P4P Working, Says CMS
Providers that participated in a Medicare pay-for-performance demonstration program earned $16.7 million in incentive payments during the program's second year by improving the quality of care for patients with several chronic conditions, including heart failure, coronary artery disease, and diabetes, according to the Centers for Medicare and Medicaid Services. All 10 of the participating physician groups achieved benchmark or target performance on at least 25 out of 27 quality markers for patients with diabetes, coronary artery disease and heart failure. Five of the groups achieved benchmark quality performance on all 27 quality measures. The groups improved their performance by changing some of their office processes and investing in health information technology. “We are paying for better outcomes and we are getting higher quality and more value for the Medicare dollar,” said Kerry Weems, CMS acting administrator. “And these results show that by working in collaboration with the physician groups on new and innovative ways to reimburse for high quality care, we are on the right track to find a better way to pay physicians.” The demonstration project was originally scheduled to last 3 years but has since been extended to a fourth year.
Obesity as Dem. Platform Plank
The drafters of the Democratic Party Platform have included a section on obesity, marking what appears to be the first time the disorder has been mentioned in any national party platform. The document, which was approved by the full platform committee in early August, reads in part, “Our nation faces epidemics of obesity and chronic diseases as well as new threats like pandemic flu and bioterrorism. Yet despite all of this, less than 4 cents of every health care dollar is spent on prevention and public health. … We will ensure that Americans can benefit from healthy environments that allow them to pursue healthy choices. Additionally, as childhood obesity rates have more than doubled in the last 30 years, we will work to ensure healthy environments in our schools.” Gary Foster, Ph.D., president of the Obesity Society, applauded the action. “We are pleased to see a major political party recognize the importance of obesity to the health of Americans and to the health care system overall,” he said.
Feds Scrutinize Generic Maker
India's Ranbaxy Inc., 1 of the top 10 generic drug makers in the world, is being investigated by various arms of the federal government for allegedly introducing “adulterated or misbranded products” into the U.S. market. The company's auditor, Parexel Consulting, is also under scrutiny. According to a subpoena for documents filed in the U.S. District Court for the District of Maryland by the federal Department of Justice and the U.S. Attorney's Office in Maryland, Ranbaxy submitted false information to the Food and Drug Administration on sterility and bioequivalence, covered up violations of good manufacturing practice, and defrauded Medicare. Rep. John Dingell (D-Mich.) and Rep. Bart Stupak (D-Mich.) said that they will formally investigate the Ranbaxy situation. “If these allegations are true, Ranbaxy has imperiled the safety of Americans in a manner similar to the generic drug scandal we uncovered 20 years ago,” said Rep. Dingell. “I would like to know whether FDA officials knew about these allegations and what, if any, action was taken.”
Patients Cutting Health Care
To save money, many Americans are reducing the amount of medical care they receive, according to a survey of nearly 700 people by the National Association of Insurance Commissioners. Twenty-two percent of respondents to the July survey said they have reduced the number of times they see the doctor. In addition, 11% said they have cut back the number of prescription drugs they take, or reduced the dosage to make the prescription last longer. “Delaying medical treatment and regular physicals puts consumers at risk for potential health issues, and increases overall health insurance costs,” said Kansas Insurance Commissioner Sandy Praeger, president of the NAIC. The vast majority of respondents did not change their health insurance policies; of the 5% who did make changes, 2% reduced coverage, 1% fell behind on payments, and 2% canceled their policies.
Specialists' Incomes Vary Widely
Incomes vary widely among the four medical specialties—geriatrics, hematology-oncology, nephrology, and rheumatology—that derive more than half of their revenues from government-run health insurance programs, a study showed. For example, geriatricians' incomes averaged $165,000 annually, versus $504,000 for hematologists, even though the two specialties require a similar amount of training, according to the study by Harvard Medical School researchers at Cambridge (Mass.) Health Alliance, published online in the Journal of General Internal Medicine. The study analyzes data from the national Medical Expenditure Panel Survey. The income disparity fuels the shortage of primary care physicians, said Dr. Karen Lasser, the study's lead author. “It's no surprise that there is a shortage of primary care doctors when debt-burdened medical students have much more lucrative career options,” Dr. Lasser said in a statement. “What is surprising is that government fee schedules are behind much of this income discrepancy.” In total, Medicare accounts for about 21% of payments to doctors, whereas Medicaid and other government programs account for 10%, according to the study.