Nursing Home Fees to Increase
The Centers for Medicare and Medicaid Services has proposed increasing the work relative value units–and therefore the physician fees–for services provided in the nursing home setting. If the increase is included when CMS publishes its final fee schedule on Nov. 1, physicians will see new reimbursement rates beginning on Jan. 1, 2008. Under CMS' proposal, fees for nursing home visits would increase 9%-50%, depending on the service. The changes come after 4 years of work by the American Medical Directors Association and other physician groups aimed at persuading CMS that the work involved in caring for a nursing home patient is similar to the work involved in caring for a hospital patient. “Because patients are moved from more intense settings much more quickly than in the past, patients in nursing facilities are often in very serious condition as they are cared for by their physician,” said Dr. David Dale, president of the American College of Physicians in a statement. “These work values are a reflection of this extraordinary responsibility.”
CMS Releases Medicaid Rule
CMS has unveiled a new method of setting limits on what the federal government will reimburse state Medicaid agencies for prescription drug payments. As part of the new regulation, states will be required to collect information from physicians about prescription drugs administered in their offices so that the state can collect any rebates offered by drug manufacturers on those products. The final rule will take effect Oct. 1. The regulation is expected to save states and the federal government $8.4 billion over the next 5 years, but even with the change, the Medicaid program still is expected to spend $140 billion for drugs over the same time period. The change is in part a reaction to a series of reports showing that Medicaid payments to pharmacies for generic drugs were much higher than what pharmacies actually were paying for the drugs. Pharmacies, the reports showed, made the most profit on those generic drugs with the highest markup, creating an incentive to dispense those drugs.
Joint Commission Announces Goals
The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations) will require health care institutions to take specific actions to reduce the risks of patient harm associated with the use of anticoagulant therapy as part of its 2008 National Patient Safety Goals. The new requirement–which applies to hospitals, ambulatory care and office-based surgery settings, and home care and long-term care organizations–addresses a widely acknowledged safety problem with anticoagulant therapy, the accrediting organization said. The 2008 safety goals also include a new requirement that addresses the recognition of and response to unexpected deterioration in a patient's condition. Under this requirement, hospitals must select a suitable method for enabling caregivers to directly request and obtain assistance from specially trained individuals if and when a patient's condition worsens. Full implementation of both requirements is targeted for January 2009.
Americans Buy Drugs Overseas
More than 5 million Americans adults, or more than 2% of the U.S. population, have recently purchased prescription drugs from another country, such as Canada or Mexico, according to a survey by the Pharmaceutical Research and Manufacturers of America. The vast majority of consumer importers said they were looking for the best price for medicines, but about half decided to buy their drugs in another country because they didn't have a physician's prescription for the drugs they wanted, the survey found. Importers were more likely to be under age 35 years, be Hispanic, live in a southern border state, and to spend more out-of-pocket money on prescription drugs than do nonimporters, PhRMA reported. Most of the drugs imported were to treat chronic ailments. PhRMA President and CEO Billy Tauzin said in a statement that importation increases a patient's risk of being exposed to “dangerous counterfeit medicines.”
HHS Expands Vaccine Capacity
The Department of Health and Human Services has awarded two contracts to expand the domestic influenza vaccine manufacturing capacity that could be used in the event of a potential influenza pandemic. The 5-year contracts were awarded to Sanofi Pasteur ($77.4 million) and MedImmune Inc. ($55.1 million). The contracts provide funding for renovation of manufacturing facilities and for manufacturing operations for 2 years, with options for an additional 3 years of operations. Upon completion, these facilities will expand domestic pandemic vaccine manufacturing capacity by 16%, according to HHS. In addition, the facilities will expand vaccine availability for the national stockpile.