April 04, 2013
A post by Sarah Kliff on the Washington Post’s Wonkblog site is getting a lot of attention this morning. She reported that cancer clinics across the country are turning away patients because sequester cuts.
Here’s the essence of this issue: Most pharmaceuticals are covered by the Medicare Part D program. That’s not the case with injectable drugs administered by a physician, such as those used for chemotherapy patients, which are covered under Medicare Part B.
Physicians are reimbursed for these drugs at the average sales price plus six percent – the six percent add-on is there to cover the costs of acquisition, storage and administering the medicines. For many physicians, particularly those in rural areas without the heavy patient volume to negotiate significant discounts, this reimbursement barely covers their costs, if it does at all.
So, when the sequester makes cuts in that Part B payment level, a story like Ms. Kliff’s results – that cancer centers aren’t seeing Medicare patients because the financial losses they would take on these drugs would force them out of business.
But, here’s the rub. During congressional deliberations over budget reductions, cuts in Medicare Part B drug payments were proposed….well before the sequester went into effect. Congress was, in fact, considering reducing the average sales price-plus-six percent payment level to ASP-plus-3%.
So, while the sequester cuts are hurting some patients, they are also providing an object lesson to policymakers. We can’t make Medicare or our nation’s health system better by constantly chipping away at payments for healthcare goods and services. Such cuts may help meet short-term budget targets, but the reduced access to critically-needed care is both unconscionable and counterproductive because of the increased acute care and hospitalizations that will eventually be required by sick patients.
It has been difficult for the White House and Congress to start serious negotiations on structural Medicare reform. Wouldn’t it be far better, though, to focus on health-affirming ways to make Medicare more financially sustainable and cost-effective than to continue with the kind of reimbursement nibbling that results in severely ill patients being turned away by caregivers?
January 24, 2013
Some suggest the Independent Payment Advisory Board (IPAB) is a beast without teeth. After all, President Obama has yet to nominate any individuals to serve on the 15-member board, and lower-than-norm Medicare spending increases suggest that IPAB wouldn’t be triggered to act anyway to cut Medicare costs. That’s the benign view. By contrast, the American Association of Neurological Surgeons in its Neurosurgery Blog referred to IPAB yesterday as “No Good Rotten Very Bad News for Medicare.”
On the whole, we believe the neurosurgeons’ perspective is the correct one.
Yesterday, Congressman Phil Roe (R-TN) and a bipartisan list of cosponsors introduced the “Protecting Seniors’ Access to Medicare Act,” a measure that would repeal IPAB. It’s imperative that Congress act on this legislation this year and not put the issue on a back burner in the mistaken belief that is not a real threat to Medicare beneficiaries.
As to the matter of the President not yet nominating anyone to serve as IPAB members, Margot Sanger-Katz pointed out in yesterday’s National Journal that IPAB’s power does not disappear with a lack of appointees. The board’s power doesn’t disappear, but rather shifts to the Secretary of Health and Human Services, still leaving the executive branch with unprecedented powers over Medicare spending that are traditionally (and, we believe, constitutionally) reserved for Congress.
Also, leaving IPAB in place creates a false sense of security that reforming the Medicare program is not an urgent imperative, that a failsafe mechanism is there to keep spending increases from becoming excessive. But, as I pointed out in my letter to Congressman Roe yesterday, “”the bulk of any recommended spending reductions will almost certainly come in the form of payment cuts to Medicare providers. This will affect patient access to care and innovative therapies.” Certainly, the number of health providers refusing to see new Medicare patients because of comparatively low reimbursement rates on the increase, arbitrary IPAB cuts that focus on numbers without regard to access, quality or value represent an ill-conceived solution to Medicare’s financial challenges.
IPAB may not look particularly dangerous to millions of Medicare beneficiaries at the current moment, but it inevitably will be. It needs to be defused before it can do serious damage.
August 23, 2012
For all of the criticisms of this year’s presidential campaign being overly negative and personalized, I actually believe one of the most important failures of the campaign thus far is spotlighted in the New York Times/CBS News poll published in today’s Times.
Despite (or perhaps, because of) the millions of dollars in advertising focused on the issue of Medicare, millions of Americans still don’t understand that the Medicare program as it currently exists can’t last. The campaign has failed, to this point, in educating voters that the status quo – or, as some politicians like to say, Medicare ‘as we know it’ – isn’t a viable option.
The NYT/CBS poll revealed that in three key swing states (Florida, Ohio, Wisconsin), approximately 60 percent of respondents said they preferred that Medicare should continue “as it is today.” Now, to be fair, the other option given in the poll question was a 28-word description of the Romney-Ryan premium support proposal, and we know from work with focus groups that premium support is not a concept that can be adequately explained in just a couple of sentences.
It’s clear, though, to anyone that watches the nonstop TV advertising from political campaigns both national and local that there is much more interest in demonizing opponents over the Medicare issue than there is in actually enlightening voters on the subject. Thus, it’s not surprising that majorities of voters would prefer the safe ground of the Medicare status quo when candidates aren’t emphasizing that:
• The Medicare Board of Trustees has said that the program, as it stands today, will be insolvent in a little over a decade – in 2024.
• 10,000 Americans per day are turning 65 and will receive approximately three dollars in healthcare benefits for every one dollar they paid in payroll taxes over the course of their working years
• It is a misnomer to say that any measure that doesn’t cut Medicare benefits to seniors, but that reduces payments to providers instead, protects beneficiaries. An American Medical Association survey from 2010 already warns that one of every three primary care doctors won’t take new Medicare patients because of low reimbursements.
What we need to hear more frequently on the campaign trail is that voters do have a choice, but it’s not between changing Medicare or keeping the program as it is. Rather, voters need to decide how they want political leaders to change a program that can’t be sustained in its current form.
We have approximately 75 days left in the campaign to see that realistic discussion take place. Fingers crossed.
July 31, 2012
The International AIDS Conference that took place last week in Washington, D.C. was a significant event in terms of nations and organizations renewing their commitment to combat the spread of the HIV virus, which has infected 1.2 million people in this nation alone. After the speeches are long completed, though, what really matters are the actions to connect those who have HIV/AIDS with the healthcare they need in order to live active, productive lives.
In that light, the Merck Company Foundation deserves thanks for the launch of its new HIV Care Collaborative for Underserved Populations in the United States. Starting in three cities, the new initiative shows great promise in reaching the one of every three Americans who have HIV and are not receiving essential medical care.
What’s sensible about the Merck approach is that it is building upon programs that are already active and working. The Atlanta/Fulton County Department of Health and Wellness, the Houston Department of Health and Human Services, and the Philadelphia Department of Public Health will each receive up to $1 million from the Merck Foundation over three years to support initiatives that are identifying local citizens living with HIV and helping them navigate their community healthcare systems.
As Merck Foundation president Geralyn S. Ritter put it, “Too many people living with HIV/AIDS are not getting the healthcare they need to stay healthy and contribute to healthy communities.” In fact, as Merck pointed out in announcing the initiative, 20 to 40 percent of patients are failing to establish care immediately after receiving an HIV-positive diagnosis. That’s why it’s so essential to fund the local outreach taking place in communities across the country.
Let’s hope that future AIDS conferences, thanks to this initiative and others like it, will feature reports on the improved healthcare being received by HIV/AIDS patients.
July 10, 2012
Governor Rick Perry’s announcement that Texas will not participate in the coming expansion of the Medicaid program – a decision made possible by last month’s Supreme Court decision forbidding the federal government to penalize states that opt out of Medicaid expansion – is extremely significant, but it’s probably not the most important Medicaid-related headline to come out of the Lone Star state this week.
Yesterday, the Texas Medical Association released new statistics showing a precipitous decline in the number of physicians accepting new Medicaid patients. In 2000, two out of every three doctors were seeing new patients on Medicaid. This year, that number has dropped to 31 percent.
That wasn’t the only worrisome aspect of the survey. The report also found that 58 percent of Texas physicians said they are seeing new Medicare patients. That number was 78 percent in 2000.
What these Texas figures show is that we have trend lines moving in opposite directions. The intent of the Patient Protection and Affordable Care Act (PPACA) is to put millions more Americas on the Medicaid program. And, at the same time, the retirement of the baby boom generation is moving over 7,000 citizens per day onto the Medicare rolls. While the Medicare-Medicaid population is increasing rapidly, more physicians are refusing to see patients reliant on government health programs.
This problem was predictable. As the head of the Texas Medical Association put it, “Every business has a breaking point, and physicians’ practices are no different.” With Medicare and Medicaid payment rates significantly lower than private insurance reimbursements, it’s naïve to expect physicians to accept an altered patient mix with a significantly higher proportion of patients receiving government health coverage.
This is a question the next Congress (understanding that this issue won’t be resolved in the current election climate) will need to address. With numerous governors not yet committing to Medicaid expansion and more physicians joining their Texas counterparts in not expecting new Medicaid patients, is there a better way to provide health coverage to low-income Americans?