via Fake drug scandal, winding down? « The Enterprise Blog.

via Nursing Homes in California Confront Pharmacists’ Errors – NYTimes.com.

The introduction of new performance indicators always has the potential to produce gaming. Observers from the USA cite experience which suggests hospitals might increase income by admitting less serious cases, thus simultaneously increasing their income and reducing their rate of readmission. There is also the possibility that there may be some shift in coding of admissions between ‘emergency’ and ‘elective’ depending on the incentives. If hospitals are performance managed on the basis of readmission rates, it would be reasonable to expect that some behaviour of this type would occur.

via Preventing emergency readmissions to hospital: A scoping review | RAND.

via U.S. GAO – Medicare Advantage: CMS Should Improve the Accuracy of Risk Score Adjustments for Diagnostic Coding Practices.

For a better understanding of what these numbers mean, let’s look at the quarterly earnings reports that were released this week by insurance companies across the country.

via Look Who Else Released Their Earnings Reports: Your Insurance Companies | American Action Forum.

via Docs Look For Unnecessary Procedures | American Action Forum.

The passage of “Obamacare” has made this deplorable situation worse. This law does increase various Medicare taxes and includes some cost-containment features. However, as Medicare’s own actuary has pointed out, “Obamacare” uses the savings not to strengthen Medicare but to start another unfunded entitlement. The changes — a $500 billion cut in the program — do nothing to shore up the existing Medicare trust fund.

via Opinion: ‘Obamacare’ shreds social safety net – Frank Donatelli – POLITICO.com.

The American Medical Association (AMA) says switching to so-called ICD-10 coding will require doctors’ offices to deal with some 68,000 codes, more than five times the current 13,000. The change will cost medical practices anywhere between $83,290 and more than $2.7 million, depending on size — at a time when Medicare payment rates face an almost 30 percent cut.

The switch will “create significant burdens on the practice of medicine with no direct benefit to individual patient care,” AMA CEO James Madara wrote to Boehner.

via Doctors lobby urges GOP to halt new insurance codes – The Hill’s Healthwatch.

If so, the timing couldn’t be worse. The first baby boomers hit age 65 last year. By 2030, 20 percent of the U.S. population will be at least 65, up from 13 percent today. In that same period, the number of 85-year-olds will increase more than 50 percent and the number of 100-year-olds nearly triple. But the number of nursing homes dropped almost 9 percent from 2000 to 2009.

via The Coming Nursing Home Shortage – Kaiser Health News.

Starting this summer, WellPoint Inc., which insures some 34 million Americans, will offer primary-care doctors a fee increase, typically of around 10%, with the possibility of additional payments that could boost what they get for treating the patients it covers by as much as 50%.

via An Rx? Pay More to Family Doctors – WSJ.com.

The healthcare law lays out 10 categories of “essential health benefits” that every insurance plan will have to cover beginning in 2014. The law left it to the Health and Human Services Department to define the specifics of essential benefits, and HHS in turn passed that job on to the states.

The approach has sparked concern that people in some states will only be entitled to a skimpy benefits package.

But Avalere’s analysis says that in the area of prescription drugs, plans are already offering much more coverage than the minimums established in HHS’s essential-benefits policy.

via Study: Drug benefits already exceed new federal standards – The Hill’s Healthwatch.

Democrats released a new report, which they had requested from the Government Accountability Office, that concludes MA plans routinely classify their customers as being sicker than if they were on traditional Medicare, triggering higher reimbursement rates.

The GAO found that MA plans were overpaid by $1.2 billion to $3.1 billion in 2010, with excess payments likely growing since then. The insurance industry however points out that the GAO report doesn’t say MA plans anything wrong but rather that they offer “diagnostic coding that is more comprehensive,” leaving open the possibility that they do a better job identifying conditions patients actually have.

via GAO report rekindles Democrats’ call for more cuts to Medicare Advantage plans – The Hill’s Healthwatch.

Wyden and Ryan are floating an idea to allow seniors to choose between traditional Medicare and private insurance programs. Ryan is considering adding provisions in his 2013 budget that would pave the way for this approach.

Though Democrats still have every intention of slamming Republicans who backed Ryan’s earlier plan, there’s sentiment in both parties that Wyden’s latest move gives the GOP at least some cover.

“It neutralizes the weapon,” Sen. John Cornyn, chairman of the National Republican Senatorial Committee, said in an interview.

via Ron Wyden gives GOP cover on Medicare reform – Jonathan Allen and Manu Raju – POLITICO.com.

via Transforming Health Care: The Role of Health IT | Bipartisan Policy Center.

via Nursing Homes in California Confront Pharmacists’ Errors – NYTimes.com.

If we knew then what we know now—that the long-term care programs added to healthcare reform to sweeten the budget numbers were unsustainable, and that so-called game changers such as disease management didn’t change the game much at all—it is almost certain that the Affordable Care Act would not have passed through Congress.

via If we knew then what we know now about healthcare reform « The Enterprise Blog.

Total premiums — the amount paid by both employers and workers combined — for family coverage rose 50 percent from 2003 to 2010, to nearly $14,000 a year, the study found. (The fund is a private foundation that researches health policy issues. The report includes an interactive map showing premium increases by state).

via Family Health Insurance Costs Doubled in 7 Years, Study Finds – NYTimes.com.

The health care reform law, which has gotten support from about 42 percent of Americans in recent polls, is Obama’s most significant domestic policy accomplishment. But it only got a fleeting mention Tuesday in his third State of the Union speech.

via State of the Union address barely mentions health care reform law – Jennifer Haberkorn – POLITICO.com.

Methods  We searched MEDLINE (1978-2009) for studies measuring US rates of overuse of procedures, tests, and medications, augmented by author tracking, reference tracking, and expert consultation. Four reviewers screened titles; 2 reviewers screened abstracts and full articles and extracted data including overuse rate, type of service, clinical area, and publication year.

Results  We identified 172 articles measuring overuse: 53 concerned therapeutic procedures; 38, diagnostic tests; and 81, medications. Eighteen unique therapeutic procedures and 24 diagnostic services were evaluated, including 10 preventive diagnostic services. The most commonly studied services were antibiotics for upper respiratory tract infections (59 studies), coronary angiography (17 studies), carotid endarterectomy (13 studies), and coronary artery bypass grafting (10 studies). Overuse of carotid endarterectomy and antibiotics for upper respiratory tract infections declined over time.

Conclusions  The robust evidence about overuse in the United States is limited to a few services. Reducing inappropriate care in the US health care system likely requires a more substantial investment in overuse research.

via Arch Intern Med — Abstract: Overuse of Health Care Services in the United States: An Understudied Problem, January 23, 2012, Korenstein et al. 172 (2): 171.

via State Progress Toward Health Reform Implementation: Slower Moving States Have Much to Gain.