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Cutting health costs by paying doctors more?
That is the premise of experiments under way by federal and state government agencies and many insurers around the country. The idea is that by paying family physicians, internists and pediatricians to devote more time and attention to their patients, insurers and patients can save thousands of dollars downstream on unnecessary tests, visits to expensive specialists and avoidable trips to the hospital.
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The company that promoted the dietary supplement Airborne as a “miracle cold buster” yesterday cut a deal with the feds, agreeing to pay up to $30 million to settle charges that it didn’t have evidence to back up its advertising claims.
“There is no credible evidence that Airborne products, taken as directed, will reduce the severity or duration of colds, or provide any tangible benefit for people who are exposed to germs in crowded places,” the Director of the FTC’s Bureau of Consumer Protection said in a statement yesterday.
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A Mexican health-care company opened clinics this week in three Miami-area pharmacies whose customers are mostly Latino. Count that as a national-trend twofer — targeting the Latino market and putting clinics in retail stores.
The clinics will be staffed by bilingual physicians (a departure from the standard practice of employing nurse practitioners), and they’re affiliated with a Miami hospital. The clinics are owned by Samoho, a Mexico City-based company that already runs a few retail clinics in Wal-Mart stores there.
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The CMS said it would not immediately take action against more than a dozen states that have extended enrollment under a federal children’s healthcare program to families with incomes above 250% of the federal poverty level.
“At this time, we are not taking compliance action,” according to a CMS statement. “Moreover, we will continue to assist the states in developing policies that will ensure that the most vulnerable, low-income children are covered first, without moving them from private to public coverage.”
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With the U.S. economy in a downturn, it appears that consumers may be responding by cutting back on medical care. According to a new survey by the National Association of Insurance Commissioners, 22 percent of respondents had cut the number of times they visit their doctors because of the economic climate. The poll, which surveyed 686 consumers, also found that 11 percent of respondents had reduced the amount of prescription medications they took, or the dosage of those medications, to make their supply last longer. Consumers are holding on to their insurance plans, however. While 2 percent had canceled their coverage due to economic concerns, 85 percent made no changes.
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The average monthly premium for Medicare's prescription drug plan will increase to an estimated $28 in 2009, three dollars more than this year's monthly premium, Medicare officials announced Thursday.
That 2009 figure is 37 percent lower than originally projected when Medicare's so-called Part D drug coverage was introduced in 2003, the officials added. The Part D program offers prescription drug benefits to Medicare beneficiaries.
"Part D continues to come in under budget, achieve consistently high satisfaction rates, and with it millions of Americans are living healthier, better lives," Kerry Weems, acting administrator of the U.S. Centers for Medicare and Medicaid Services, said during an afternoon teleconference.
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You've gotta love it when CMS gives out money above and beyond the usual reimbursement rates--and it's even better when the bonuses involved work out for pretty much everyone involved. That's the cheery outcome for the second year of CMS's pay-for-performance demonstration project, under which 10 physician groups earned a total of $16.7 million in incentive payments. Under the terms of the demonstration project, which addresses the quality of care for heart patients and diabetics, physician groups were asked not only to improve outcomes for Medicare patients, but also to coordinate their care.
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As just about everyone knows by this point, the courts decided last year that former UnitedHealth CEO Bill McGuire had been a bad boy when it came to stock options. McGuire was asked to give up $420 million in dicey stock-option gains and retirement pay to settle shareholder and SEC complaints over how the stock options were awarded. (We're talking a slight case of backdating for profit here.)
Despite this decision, which was arrived at by a special litigation committee, things reached a stalling point after that, notes the Wall Street Journal. A judge overseeing the case decided not to finalize the agreement, as he wanted to know whether he had to follow the word of the litigation committee. Delay, delay and more delay.
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New Jersey’s largest insurer, Horizon Blue Cross and Blue Shield, filed an application with the state’s attorney general and Banking and Insurance Department to convert from not-for-profit to for-profit corporation.
The Newark-based insurer said in its application that the switch will give Horizon financial flexibility and greater access to capital for information technology and pay-for-performance initiatives and for business operations. The Blues plan said investment during the next five years will exceed its annual $35 million budget by an estimated $20 million to $30 million per year. Conversion will allow the insurer to remain competitive and maintain its credit strength, the application said. Horizon holds 46% of New Jersey’s market, according to the document.
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A record number of patients in the U.S. sought medical attention from providers in 2006, partly due to growth in both the overall general and aging population, according to statistics released by the Centers for Disease Control and Prevention. Patients across the country made an estimated 1.1 billion visits to doctors’ offices and hospitals in 2006, a 26% increase from 1996 and an average of four visits per person per year, the data show.
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For the last few years, a group of physicians has been working to force the health insurer administering Georgia's state employee health benefits plan to disclose what it pays physicians around the state, as well as language found in its physician and hospital contacts. While the doctors assert that such details should be public--given state open records laws--United continues to insist that such details are proprietary. Now, it appears that the state Supreme Court will get to decide whether the group will get its wish.
In 2005, United Healthcare got a five-year, $55 million contract to service the state's self-funded plan. The medical group, the South Georgia Physicians Assn. LLC, later became aware that United Healthcare was paying different fee schedules to physicians in different parts of the state. South Georgia Physicians, an IPA, has about 280 physician members that practice in about 30 counties that are largely rural.
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Following a trend emerging in recent years across the country, New Jersey has enacted a law capping hospital prices for low- and middle-income uninsured patients. The new law is one of four bills signed by the state's governor, including a measure expanding the state's power of oversight over troubled hospitals. Under the new pricing law, hospitals aren't allowed to charge more than 15 percent above Medicare's rate for services to uninsured patients with incomes below 500 percent of the federal poverty level. (The poverty level is presently $21,200 for a family of four.) The monitoring law, meanwhile, allows the state's health commissioner to appoint an official for hospitals at risk of foreclosure, as measured by the guidelines for intervention created by the New Jersey Commission on Rationalizing Health Care Resources.
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Massachusetts is getting tough on drug and device reps.
Over the weekend, Governor Deval Patrick signed into law a broad health bill that requires drugmakers and medical devices companies to disclose any gifts to doctors worth more than $50, the Boston Globe reports.
But wait, there’s more. The law, whose main purpose is to rein in soaring health spending in the state, requires the University of Massachusetts Medical School in Worcester to increase class sizes to produce more primary care doctors. The law also gives state regulators the authority to call hearings when insurers want to hike rates.
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It’s natural for the price of drugs to rise a little every year, just like the price of everything else. But in the first half of this year, the average wholesale price of 17 drugs jumped 100% or more in a single cost adjustment, USA Today reports.
Last year, the price of 26 drugs increased by 100% or more, up from 15 in 2004, the article says, citing figures compiled by researchers at the University of Minnesota.
For comparison, drug prices rose about 7.4% on average last year for more than 1,300 brand-name drugs, USAT reported, based on figures from PBM Express Scripts.
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There were 119 million emergency room visits in 2006, the feds are reporting this morning. That’s the most ever, and an increase of 36% in the course of a decade.
During the same period, the number of emergency rooms fell, from 4,019 to 3,833.
The authors, from the government’s division of health care statistics, duly note that the increase is driving longer wait times for minor and serious problems as well as boarding of patients in hallways.
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