The Impending IPAB Deadline

October 24, 2012
7:31 am

After the new Congress takes its oath of office in January, it will have no shortage of big issues on its plate.  Among them should be a reconsideration of the Independent Payment Advisory Board (IPAB).

To recap, IPAB is a key component of the Patient Protection and Affordable Care Act.  It is a board of political appointees (no one has yet been nominated to serve on IPAB, it should be noted) that would make recommendations on reducing Medicare spending if the Medicare Chief Actuary determines that the program’s per capita growth rate will exceed arbitrary spending limits.  Unless Congress overturns the IPAB recommendations with a three-fifths vote in the Senate or approves an alternative that achieves the same level of savings, the proposals made by this unelected board will have the power of law and would not be subject to judicial review.

There is a superb article on IPAB published this month in the American Medical News that details exactly how the IPAB process would work and the dangers it poses to healthcare access and quality by making cuts in what Medicare pays for goods and services without regard to elevating the program’s value to beneficiaries and taxpayers.

This year, the House has voted to repeal IPAB, with bipartisan support, but the Senate has not allowed the measure to come to a vote.

In the past year, there was not a sense of congressional urgency surrounding this issue because IPAB was still seen more as concept than reality.   That won’t be the case in 2013.  According to the law, the Chief Actuary must determine by April 30 if projected spending will exceed per capita limits and then IPAB members must submit their spending control proposal by September 1.

There are serious arguments to be made about whether IPAB represents a transfer of power to unelected individuals that the framers of the Constitution never envisioned or would have allowed.  There are equally important arguments that IPAB will do serious harm to Medicare beneficiaries when lawmakers should pursue better alternatives that will actually enhance program value and care quality.

As the timetable tells us, Congress needs to consider those arguments with a certain degree of urgency when the calendar turns to 2013.

Comparative Effectiveness and the “Average” Patient

October 23, 2012
8:33 am

Comparative effectiveness research has the potential to bring great value to the U.S. healthcare system

One of the key components of the Patient Protection and Affordable Care Act, research evaluating the effectiveness of various therapies and medical technologies can contribute to a database of knowledge that will enhance clinical outcomes.

Even the best of ideas, though, require sound and well-conceived usage, and that’s certainly the case with comparative effectiveness research.  It’s essential that clinical effectiveness be the goal, as opposed to using this information to close off access to therapies that have value for significant numbers of patients.

That’s the subject of a forum being hosted by the National Pharmaceutical Council (the Healthcare Leadership Council is a cosponsor).  “The Myth of Average:  Why Individual Patients Matter,” will take place on November 30 in Washington, DC.   A number of expert speakers will focus on clinical differences between patients, whether those variations are the result of biology, genetics or social and environmental factors.  Optimally, this forum will shed light on the fact that there is no such thing as the “average” patient when various therapies will achieve different outcomes with different patients.

More information on the event can be found at www.npcnow.org/myth2012.

We all want the same thing — to deliver the right care to the right patient in the right setting at the right time.  The forum we’re privileged to cosponsor on November 30 will help illuminate how comparative effectiveness research can best help us achieve that objective.

Medicare Part D: The Successes and the Challenges

October 15, 2012
10:44 am

The Medicare Part D prescription drug program open enrollment season begins today, October 15, and runs until December 7.  This is the time all beneficiaries should be reviewing their current plans and shopping among their available options to make sure they are getting the best possible value in their prescription drug coverage.

The fact is that most Part D enrollees won’t spend a great deal of time checking out different prescription drug plans during this period.  When we analyze the reasons why, we see both good news and a message that a well-executed program could be carried out even more effectively.

The good news is that Medicare Part D enjoys overwhelming popularity, and people have a high rate of satisfaction with their current plan.  The Medicare Today coalition, which HLC founded at the launch of the Part D program, conducts an annual survey with KRC Research to fully understand how seniors view their Part D coverage.  This year’s survey showed a 90 percent satisfaction rate, the highest level in the seven years we’ve been doing this polling.

This high satisfaction rate stems from both the user-friendliness of the Part D program as well as its affordability.  Among the seniors surveyed, 94 percent say their plan is convenient to use and strong majorities say their monthly premiums (85 percent) and co-pays (86 percent) are affordable.

Two out of every three seniors say they are unlikely to shop for other Part D plans during this open enrollment period.  The good news is that 91 percent say they won’t shop because they’re satisfied with their current coverage.

But where there is room for improvement is in the finding that 61 percent of seniors say they are unaware of the PlanFinder tool created by the Centers for Medicare and Medicaid Services and located on the www.medicare.gov website.  The PlanFinder enables beneficiaries to easily type in the medications they’re taking and find out the list of plans that are the best value for their individual needs.  Every Medicare beneficiary should be aware of this tool.

So, despite the success of the Part D program, there’s no room for complacency.  The federal government, the private sector and non-profit advocacy organizations all have a responsibility to continue outreach to the Medicare beneficiary population, continuing to provide information on the Part D program and the consumer tools available to enrollees.  In this way, the consumer choice aspects of Medicare Part D that make the program so popular and affordable can achieve optimum value in bettering the lives of the millions who participate in this vitally important program.

Are Smartphones Leading to Smarter Healthcare?

October 12, 2012
11:09 am

A topic of conversation for years in health policy circles involved how to get patients and consumers more personally engaged in their own healthcare.  We’ve held the conviction for quite some time that a better informed, more personally involved patient population could lead to better health maintenance and improved cost containment.

There’s a statistic that emerged this year that holds an important key in helping us achieve a more health-conscious society.

According to Nielsen, the people known for calculating TV ratings, we have now cracked the 50 percent barrier in the number of people who own smartphones.  More than half of us are carrying iPhones, Blackberries, Androids and the like.  And having these mini-computers in our hands opens up a wealth of opportunities to bring meaningful, proactive healthcare into our daily lives.

That’s happening today.  Health insurers like Aetna and Humana are providing mobile apps that enable policy holders to find the nearest urgent care centers and locate physicians in their network.  Health providers are using apps to allow patients to make doctor appointments, check lab results and gain access to a wealth of wellness information.

And then there are also smartphone apps that are both innovative and extremely practical like SleepChamp, a program that enables parents to determine if their children may be at risk for sleep-related breathing disorders.  A program like this truly exemplifies the way a smartphone can be used for proactive health purposes.  When parents answer questions on the SleepChamp program about their child’s sleeping habits, the app generates a score that alerts parents as to whether they should consult their pediatrician regarding potential problems.

There are important lessons to be learned through an app like this one, which was created by a health information technology company, Zansors, and the University of Michigan Health System, on making programs easy to use and visually appealing.  This will enable parents to identify signs of serious disorders like sleep apnea at an early stage.

One of the challenges, though, with so many smartphone apps entering the market is determining which ones are most reliable and useful.  On that front, Dr. Mike Roizen, the chief medical officer of the Cleveland Clinic (a Healthcare Leadership Council member) Wellness Institute and his frequent partner Dr. Mehmet Oz of television renown have written a column to help consumers determine which healthcare apps are most suitable for our individual needs.

Dr. Villalobos’s Story

October 02, 2012
2:37 pm

This month, a guest editorial in the Odessa (TX) American spoke volumes about the state of medical liability laws in the United States, a patchwork quilt of vastly different liability climates that is driving some physicians’ decisions on where to practice medicine.

Dr. Jackelinne Villalobos was an obstetrician in New York, working in a clinic where her bilingual skills enabled her to better treat her predominantly Spanish-speaking clientele.  As she tells it, she found her work in New York to be challenging and rewarding, but also unaffordable because of the $168,000 she was paying annually for medical liability insurance.  With a five to 12 percent rate hike expected the next year, she realized that even extended office hours and working six days a week wouldn’t allow her to maintain a viable practice with those crushing liability costs.

And, keep in mind, Dr. Villalobos points out that she had an unblemished practice without a single lawsuit payment ever made to a patient.

Today, Dr. Villalobos practices medicine in Houston, her decision made easy by the action of the Texas legislature in 2003 to pass landmark liability reform laws.  She’s not alone.  In the last fiscal year, the Texas Medical Licensing Board issued over 3,600 new medical practice licenses.  That’s 70 percent more doctors than in the years immediately before the legislature passed tort reform measures.

This is an issue that has been stymied in Congress, largely due to partisan gridlock and strong pressure applied by the nation’s trial attorneys.  As we face increasing physician shortages in the not-too-distant future – 130,000 fewer doctors than the number of patients will require in 2025, according to the Association of American Medical Colleges – it’s increasingly necessary that lawmakers learn from the Texas experience and the story of physicians like Jackelinne Villalobos.