In This Edition:
From Kaiser Health News:
A reader asks if it’s fair for his health plan to classify his son’s treatment by a psychologist as specialty care that requires a higher copayment. (Michelle Andrews, 4/12)
A California Assembly bill would require creating a mandatory registry for available psychiatric hospital beds, but the state hospital association calls it unworkable. (Jenny Gold, 4/12)
Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Oh, The Irony'" by Jim Toomey.
Here's today's health policy haiku:
THE FAILURE OF THE 'FEMALE VIAGRA'
Addyi ... so bad ye.
Hell hath no fury like a
Woman's sex drug scorned.
If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.
Summaries Of The News:
The Obama administration hopes to recruit as many as 20,000 primary care doctors to participate in this plan to shift how physicians get paid and provide care.
NPR: Medicare Seeks Savings And Innovation With A Switch In Doctors' Pay
The Obama administration is recruiting as many as 20,000 primary care doctors for an initiative it hopes will change the way physicians get paid and provide care. The program, which was announced Monday, will be run by the Centers for Medicare and Medicaid Services. The aim is to stop paying doctors based on the number of billable services and visits provided to Medicare beneficiaries and instead to tie payments to overall patient health and outcomes. (Kodjak, 4/11)
Modern Healthcare: New CMS Primary-Care Payment Model Would Affect 20K Doctors
Provider practices will be able to participate in two ways. In Track 1, the agency will pay a monthly fee to practices that provide specific services. That fee is in addition to the fee-for-service payments under the Medicare Physician Fee Schedule for care. Providers currently perform a service and then submit a claim to Medicare for payment. In Track 2, practices will also receive a monthly care management fee and, instead of full Medicare fee-for-service payments for evaluation and management services, they will receive reduced Medicare fee-for-service payments and up-front comprehensive primary-care payments. This hybrid payment design will allow greater flexibility in how practices deliver care outside of the traditional face-to-face encounter, the agency said. (Dickson, 4/11)
CNN: Medicare Change: 'Perverse' Incentive Or 'Perverse' Reform?
If you have cancer or Crohn's disease, does the doctor give you the best drug to fight that illness, or are you getting the drug that makes your doctor the most money? That's what a proposed pilot program for Medicare is trying to figure out and it's become a political hot potato. (Christensen, 4/11)
CQ Healthbeat: Medicare Announces Major Test For Changing Pay For Primary Care
Medicare officials announced on Monday a major plan to shift primary care for the nation's elderly and disabled toward a more coordinated approach through a large-scale test program. The initiative is part of the Obama administration's bid in its final months for an overhaul of how the federal health program pays for medical services. (Young, 4/11)
The Obama administration's effort to reform how doctors earn money from high-priced injection drugs is being met by opposition and warnings that the move goes to far.
The Hill: Drug Plan Hit With Backlash
The Obama administration’s aggressive move to rein in the cost of prescription drugs in Medicare has triggered a backlash, with some advocates warning the plan goes too far. The administration is pursuing a pilot program that could squeeze the margins for doctors that prescribe high-cost drugs, potentially saving the government billions of dollars in the process. ... But the proposal is facing mounting opposition from groups that represent people with some of the costliest conditions to treat, including cancer, multiple sclerosis and rheumatoid arthritis. “I think they are shocked by the pushback,” said the head of one advocacy group that recently met with the CMS. “They didn’t anticipate what was going to happen and now they are really backing up now going, ‘What do we do about this?’” (Ferris, 4/11)
The Washington Post's Wonkblog: This Controversial Rule Could Change How Doctors Profit From Using The Most Expensive Drugs
A controversial effort by the Obama administration to reform how doctors earn money from administering injection drugs would reduce their earnings on the most expensive drugs while making many older generics more lucrative, according to a new analysis. A high-stakes debate exploded last month over the administration's drug payment pilot program, which would test a fundamental change in how doctors are reimbursed for giving chemotherapy and other injectable drugs through Medicare. (Johnson, 4/11)
News outlets also report on developments regarding small-business exchanges and the state health marketplaces in New York and Idaho.
CBS News: Priced Out Of Obamacare, Some Opt For Short-Term Plans
One of the ideas behind the Affordable Care Act was to enable more Americans to afford health care coverage. But it turns out that some consumers are snubbing the ACA and picking another path: short-term coverage. (Picchi, 4/12)
CQ Healthbeat: States To Offer New Choices On Small Business Exchanges
Twenty-one states opted to add a new option for choosing insurance coverage to their small business insurance exchanges -- a move that regulators hope will encourage more participation from employers. The Small Business Health Option Program, or SHOP, exchanges, created under the health overhaul (PL 111-148, PL 111-152) to help small business owners offer their employees more options for health insurance coverage, have until now focused on letting employees choose between different insurers. Under the new option, called "vertical choice," employers can select a specific insurer and let employees choose from among different benefit levels that the company offers on the exchange. Those levels include bronze, silver, gold and platinum plans. (Mershon, 4/11)
The Associated Press: NY Opens Insurance Enrollment To Domestic Violence Victims
New York is requiring insurers providing individual coverage through the state health exchange to allow victims of domestic violence or abandonment to enroll at any time. The Department of Financial Services says those enrollments should be available starting Friday for coverage outside the state-operated exchange. (4/11)
The Idaho Statesman: Idaho Health Insurance Exchange Facing Service Challenges
The staff at Your Health Idaho issued a bulletin to insurance agents on March 29, telling them what to do if a client cannot get treatment for a life-threatening illness or injury because of problems with health insurance. ... Your Health Idaho, the state's exchange, is not an insurance company. It is a conduit, responsible for helping Idahoans buy health plans that comply with the Affordable Care Act. ... Idaho's exchange operated with little turbulence and received praise for being lean and efficient after it opened in 2013, at first piggybacking on the federal exchange until Idaho built its own machinery to process tens of thousands of insurance applications each year. Now, however, some Idaho consumers and agents say the exchange is struggling to do its job. (Dutton, 4/11)
Meanwhile, Massachusetts celebrates an anniversary for its health reform —
The Associated Press: State Law That Served As Model For 'Obamacare' Turns 10
Massachusetts is marking the tenth anniversary of a landmark health care law that would later serve as a model for the federal Affordable Care Act. On April 12, 2006, then-Republican Gov. Mitt Romney signed the law during a Faneuil Hall ceremony, calling it a big step forward in health care reform. At Romney's side were Democratic leaders including the late U.S. Sen. Edward Kennedy, who championed universal health insurance on a national level. (4/11)
WBUR: On Mass. Health Law’s 10th Anniversary, Here Are 12 Things To Know
Ten years ago today, then-Gov. Mitt Romney signed into law a bill with an ambitious goal: health coverage for virtually every Massachusetts resident. To mark the 10th anniversary, we asked health experts of all stripes to assess the law’s first decade. Links to the commentaries are gathered here and at the bottom of this post. But first, 12 facts and figures. (Bebinger, 4/12)
The House speaker said the cuts to schools, prisons and other programs would be necessary to fill a $122 million gap if the legislature doesn't agree to fund Medicaid so that the state can get federal financing. Also, news from Kentucky and Louisiana.
Arkansas Online: Plan Wields Ax To Anticipate A Medicaid No
Funding for public schools, higher education, prisons and other state needs would be cut under a budget proposal released Monday by House Speaker Jeremy Gillam in anticipation of a possible legislative failure to reauthorize funding of the state's expanded Medicaid program in the coming fiscal session. The speaker said the cuts would be necessary to fill a $122 million shortfall created from the state no longer accepting federal Medicaid dollars to purchase private health insurance for low-income Arkansans. (Willems, Fanney and Wickline, 4/12)
The Associated Press: Arkansas House Leaders Detail Cuts If Medicaid Plan Fails
The Legislature last week approved Gov. Asa Hutchinson's plan to keep and rework the expansion, which uses federal funds to purchase private insurance for the poor. The votes were shy of the three-fourths support that the Medicaid budget bill funding the expansion will need. Lawmakers will take up that measure at a legislative session set to begin Wednesday. Gillam said most state agencies w
All titles, content, publisher names, trademarks, artwork, and associated imagery are trademarks and/or copyright material of their respective owners. All rights reserved. The Spam Archive website contains material for general information purposes only. It has been written for the purpose of providing information and historical reference containing in the main instances of business or commercial spam.
Many of the messages in Spamdex's archive contain forged headers in one form or another. The fact that an email claims to have come from one email address or another does not mean it actually originated at that address! Please use spamdex responsibly.