a drug or drug candidate because it has several other biological effects which could cause harmful inflammation. After examining the precise molecular structure of the RANTES protein, the researchers discovered that only a small fragment of the RANTES protein is actually responsible for blocking HIV entry into cells. From there, they dissected the desired section of the RANTES protein and worked to stabilize it without compromising its protective effects. After several sequential steps of molecular refinement and some virtual modeling, the researchers created a peptide with very high potency against HIV, with possible benefits for treating inflammatory diseases such as arthritis and lupus, as well as the prevention of transplant rejection.

“We’re finally able to design smart anti-HIV drugs aimed at the right target. That’s because scientists have spent decades figuring out the molecular details of how the virus enters cells, and the exact chemical structures involved,” Weissmann added. “As the Renaissance sculptors wrought art from crude marble, today’s molecular engineers today use intelligent design to create life-saving chemical masterpieces.”

Details:
Paolo Lusso, Luca Vangelista, Raffaello Cimbro, Massimiliano Secchi, Francesca Sironi, Renato Longhi, Marina Faiella, Ornella Maglio, and Vincenzo Pavone. Molecular engineering of RANTES peptide mimetics with potent anti-HIV-1 activity. FASEB J. April 2011 25:1230-1243; doi:10.1096/fj.10-167627.

Source:
Cody Mooneyhan
Federation of American Societies for Experimental Biology



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The Value Of Otolaryngologists’ Services In America: A National Survey

Main Category: Ear, Nose and Throat
Also Included In: Primary Care / General Practice;  Medicare / Medicaid / SCHIP
Article Date: 01 Apr 2011 – 5:00 PDT

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In recent years reimbursement for surgical services has declined, failing to keep up with inflation and economic growth. Financial incentives aimed at re-distributing reimbursement from procedural specialties to primary care specialties have been ineffective thus far, and the financial returns of being a physician continue to decrease, according to new research published in the April 2011 issue of Otolaryngology – Head and Neck Surgery.

According to a national survey of 409 members of the general population, survey participants said that a reasonable price for a doctor to be paid for performing a tonsillectomy is $955.58, whereas the national average Medicare reimbursement is $257.74. Furthermore, 59% of respondents also believe that insurers, Medicare, and Medicaid pay doctors more than they had input into the survey.

“The Patient Protection and Affordable Care Act of 2010 will bring many changes to the American health care system,” said study author Paul Frake, MD. “More Americans will soon have health insurance, but this legislation does not include a permanent correction to the proposed spending cuts mandated under the Sustainable Growth Rate Formula (SGR) or meaningful malpractice litigation reform. As a result, physicians will face an even larger payment adjustment in January of 2012.”

Physicians must continue to keep the interests of their patients at the forefront of further discussions on modernization of the American health care system. It is not clear what the ultimate economic effects of recent health care legislation will be, but greater patient education about the realities of reimbursement may aid physicians in advocating for appropriate financial consideration as health care reform continues to evolve.

Survey respondents represented 48 of the 50 states and the District of Columbia. The mean age of respondents was 35.7 years old. The average number of people per household was 2.8. Women comprised the majority of respondents at 79.7%, and men were the minority, 20.3%. With respect to health insurance coverage, 63% had health insurance, 26% had no health coverage, 5% had Medicare, 4% had Medicaid, and 2% reported “other” sources of coverage.

The study was reviewed and approved by the Institutional Review Board (IRB) of The George Washington University Medical Center and granted “IRB exempt” status due to its anonymity and minimal risk to participants.

Source:
Mary Stewart
American Academy of Otolaryngology – Head and Neck Surgery






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New Bundle Reimbursement For End-Stage Renal Disease (ESRD) To Have Predominantly Negative Effect On $535 Million Treatment Device Market

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Urology / Nephrology;  Medical Devices / Diagnostics
Article Date: 01 Apr 2011 – 10:00 PDT

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According to Millennium Research Group (MRG), the global authority on medical technology market intelligence, the new reimbursement system from the Centers for Medicare Medicaid Services (CMS) for end stage renal disease will have a mixed but mostly negative effect on the market for ESRD treatment devices. Medicare bears the largest cost burden for ESRD treatments for an increasing elderly and diabetic population, and its reimbursements drive the market for treatment devices such as specialized catheters, hemodialysis dialyzers and arteriovenous (AV) access grafts.

Until the end of 2010, Medicare employed a basic case-mix adjusted composite payment system that covered costs for dialysis-related services and items for outpatient dialysis care facilities, with separately billed items such as laboratory test and drugs. Since January 1, 2011, under its new bundle reimbursement system called End-Stage Renal Disease Prospective Payment System (PPS), CMS will make a single bundled payment to the dialysis facilities for both dialysis services and those previously billable separately.

“This change will place cost constraints on clinics,” says April Lee, analyst at MRG. “They will probably increase the use of less-expensive devices such as reusable dialyzers. These have a higher up-front cost, but tend to be more cost-effective in the long run. If clinics try to save staffing costs by encouraging home hemodialysis or peritoneal dialysis (PD), this will increase PD catheter use, while negatively affecting sales of hemodialysis catheters and AV access grafts. Although PD catheters are a small but growing part of the entire ESRD market, revenue gains in the PD catheter market will not be enough to outweigh losses in the other market segments.”

End-stage renal disease (ESRD) is a classification of kidney disease in which the patient’s kidney function has declined to approximately 10% of normal function. The most common causes of ESRD in the US are type 2 diabetes and high blood pressure, and its incidence increases dramatically with age. ESRD patient numbers are expected to increase steadily in the US as a result of the aging US population and a rising number of diabetes sufferers.

Millennium Research Group’s US Markets for End-Stage Renal Disease Treatment Devices 2011 covers sales of hemodialysis dialyzers, hemodialysis catheters, PD catheters and AV access grafts.

Source:

Millennium Research Group

Decision Resources, Inc.



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