Tuesday, January 31, 2012
Monday, January 30, 2012
Sunday, January 29, 2012
Thursday, January 26, 2012
Wednesday, January 25, 2012
Grassley Sends Letters Examining Overprescription of Drugs in Medicaid Programs
Grassley Sends
Letters Examining Overprescription of Drugs in Medicaid Programs
By Rebecca Adams, CQ HealthBeat Associate
Editor
Sen. Charles E. Grassley, R-Iowa, is one of several senators who has raised concerns about whether some physicians are committing Medicaid fraud or allowing patients to abuse the use of the drugs. Medicaid is the federal-state program for the low-income.
“When a doctor writes more prescriptions than seems humanly possible, it makes sense to ask questions,” Grassley said in a written statement. “Maybe there’s a logical explanation or maybe there’s poor medical care or even fraud...If state and federal taxpayers are being cheated because of inappropriate prescriptions, the state and federal governments have to get to the bottom of it and stop it. Medicaid serves millions of people and costs billions of dollars. The more money wasted, the less there is for the people who rely on the program.”
The Republican is sending letters to 34 Medicaid directors who provided some information after Grassley wrote state officials in 2010 asking them to identify the top prescribers of several pain management and mental health drugs. He is sending another letter to 12 states that didn’t respond to his initial request. Grassley was satisfied with the responses from a handful of other states. The letters were first reported Tuesday by ProPublica.
In the letters, Grassley wrote, “Mental health drugs continue to be prescribed at astounding rates and pain management clinics are turning into a hotbed for black market painkillers. When these drugs are prescribed to Medicaid patients, it is the American people who pay the price for over-prescription, abuse, and fraud. After an extensive review of prescribing habits of the serial prescribers of pain and mental health drugs, I have concerns about the oversight and enforcement of Medicaid abuse in your state.”
Each letter was tailored to cite specific concerns in a state, but Grassley is asking all of the 34 states to answer a dozen questions by Feb. 13. The questions include probes about whether a state’s top prescribers continue to be allowed to bill Medicaid; if the state has a system to monitor excessive prescription writing; what types of sales restrictions and databases to track drug sales exist; and what kinds of interactions the state has had with federal Centers for Medicare and Medicaid Services (CMS) officials about the issue.
Grassley noted that
Florida Gov. Rick Scott also signed a law in June to crack down on the state’s “pill mills” that hand out prescription pain drugs. Nearly 15,000 people die every year of overdoses of prescription painkillers, which is more than the number of people who died as a result of overdoses of heroin and cocaine combined, according to the Centers for Disease Control and Prevention.The problem of potential abuse of painkiller or mental health drugs is also a problem in Medicare, the federal program for seniors and people with disabilities. Not only are some physicians writing too many prescriptions, but some patients are apparently visiting multiple doctors to get additional prescriptions. CMS officials have been collecting public comments on ways to strengthen its oversight of prescription painkillers. A Government Accountability Office (GAO) report found that at least 170,029 individuals in Medicare got prescriptions for often-abused painkillers from five or more physicians, which indicated that the patients might be visiting different doctors to get more painkillers than a physician would normally give to one patient.
But Grassley said that efforts to crack down on overprescribing in Medicaid have been lackluster.
“I haven’t noticed a groundswell of state or federal efforts to get to the bottom of anything that looks questionable since I made my original inquiry in 2010,” he said in his statement.
Medicaid ‘Very Serious’ Issue in Health Care Challenge, States’ Lawyer Says
Medicaid ‘Very
Serious’ Issue in Health Care Challenge, States’ Lawyer Says
By Jane Norman, CQ HealthBeat Associate
Editor
One of the top lawyers representing those challenging the health care law
said Monday that even opponents were surprised that the Supreme Court ordered
arguments on the measure’s Medicaid expansion. And a second plaintiff attorney
characterized it as a “very serious issue” that goes to the heart of the
question of the overhaul’s constitutionality.
Their remarks again underlined the significance of the unexpected entry
into the legal fight of the law’s provision that states must expand their
Medicaid rolls to uninsured adults earning less than 133 percent of the federal
poverty level. States say that requirement usurps a traditional federal-state
partnership and crosses the line into coercion because if they opt out, they’d
have to give up the federal Medicaid funding that makes up a large portion of
state budgets.
Although federal district courts and appeals courts ignored states’
protests, the Supreme Court has slotted an hour of argument about Medicaid on
March 28 as the finale to three days of battle over the overhaul (PL 111-148, PL 111-152). Some supporters of the
law fear that if the court strikes down the Medicaid expansion, it could also
lead to a wider unraveling of the federal government’s power to impose
conditions on state spending (See related
story, CQ Weekly, Nov. 21, 2011).
Randy Barnett, who’s among the lawyers representing the National Federation
of Independent Business, and Paul Clement, who represents the 26 state
attorneys generals and governors fighting the law, appeared at a Georgetown University Law
Center Clinton
States have long argued that the law disrupts their sovereignty, including
its requirement that they expand their Medicaid rolls to cover poor adults,
said Barnett.
“That’s a very important part of the litigation. It became more important
than any of us imagined when the Supreme Court granted cert on that issue,” he
said. The addition of the Medicaid issue also has helped to set up the suit to
be one of the most important cases in the nation’s constitutional history when
it comes to the scope of federal powers, he said.
That’s because Congress uses its power under the Commerce Clause of the
Constitution and its spending power as authority for nearly everything it
legislates, he said. “If a court is actually going to do something important on
one side of the line, the commerce side of the line, it would be very good for
them to be mindful of what’s happening on the spending side of the line,”
Barnett said.
Clement warned, “Don’t forget about the Medicaid part of the case.” He said
that constitutional lawyers are “really excited” about arguments in the case
over whether or not the individual mandate violates the Commerce Clause and
tend to miss the separate question of whether states have been coerced into increasing
their Medicaid case load.
Clement said the Medicaid expansion is the mechanism through which many
very poor people will comply with the individual mandate. “But there’s no other
way in the statute for the poorest of the poor to get qualifying coverage,” he
said. “There is no Plan B for a very good reason: No state given their current
dependency on Medicaid can make a rational, voluntary decision to refuse the
expanded terms of the Medicaid provision.”
Government lawyers have defended the expansion as permissible because it
was done in accordance with previous court rulings. Those rulings say such a
provision must provide for the general welfare of Americans, have a
“reasonable” relationship to the goals of the law, allow states to “knowingly”
exercise a choice and not force states to take unconstitutional actions.
A federal district court judge who ruled the rest of the health care law
unconstitutional in January 2011 said that there was “simply no support” for
the Medicaid coercion claims by the states.
Neither Barnett nor Clement would predict how the high court might rule,
though Barnett dismissed as “spin” predictions by some legal experts that it
might turn out to be an 8-1 or 7-2 decision. “I think this is a difficult case
and that’s part of the reason the court allocated so much time to it,” he said.
“I would discount those who make that prediction and whether they even believe
it themselves.”
Moss, however, predicted that the court will uphold the law, though he said
justices likely will look for a principle — raised by Barnett — that addresses
whether there are any limits on Congress’ ability to make individuals enter
into contracts with private companies, such as health insurance companies.
Moss said that as a lawyer reviewing legislation at the Office of
Legislative Counsel, he would not have objected to the health care law. “I
don’t think I would have raised any constitutional concerns,” he said, because
it appears legal under the Commerce Clause and deals with a large portion of
the economy. “There’s no doubt this legislation plays a very significant role
in the regulation of interstate commerce,” Moss said.
Tuesday, January 24, 2012
Monday, January 23, 2012
Friday, January 20, 2012
Thursday, January 19, 2012
Wednesday, January 18, 2012
Tuesday, January 17, 2012
Monday, January 16, 2012
Don't Miss This Event! Winter Symposium to be held February 25, 2012
GAAAP is launching a new CME event this winter with a first-ever CME meeting between the Chapter and the Georgia OB/Gyn Society, on Saturday, Feb. 25th. The session is entitled "Pediatricians & OB/Gyn's: Working Together to Improve Patient Care" will be held at the Marriott Buckhead Hotel, 3405 Lenox Rd., Atlanta.
We look forward to meeting with our OB/Gyn's colleagues to discuss mutual issues in patient care. You won't want to miss this special meeting. Click here for the Agenda and Registration Form.
We look forward to meeting with our OB/Gyn's colleagues to discuss mutual issues in patient care. You won't want to miss this special meeting. Click here for the Agenda and Registration Form.
Save the Date! February 8, 2012! GAAAP Legislative Day @ the Capitol.
The Georgia General Assembly has convened to begin its 2012 legislative session. On Wednesday, February 8, we'll have our Legislative Day at the Capitol when we'll get to meet legislative leaders and hear about the issues that effect pediatrics in our state. Plan to attend this interesting and informative half-day event.
Please click on the following link for a registration form and further details! GAAAP Legislative Day @ the Capitol
Please click on the following link for a registration form and further details! GAAAP Legislative Day @ the Capitol
Thursday, January 12, 2012
Wednesday, January 11, 2012
Tuesday, January 10, 2012
Decision sharing tied to lower cost for kids' care
Decision sharing tied to lower cost for kids' care
By Kerry Grens
The researchers, who looked only at families with children who have long-term health conditions, also found that those who joined doctors in making medical decisions had lower costs for their kids' medical care.
"This suggests that if you involve people in decision-making, they may be making choices that lead to decreasing the financial burden on them," said the study's lead author, Dr. Alexander Fiks, a professor at the Children's
Cost is especially important for these families, Fiks told Reuters Health, because there's a large out-of-pocket burden for kids who have asthma, autism or other chronic health problems.
His study, published in the journal Pediatrics, used responses from a large, annual health care spending survey, and they compared the results over two years.
The parents of more than 2,800 kids with special health care needs answered questions not only about costs, but the relationship they had with their child's doctor.
For instance, the survey asked how often doctors invited the parents to help in making decisions about treatment, and how often health care providers listened carefully to the parents.
Shared decision-making in medicine is considered a relatively new approach to determining a plan of treatment for patients, compared to the older, more paternalistic approach of the doctor calling the shots without input from the family or patient.
Fiks and his colleagues found that about half of the families experienced a high level of shared decision-making with doctors over the two years, while 17 percent continued to have a low level of participation.
About 16 percent of the families played an increasing role in making decisions over the span of the study, which was linked with a drop in trips to the hospital.
In the first year, seven out of every 100 kids in this group of families were admitted to the hospital, compared to three out of every 100 kids in the second year of the study.
Similarly, 26 out of every 100 kids went to the E.R. in the first year, compared to 15 in the second year.
Dr. Stephen Berman, a professor of pediatrics and public health at the
"In my own practice I find that when parents become partners in these decisions...they understand the care plan much better and they're much more compliant with giving medications (to their kids) and recognizing danger signs," said Berman, who was not involved in this study.
"If families are following treatments more closely, it's possible that the kids may get better," Fiks said.
SPENDING DROPS
Health care spending for kids also dropped in the second year of the study if families had a growing part in making decisions.
The total spending on health care was more than $2,000 in the first year, and dropped to about $1,700 in the second year.
Fiks and his colleagues didn't prove that sharing decisions was the sole reason for the benefits they saw.
There are other possibilities that could explain why the researchers found a benefit for families who took a larger part in making choices in the second year.
For one, parents who are stronger advocates for their children -- and who are more likely to aggressively pursue treatments -- might seek out doctors willing to involve them in making decisions.
Another explanation is that as children get sicker, their parents might be less willing or able to make choices, and the decisions fall primarily on the doctor. On the flip side, as kids gets healthier, their parents might be more able to take on a greater role in their care.
Fiks said he'd like to see future studies work out whether shared decision-making alone can result in cost savings and health benefits for children with health problems.
"I personally believe that when we do those studies...we will find an impact from shared decision-making," Berman told Reuters Health.
Private insurers increasingly reliant on government business
Private insurers
increasingly reliant on government business
By N.C. Aizenman,
Despite the sluggish economy, the nation’s major health insurers have
prospered in large part by expanding their role in government programs such as
Medicare and Medicaid, according to a study released Thursday.The share of large insurers’ revenues contributed by their Medicare and Medicaid business has jumped from 36 to 42 percent over the past three years. And the report by Bloomberg Government, a research division of Bloomberg LP, suggests that insurers will further increase their reliance on federal dollars with full implementation of the health-care law in 2014 — when Medicaid will expand to cover an eventual 16 million additional low-income Americans and the federal government will begin subsidizing private-insurance policies for an estimated 19 million more.
The study found that since 2009, carriers have enjoyed substantial growth to their operating margin, the share of a company’s revenue left over after accounting for operating expenses.
During last year’s first three quarters, the combined operating margin of the five largest publicly traded insurance companies averaged 8.65 percent — the best three-quarter performance of the past three years.
This occurred even as revenues from traditional private-insurance business have remained virtually flat since the end of 2008.
The five insurers combined — UnitedHealth Group, Wellpoint,
The insurers’ government business involves taking over components of the Medicare and Medicaid programs that government policymakers are increasingly outsourcing in hopes of cutting expenditures.
Essentially, the private companies are hired to run managed-care plans as an alternative to the traditional fee-for-service plans provided by the two programs. Under the arrangement, the insurer receives a fixed amount from the state or federal authority ultimately responsible for a given Medicaid or Medicare population. In many cases, the insurer can then keep part of any savings it generates by managing the care of the covered population more cost-effectively.
The practice is attractive to states seeking to curb spending on Medicaid, which is funded with a combination of state and federal dollars. Privately run Medicare managed-care plans — called Medicare Advantage Plans — have also long been common.
The health-care law will actually reduce federal payments to Medicare Advantage Plans by $136 billion. Nonetheless, the study’s author, Peter Gosselin, posits that insurers still expect the plans to prove profitable, because the current national focus on debt reduction will give them political cover to manage beneficiaries’ care more tightly than was considered palatable in years past.
That same logic might explain why insurance companies and their investors appear unruffled by the possibility that the health-care law could be overturned by the Supreme Court or drastically altered by the next Congress.
In the absence of the law, Medicaid might not be expanded. But the political imperative will still be to reduce spending on both Medicaid and Medicare — and this would probably be done through further outsourcing to private companies.
“It seems as if insurers have figured out a way to win whether the law is fully implemented or not,” Gosselin said.
Monday, January 9, 2012
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