Medicare Advantage Criteria
Medicare officials have identified 15 chronic conditions that would make individuals eligible for enrollment in a Chronic Care Medicare Advantage Special Needs Plan. The conditions were selected by a panel of advisers as being medically complex, substantially disabling or life threatening, and as having a high risk of hospitalization or adverse outcome. Included are certain neurologic disorders, stroke, chronic alcohol and other drug dependence, certain autoimmune disorders, cancer excluding precancer conditions, certain cardiovascular disorders, chronic heart failure, dementia, diabetes, end-stage liver disease, end-stage renal disease requiring dialysis, certain severe hematologic disorders, HIV/AIDS, certain chronic lung disorders, and certain chronic and disabling mental health conditions. The list of conditions is part of new guidelines for the special needs plans that will go into effect in 2010. Medicare officials noted the list is an effort to ensure that the plans stay focused on a specific population and do not expand to the larger Medicare Advantage population.
HHS Releases Quality Measures
The Department of Health and Human Services has released its first-ever inventory of the quality measures its agencies use for reporting, payment, and quality improvement. The HHS measure inventory is available from the National Quality Measures Clearinghouse, a Web site run by the Agency for Healthcare Research and Quality, and is designed to advance collaboration within the quality measurement community and to synchronize measurement, according to the HHS. “This effort is pivotal to achieving the goal of transparency in quality measurement as a cornerstone of value-driven health care,” said HHS Secretary Mike Leavitt in a statement. The inventory is available at
Army and NIMH to Study Suicides
The National Institute of Mental Health has signed a memorandum of understanding with the U.S. Army to study suicide and suicidal behavior among active-duty soldiers, National Guard members, and Army Reservists. The 5-year, $50 million effort will be the largest study of suicide ever undertaken by the institute, according to a statement. The goal is to identify risk and protective factors for suicide and to help the Army develop effective intervention programs. In 2007, 115 Army members committed suicide; of those, 36 committed suicide while deployed, 50 did so post deployment, and 29 had never been deployed.
FDA Opens China Offices
The Food and Drug Administration has opened offices in Beijing, Guangzhou, and Shanghai, China, as part of an effort to improve the safety of food and other consumer products. “A permanent FDA presence in China will help us address the challenges presented by globalization,” said the FDA Commissioner Andrew von Eschenbach in a statement. “We look forward to working with the Chinese government and manufacturers to ensure that FDA standards for safety and manufacturing quality are met before products ship to the United States.” Establishing a permanent presence by the FDA in China will greatly enhance efforts to protect consumers in both countries and also will enable the FDA officials to help the Chinese government in its ongoing efforts to improve its regulatory systems for exports to help ensure product safety, agency officials said. The FDA also intends to open offices in other parts of the world and ultimately will have a presence in five geographic regions, including China, India, Europe, Latin America, and the Middle East, the agency said.
MedPAC Calls for Disclosure
Congress should pass legislation to require drug, device, and medical supply makers and distributors, along with hospitals, to disclose their financial ties to physicians and physician groups, the Medicare Payment Advisory Commission has decided. The companies also should be required to disclose financial relationships with pharmacies, pharmacists, health plans, pharmacy benefit managers, hospitals, medical schools, continuing medical education organizations, patient organizations, and professional organizations. MedPAC said it will urge Congress to require drug manufacturers to post on a Web site all details about free drug samples given to providers. In addition, MedPAC said that lawmakers should require the HHS to submit a report describing financial arrangements between hospitals and physicians. MedPAC advises Congress on Medicare issues, but lawmakers are not required to implement the commission's recommendations.
Payments Backlogged in West
Medicare payments to physicians in California, Hawaii, and Nevada have been held up because of problems stemming from the new National Provider Identifier numbers and from the transition to a new claims processor. Columbia, S.C.-based Palmetto GBA began processing fee-for-service Medicare claims for the three states in September, and the California Medical Association said that it had received calls from more than 1,000 physicians complaining of delays in payment. The transition to Palmetto has been “marred by missteps,” and “the delay in payments threatens to compromise patient care and provider solvency,” said Rep. Henry Waxman (D-Calif.), in a statement. To address the issue, Palmetto said in a statement that it has added 35 staffed phone lines and expects the backlog will be cleared or nearly cleared by Dec. 31.