By DEAN TRAVINSKI - WFAA - June 14, 2010
The nation's largest doctors' group says one in five medical claims is processed inaccurately by commercial health insurers, often leaving physicians shortchanged.
The American Medical Association released its third annual report card on insurers Monday. Medicare performed well in how quickly and accurately it paid doctors.
Commercial insurers such as Aetna Inc. and Anthem Blue Cross matched their payments to what they agreed to pay doctors about 80 percent of the time.
The group's report card is an effort to reduce the cost of claims processing for doctors.
The AMA is meeting in Chicago in its first annual meeting since the passage of President Barack WFAA
Showing posts with label Medicare. Show all posts
Showing posts with label Medicare. Show all posts
Tuesday, June 15, 2010
Wednesday, July 16, 2008
Medicare Advantage: Congress rightly overrides President Bush's veto of a bill that levels the playing field between health-care providers
By Washington Post - Wed., July 16, 2008
WHY DID President Bush veto the Medicare bill, only to be swiftly overridden by both houses of Congress? It's not because he disagrees with the fundamental purpose, to reverse a 10.6 percent cut in Medicare payments to doctors. The administration's main beef is paying the cost, $13.8 billion over five years, by reducing projected payments to Medicare Advantage plans. These are the private plans -- HMOs or preferred-provider networks -- set up to compete with traditional fee-for-service Medicare, in which seniors go to doctors of their choice who accept Medicare reimbursements.
Medicare Advantage plans, which currently enroll about 20 percent of Medicare beneficiaries, could be a cost-effective alternative to traditional Medicare. The problem is that these plans now enjoy an undue advantage: They are paid, on average, 13 percent more per beneficiary than traditional Medicare costs. Numerous experts have recommended leveling the playing field between private plans and traditional Medicare. The legislation takes a few small, sensible steps in that direction.
How small? The savings from Medicare Advantage plans would amount to less than 2 percent of the money the government is projected to spend on them in the next five years. The Congressional Budget Office projects that enrollment in Medicare Advantage plans would still grow by 25 percent over that period. The changes would eliminate double payments for educational activities (since the plans don't engage in these) and impose new requirements on so-called private fee-for-service plans, which operate much like traditional Medicare but end up costing more.
The president said he vetoed the bill because "taking choices away from seniors to pay physicians is wrong." But no choices are taken away. The changes in the costly private fee-for-service plans, for instance, apply only in areas where at least two other Medicare Advantage plans are operating. Enrollment in these plans is projected to grow 39 percent by 2013 under the new rules. The CBO estimates only that the slightly more level playing field would result in about 2 million fewer seniors choosing the private plans than would have otherwise. It's telling that not even lawmakers of his own party were cowed by the president's effort to scare seniors.
Read more in the Washington Post
WHY DID President Bush veto the Medicare bill, only to be swiftly overridden by both houses of Congress? It's not because he disagrees with the fundamental purpose, to reverse a 10.6 percent cut in Medicare payments to doctors. The administration's main beef is paying the cost, $13.8 billion over five years, by reducing projected payments to Medicare Advantage plans. These are the private plans -- HMOs or preferred-provider networks -- set up to compete with traditional fee-for-service Medicare, in which seniors go to doctors of their choice who accept Medicare reimbursements.
Medicare Advantage plans, which currently enroll about 20 percent of Medicare beneficiaries, could be a cost-effective alternative to traditional Medicare. The problem is that these plans now enjoy an undue advantage: They are paid, on average, 13 percent more per beneficiary than traditional Medicare costs. Numerous experts have recommended leveling the playing field between private plans and traditional Medicare. The legislation takes a few small, sensible steps in that direction.
How small? The savings from Medicare Advantage plans would amount to less than 2 percent of the money the government is projected to spend on them in the next five years. The Congressional Budget Office projects that enrollment in Medicare Advantage plans would still grow by 25 percent over that period. The changes would eliminate double payments for educational activities (since the plans don't engage in these) and impose new requirements on so-called private fee-for-service plans, which operate much like traditional Medicare but end up costing more.
The president said he vetoed the bill because "taking choices away from seniors to pay physicians is wrong." But no choices are taken away. The changes in the costly private fee-for-service plans, for instance, apply only in areas where at least two other Medicare Advantage plans are operating. Enrollment in these plans is projected to grow 39 percent by 2013 under the new rules. The CBO estimates only that the slightly more level playing field would result in about 2 million fewer seniors choosing the private plans than would have otherwise. It's telling that not even lawmakers of his own party were cowed by the president's effort to scare seniors.
Read more in the Washington Post
Thursday, December 6, 2007
Medicare to Cut Payment for Two Promising Cancer Drugs
By ALEX BERENSON - The New York Times - December 6, 2007
New Medicare rules for a small but promising class of cancer drugs may cause thousands of lymphoma patients to lose access to the treatment, which in some cases is the only therapy available to them.
The companies that make the drugs, and patient advocacy groups, say the changes will sharply cut reimbursement for the medicines next year, and they predict that many hospitals will stop offering the treatments. The Medicare changes come just as new data provide additional evidence that the medicines, called Bexxar and Zevalin, are effective.
The drugs are given to treat non-Hodgkins lymphoma, the fifth-most common cancer, and are usually prescribed for patients who have not responded to other therapies and who have few remaining treatment options. Clinical trial data show that they put the disease into remission for years in many of those patients.
Under the new rules, after Jan. 1, Medicare will reimburse hospitals about $16,000 for each treatment with the drugs, which a patient needs to receive only once. GlaxoSmithKline, which markets Bexxar, say it is priced at almost $30,000 per treatment, and Biogen Idec, which sells Zevalin, says it costs nearly as much. While high, such prices are not unusual for new cancer therapies, which can cost $50,000 or more for a year of treatment.
Senior Medicare officials say they are not trying to prevent hospitals from giving Bexxar and Zevalin. The $16,000 figure is a fair price and is based on the actual prices hospitals have paid for the medicines this year, they say.
Zevalin was introduced in 2002, and Bexxar in 2003. Until now, Medicare has reimbursed each hospital claim individually, without setting a single nationwide price for the drug. The practice has resulted in wildly varying reimbursement, Medicare says.
But the companies say Medicare’s data must be inaccurate and that no hospital will offer the drugs to Medicare patients if it is losing $10,000 or more per treatment. Hospitals typically do not disclose their reimbursement rates, or whether they make money on any given treatment.
Under federal rules, hospitals that do not offer a drug to Medicare patients are barred from offering it to other patients, even if their insurers fully cover the cost of treatment. Because Bexxar and Zevalin contain radioactive material, the drugs must be administered by specially licensed technicians and doctors. They are usually given in hospitals..
Sarah Alspach, a spokeswoman for Glaxo, said the company had voluntarily submitted its pricing data to Medicare to prove that that the hospital claims data is wrong. “Our feeling is there is a flaw in the methodology,” Ms. Alspach said.
Doctors, lymphoma patients, and advocacy groups say they do not understand Medicare’s decision. About 60,000 people are diagnosed with non-Hodgkins lymphoma every year, and 20,000 people die of the disease.
“The explanation that they’re giving is really flawed,” said Dr. Mark Kaminski, the co-director of leukemia and lymphoma transplant program at the University of Michigan. Dr. Kaminski helped discover Bexxar two decades ago and receives a small royalty when the drug is used.
Bexxar and Zevalin are part of a new class of drugs called radioimmunotherapies. They combine a radioactive particle with a biologically engineered molecule that attaches to cancerous white blood cells.
In clinical trials, they have proven as good as or better than standard treatments for non-Hodgkins lymphoma, a cancer of the immune system. In a trial of 414 patients scheduled to be discussed next Monday at a hematology conference, the combination of Zevalin and chemotherapy put lymphoma into remission for three years on average, compared with one year for chemotherapy alone.
Marion Swan, a spokeswoman for the Lymphoma Research Foundation, says the drugs are the only option for some patients. “Our number one concern is that patients have access to all viable treatment options,” she said, “and it looks like this might be denying access.”
The drugs have already faced hurdles because they can require private cancer doctors to transfer their patients to hospitals for the treatments, and the private doctors may view the hospitals as competitors. That problem, and doctors’ general unfamiliarity with the drugs, has left them as niche products used in fewer than 10 percent of patients who are candidates for them.
Advocates for the drugs had hoped that new clinical trial evidence, like the Zevalin data that will be presented next week, would convince more doctors to prescribe them. Now they worry that Medicare’s decision will end most use of the drugs and chill the development of other radioimmunotherapies.
“If you can’t get two products that basically hit home runs into the marketplace, there’s very little incentive for further development,” Dr. Kaminski said.
Herb B. Kuhn, deputy administrator of the Centers for Medicare and Medicaid Services, the agency overseeing Medicare, said that the agency recognized the value of the drugs. But Medicare does not want to overpay for the medicines and believes that hospital data is the most accurate way to set reimbursement, he said.
But most other drugs administered via injection in doctors’ offices or hospital outpatient clinics — as Bexxar and Zevalin are — are not reimbursed on the basis of what hospitals say they have paid. Instead, companies report the average price of their drugs to Medicare. Medicare then reimburses doctors and hospitals at that price, plus a 6 percent fee to cover handling costs.
GlaxoSmithKline said it had asked Medicare to switch to that system for Bexxar. So far, Medicare has refused.
Meanwhile, lymphoma patients are anxiously watching the fight between Medicare and the companies.
Lora Beckwith, 66, was first diagnosed with the disease in 2004. So far, her illness has progressed slowly, but last month, she was told that she would probably need treatment by February.
Because Ms. Beckwith, who lives in Ann Arbor, Mich., has Parkinson’s disease, she cannot receive standard chemotherapy for the disease, making Bexxar and Zevalin among her only alternatives. Now she fears she may not be able to get them.
“I’m not usually a vengeful or resentful person,” she said. “But I am feeling a bit resentful about having this taken away — if I can’t have access to a drug that would extend my life.”
Read more
New Medicare rules for a small but promising class of cancer drugs may cause thousands of lymphoma patients to lose access to the treatment, which in some cases is the only therapy available to them.
The companies that make the drugs, and patient advocacy groups, say the changes will sharply cut reimbursement for the medicines next year, and they predict that many hospitals will stop offering the treatments. The Medicare changes come just as new data provide additional evidence that the medicines, called Bexxar and Zevalin, are effective.
The drugs are given to treat non-Hodgkins lymphoma, the fifth-most common cancer, and are usually prescribed for patients who have not responded to other therapies and who have few remaining treatment options. Clinical trial data show that they put the disease into remission for years in many of those patients.
Under the new rules, after Jan. 1, Medicare will reimburse hospitals about $16,000 for each treatment with the drugs, which a patient needs to receive only once. GlaxoSmithKline, which markets Bexxar, say it is priced at almost $30,000 per treatment, and Biogen Idec, which sells Zevalin, says it costs nearly as much. While high, such prices are not unusual for new cancer therapies, which can cost $50,000 or more for a year of treatment.
Senior Medicare officials say they are not trying to prevent hospitals from giving Bexxar and Zevalin. The $16,000 figure is a fair price and is based on the actual prices hospitals have paid for the medicines this year, they say.
Zevalin was introduced in 2002, and Bexxar in 2003. Until now, Medicare has reimbursed each hospital claim individually, without setting a single nationwide price for the drug. The practice has resulted in wildly varying reimbursement, Medicare says.
But the companies say Medicare’s data must be inaccurate and that no hospital will offer the drugs to Medicare patients if it is losing $10,000 or more per treatment. Hospitals typically do not disclose their reimbursement rates, or whether they make money on any given treatment.
Under federal rules, hospitals that do not offer a drug to Medicare patients are barred from offering it to other patients, even if their insurers fully cover the cost of treatment. Because Bexxar and Zevalin contain radioactive material, the drugs must be administered by specially licensed technicians and doctors. They are usually given in hospitals..
Sarah Alspach, a spokeswoman for Glaxo, said the company had voluntarily submitted its pricing data to Medicare to prove that that the hospital claims data is wrong. “Our feeling is there is a flaw in the methodology,” Ms. Alspach said.
Doctors, lymphoma patients, and advocacy groups say they do not understand Medicare’s decision. About 60,000 people are diagnosed with non-Hodgkins lymphoma every year, and 20,000 people die of the disease.
“The explanation that they’re giving is really flawed,” said Dr. Mark Kaminski, the co-director of leukemia and lymphoma transplant program at the University of Michigan. Dr. Kaminski helped discover Bexxar two decades ago and receives a small royalty when the drug is used.
Bexxar and Zevalin are part of a new class of drugs called radioimmunotherapies. They combine a radioactive particle with a biologically engineered molecule that attaches to cancerous white blood cells.
In clinical trials, they have proven as good as or better than standard treatments for non-Hodgkins lymphoma, a cancer of the immune system. In a trial of 414 patients scheduled to be discussed next Monday at a hematology conference, the combination of Zevalin and chemotherapy put lymphoma into remission for three years on average, compared with one year for chemotherapy alone.
Marion Swan, a spokeswoman for the Lymphoma Research Foundation, says the drugs are the only option for some patients. “Our number one concern is that patients have access to all viable treatment options,” she said, “and it looks like this might be denying access.”
The drugs have already faced hurdles because they can require private cancer doctors to transfer their patients to hospitals for the treatments, and the private doctors may view the hospitals as competitors. That problem, and doctors’ general unfamiliarity with the drugs, has left them as niche products used in fewer than 10 percent of patients who are candidates for them.
Advocates for the drugs had hoped that new clinical trial evidence, like the Zevalin data that will be presented next week, would convince more doctors to prescribe them. Now they worry that Medicare’s decision will end most use of the drugs and chill the development of other radioimmunotherapies.
“If you can’t get two products that basically hit home runs into the marketplace, there’s very little incentive for further development,” Dr. Kaminski said.
Herb B. Kuhn, deputy administrator of the Centers for Medicare and Medicaid Services, the agency overseeing Medicare, said that the agency recognized the value of the drugs. But Medicare does not want to overpay for the medicines and believes that hospital data is the most accurate way to set reimbursement, he said.
But most other drugs administered via injection in doctors’ offices or hospital outpatient clinics — as Bexxar and Zevalin are — are not reimbursed on the basis of what hospitals say they have paid. Instead, companies report the average price of their drugs to Medicare. Medicare then reimburses doctors and hospitals at that price, plus a 6 percent fee to cover handling costs.
GlaxoSmithKline said it had asked Medicare to switch to that system for Bexxar. So far, Medicare has refused.
Meanwhile, lymphoma patients are anxiously watching the fight between Medicare and the companies.
Lora Beckwith, 66, was first diagnosed with the disease in 2004. So far, her illness has progressed slowly, but last month, she was told that she would probably need treatment by February.
Because Ms. Beckwith, who lives in Ann Arbor, Mich., has Parkinson’s disease, she cannot receive standard chemotherapy for the disease, making Bexxar and Zevalin among her only alternatives. Now she fears she may not be able to get them.
“I’m not usually a vengeful or resentful person,” she said. “But I am feeling a bit resentful about having this taken away — if I can’t have access to a drug that would extend my life.”
Read more
VIEWPOINT: Myths and Realities about Social Security and Privatization
By National Committee to Preserve Social Security and Medicare - Read More
Monday, November 5, 2007
Changes ahead for Medicare drug program
By KEVIN FREKING, Associated Press Writer - Sat Nov 3, 2007
WASHINGTON - Nearly 2 million low-income Medicare participants could be switched to different insurance plans for their prescription drug coverage next year.
Millions more will have to shop around if they want to avoid double-digit increases in their monthly premiums.
The reassignment of the poorest beneficiaries and the higher premiums for many others are just two reasons why seniors and the disabled may want to look into other plans as the Medicare drug benefit enters its third year.
The shopping season officially begins Nov. 15 — the first day of an open enrollment period that continues through Dec. 31.
Advocacy groups warn the benefit's 24.5 million participants to take nothing for granted even if they're happy with their current coverage.
"Everybody needs to shop around every year," said Patricia Nemore, senior policy attorney at the Center for Medicare Advocacy. "Just because you like your plan this year doesn't mean that plan will work the same next year."
Under the drug benefit, Medicare subsidizes insurance plans that cover an enrollee's prescription drug buys. The government pays insurers extra for covering the very poor.
The plans adjust their coverage to reflect the changing marketplace. They change which drugs they will cover for safety and financial reasons. They also make adjustments to the monthly premiums they charge customers, trying to maximize demand for their product and profitability.
On average, Medicare Part D plans will charge a monthly premium of $28 in 2008, but the premiums vary widely across the nearly 1,800 plans around the country. The premiums range from $9.80 for a basic benefit to $107.50 for enhanced coverage.
About a quarter of the poorest beneficiaries don't pay any monthly premium. They will still be entitled to that extra benefit next year, but they will have to get their coverage though other plans meeting Medicare's requirements for offering coverage to low-income beneficiaries. Medicare officials sent letters this past week to nearly 2 million people to inform them that they will be moved to a new plan.
Kerry Weems, administrator for the Centers for Medicare and Medicaid Services, said those beneficiaries can opt to stay with their current coverage if they like, but would have to start paying. He anticipates that the government will make changes to the drug benefit in future years to reduce the number of people "pingponging" from insurer to insurer with each new year of coverage.
"It's not good for them," Weems said. "There's some things we could have done this year to avoid that, but it would have meant changing the business rules after companies had bid. That didn't seem like the right thing to do."
Most of the low-income beneficiaries being reassigned participate in plans offered through UnitedHealthcare and Humana, according to an analysis from Avalere Health, a consulting firm based in Washington. Two companies, Silverscript and Medco, should pick up many of the reassignments.
The poorest participants can switch their drug plans at any time, so if they get a reassignment notice from the government, they should make sure their new plan covers all their medicine, Nemore said. They can do that by consulting 1-800-Medicare, or by contacting the State Health Insurance Assistance Program, which has counselors in every state.
But it's not only the poor facing major changes, officials note. Enrollment in the drug benefit is highly concentrated, and some of the most popular plans will charge considerably higher monthly premiums next year.
For example, the most popular plan, the AARP Medicare RX Preferred Plan, will increase its monthly premium by 16 percent. Humana Inc. will increase the premium for its standard plan by 71 percent. And the AARP Medicare RX Save Plan will jump 65 percent, according to Avalere Health.
Silverscript, the ninth largest plan, lowered its monthly premium by 24 percent.
Weems said he had not seen Avalere's analysis, but he pointed out that beneficiaries have a wide array of choices and more than 90 percent of participants can move into a plan with a lower premium than they are currently paying. They just need to shop around, Weems said.
The open enrollment season lasts until Dec. 31, but officials warn beneficiaries that it's safer to make a decision sooner rather than later, if they want to be sure their new coverage is in effect when they pick up their first prescriptions in January.
While the drug benefit affects people differently depending upon their incomes, their health and where they live, the standard benefit looks like this: Participants pay the first $275 in drug costs. Then, the plan pays 75 percent of the tab until total drug costs reach $2,510. That's when beneficiaries hit the so-called doughnut hole, where they pick up all cost until they've paid $4,050 out of pocket. After that point, they only have to pay 5 percent of the tab for their medicine.
About a quarter of the plans offering the drug benefit do cover generic drugs when customers hit the doughnut hole.
___
WASHINGTON - Nearly 2 million low-income Medicare participants could be switched to different insurance plans for their prescription drug coverage next year.
Millions more will have to shop around if they want to avoid double-digit increases in their monthly premiums.
The reassignment of the poorest beneficiaries and the higher premiums for many others are just two reasons why seniors and the disabled may want to look into other plans as the Medicare drug benefit enters its third year.
The shopping season officially begins Nov. 15 — the first day of an open enrollment period that continues through Dec. 31.
Advocacy groups warn the benefit's 24.5 million participants to take nothing for granted even if they're happy with their current coverage.
"Everybody needs to shop around every year," said Patricia Nemore, senior policy attorney at the Center for Medicare Advocacy. "Just because you like your plan this year doesn't mean that plan will work the same next year."
Under the drug benefit, Medicare subsidizes insurance plans that cover an enrollee's prescription drug buys. The government pays insurers extra for covering the very poor.
The plans adjust their coverage to reflect the changing marketplace. They change which drugs they will cover for safety and financial reasons. They also make adjustments to the monthly premiums they charge customers, trying to maximize demand for their product and profitability.
On average, Medicare Part D plans will charge a monthly premium of $28 in 2008, but the premiums vary widely across the nearly 1,800 plans around the country. The premiums range from $9.80 for a basic benefit to $107.50 for enhanced coverage.
About a quarter of the poorest beneficiaries don't pay any monthly premium. They will still be entitled to that extra benefit next year, but they will have to get their coverage though other plans meeting Medicare's requirements for offering coverage to low-income beneficiaries. Medicare officials sent letters this past week to nearly 2 million people to inform them that they will be moved to a new plan.
Kerry Weems, administrator for the Centers for Medicare and Medicaid Services, said those beneficiaries can opt to stay with their current coverage if they like, but would have to start paying. He anticipates that the government will make changes to the drug benefit in future years to reduce the number of people "pingponging" from insurer to insurer with each new year of coverage.
"It's not good for them," Weems said. "There's some things we could have done this year to avoid that, but it would have meant changing the business rules after companies had bid. That didn't seem like the right thing to do."
Most of the low-income beneficiaries being reassigned participate in plans offered through UnitedHealthcare and Humana, according to an analysis from Avalere Health, a consulting firm based in Washington. Two companies, Silverscript and Medco, should pick up many of the reassignments.
The poorest participants can switch their drug plans at any time, so if they get a reassignment notice from the government, they should make sure their new plan covers all their medicine, Nemore said. They can do that by consulting 1-800-Medicare, or by contacting the State Health Insurance Assistance Program, which has counselors in every state.
But it's not only the poor facing major changes, officials note. Enrollment in the drug benefit is highly concentrated, and some of the most popular plans will charge considerably higher monthly premiums next year.
For example, the most popular plan, the AARP Medicare RX Preferred Plan, will increase its monthly premium by 16 percent. Humana Inc. will increase the premium for its standard plan by 71 percent. And the AARP Medicare RX Save Plan will jump 65 percent, according to Avalere Health.
Silverscript, the ninth largest plan, lowered its monthly premium by 24 percent.
Weems said he had not seen Avalere's analysis, but he pointed out that beneficiaries have a wide array of choices and more than 90 percent of participants can move into a plan with a lower premium than they are currently paying. They just need to shop around, Weems said.
The open enrollment season lasts until Dec. 31, but officials warn beneficiaries that it's safer to make a decision sooner rather than later, if they want to be sure their new coverage is in effect when they pick up their first prescriptions in January.
While the drug benefit affects people differently depending upon their incomes, their health and where they live, the standard benefit looks like this: Participants pay the first $275 in drug costs. Then, the plan pays 75 percent of the tab until total drug costs reach $2,510. That's when beneficiaries hit the so-called doughnut hole, where they pick up all cost until they've paid $4,050 out of pocket. After that point, they only have to pay 5 percent of the tab for their medicine.
About a quarter of the plans offering the drug benefit do cover generic drugs when customers hit the doughnut hole.
___
Saturday, August 25, 2007
Medicare's missing $34 million
Star-Telegram - Thu, Aug. 16, 2007
Imagine if $34 million slipped through your fingers. For Medicare officials, no imagination is required. Medicare Advantage patients should have received that amount of additional benefits or reduced premiums from companies administering the alternative Medicare program, the federal Centers for Medicare & Medicaid Services determined after reviewing 2003 audits of the companies. But in May, the federal agency gave up trying to recover the money, saying it lacked the legal authority. A recent government audit says the agency does have the authority, but it needs to say so when writing contracts with the companies. Read full Government Accounting Office report.
Imagine if $34 million slipped through your fingers. For Medicare officials, no imagination is required. Medicare Advantage patients should have received that amount of additional benefits or reduced premiums from companies administering the alternative Medicare program, the federal Centers for Medicare & Medicaid Services determined after reviewing 2003 audits of the companies. But in May, the federal agency gave up trying to recover the money, saying it lacked the legal authority. A recent government audit says the agency does have the authority, but it needs to say so when writing contracts with the companies. Read full Government Accounting Office report.
Friday, August 10, 2007
Think Tank Officials Respond To Samuelson Opinion Piece In Washington Post
Friday, Aug. 10, 2007
The Washington Post on Wednesday published responses from three think tank officials to a recent opinion piece by Post columnist Robert Samuelson. In his piece last week, Samuelson wrote that the "major presidential candidates -- Republican and Democratic -- are dodging one of the thorniest problems they would face if elected: the huge budget costs of aging baby boomers" for Medicare, Medicaid and Social Security, and "Washington's vaunted think tanks -- citadels for public intellectuals both liberal and conservative" -- also have "tiptoed around the problem."
He proposed that "some public-spirited sugar daddy ... sponsor a short book" that would invite six think tanks, three liberal and three conservative, to discuss the issue. Such a book "would force think tanks to compete," he wrote, adding, "They'd have to make their vision of the future explicit within the untidy framework of government's past commitments. It would illuminate the connections between defense spending, retirement benefits, health care, economic growth and much more" (Kaiser Daily Health Policy Report, 8/1). Summaries of responses appear below.
Robert Bixby, Concord Coalition: "Think tanks are not political parties," Bixby, executive director of the Concord Coalition, writes, adding, "They are a collection of scholars who do not necessarily agree on specifics. Thus the absence of a competition among them on specific plans does not, as Samuelson implies, indicate venal motives." Bixby concludes, "The problem is not timid think tanks. It is timid politicians" (Bixby, Washington Post, 8/8).
Stuart Butler, Heritage Foundation: "Another book-length compendium of detailed plans, as Samuelson proposes, would do nothing to resolve" U.S residents' "emotional and contradictory feelings about entitlements and intergenerational obligation," Butler, vice president for domestic and economic policy studies at the Heritage Foundation, writes. He concludes, "That's why leading think tanks are focused on understanding and changing public perceptions about the values and risks involved in controlling entitlements, to improve the climate for political debate," adding, "That's why {The Brookings Institution] and Heritage have joined others in talking directly to real Americans and why we are working to structure public dialogues to explore ways to craft serious reform" (Butler, Washington Post, 8/8).
Maya MacGuineas, New America Foundation: "Samuelson suggests that think tanks aren't proposing specific solutions to the demographic and budgetary crises facing the country. As the recipient of more than my fair share of angry e-mails from people who haven't appreciated some of the specifics our think tank has recommended, I would respectfully disagree," MacGuineas, fiscal policy program director at the New America Foundation, writes. She continues, "Samuelson is right, of course, that one of the important roles of a think tank is to provide bold policy solutions to help move the political discussion forward. That is what the New America Foundation has been doing for years" (MacGuineas, Washington Post, 8/8).
Additional responses from think tank officials are available online as a part of the Post's regular Think Tank Town, which features such organizations debating public policy.
Reprinted with permission Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at The Kaiser Daily Health Policy Report, a free service of The Henry J. Kaiser Family Foundation. © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
The Washington Post on Wednesday published responses from three think tank officials to a recent opinion piece by Post columnist Robert Samuelson. In his piece last week, Samuelson wrote that the "major presidential candidates -- Republican and Democratic -- are dodging one of the thorniest problems they would face if elected: the huge budget costs of aging baby boomers" for Medicare, Medicaid and Social Security, and "Washington's vaunted think tanks -- citadels for public intellectuals both liberal and conservative" -- also have "tiptoed around the problem."
He proposed that "some public-spirited sugar daddy ... sponsor a short book" that would invite six think tanks, three liberal and three conservative, to discuss the issue. Such a book "would force think tanks to compete," he wrote, adding, "They'd have to make their vision of the future explicit within the untidy framework of government's past commitments. It would illuminate the connections between defense spending, retirement benefits, health care, economic growth and much more" (Kaiser Daily Health Policy Report, 8/1). Summaries of responses appear below.
Robert Bixby, Concord Coalition: "Think tanks are not political parties," Bixby, executive director of the Concord Coalition, writes, adding, "They are a collection of scholars who do not necessarily agree on specifics. Thus the absence of a competition among them on specific plans does not, as Samuelson implies, indicate venal motives." Bixby concludes, "The problem is not timid think tanks. It is timid politicians" (Bixby, Washington Post, 8/8).
Stuart Butler, Heritage Foundation: "Another book-length compendium of detailed plans, as Samuelson proposes, would do nothing to resolve" U.S residents' "emotional and contradictory feelings about entitlements and intergenerational obligation," Butler, vice president for domestic and economic policy studies at the Heritage Foundation, writes. He concludes, "That's why leading think tanks are focused on understanding and changing public perceptions about the values and risks involved in controlling entitlements, to improve the climate for political debate," adding, "That's why {The Brookings Institution] and Heritage have joined others in talking directly to real Americans and why we are working to structure public dialogues to explore ways to craft serious reform" (Butler, Washington Post, 8/8).
Maya MacGuineas, New America Foundation: "Samuelson suggests that think tanks aren't proposing specific solutions to the demographic and budgetary crises facing the country. As the recipient of more than my fair share of angry e-mails from people who haven't appreciated some of the specifics our think tank has recommended, I would respectfully disagree," MacGuineas, fiscal policy program director at the New America Foundation, writes. She continues, "Samuelson is right, of course, that one of the important roles of a think tank is to provide bold policy solutions to help move the political discussion forward. That is what the New America Foundation has been doing for years" (MacGuineas, Washington Post, 8/8).
Additional responses from think tank officials are available online as a part of the Post's regular Think Tank Town, which features such organizations debating public policy.
Reprinted with permission Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at The Kaiser Daily Health Policy Report, a free service of The Henry J. Kaiser Family Foundation. © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Saturday, July 28, 2007
Children's Health Care Bill Loaded with Extras
by Julie Rovner - NPR Morning Edition, July 27, 2007
On Capitol Hill, two House committees have begun work on their version of a bill to renew and expand the State Children's Health Insurance Program.
Last week, a Senate committee overwhelmingly approved a bipartisan bill to continue the popular SCHIP program. But in the House, the parties are far more polarized.
Republicans and Democrats on two panels — Energy and Commerce and Ways and Means — said they want to renew the SCHIP program, which otherwise is set to expire at the end of September. But that was about all they agreed on at simultaneous meetings that stretched late into the night on Thursday.
Republicans like former House Speaker Dennis Hastert of Illinois said the bill written by House Democrats expands the children's health program so much that it will substitute government for private coverage.
"Now we're sending messages to families across the country: Drop your private health insurance plans, the American taxpayer will foot the bill," Hastert said.
Democrats like Rep. Henry Waxman of California, however, said the Republican substitute proposal doesn't go nearly far enough.
"With the amount of money they're proposing, they won't even be able to keep pace with current enrollees," Waxman said. "They'd have to drop kids out of the program, let alone cover more of the children that need it."
But differences over how much to expand the children's insurance program are only the start of the dispute — although the expansion alone is enough to have drawn a veto threat from the Bush administration.
What angered Republicans even more is how the bill proposes to pay for the additional $50 billion that would go to the SCHIP program over the next five years. In particular, they object to cuts in spending for private HMOs and other health plans that serve Medicare patients.
Rep. John Shadegg, an Arizona Republican, said that makes no sense.
"So we're going to take money away from our seniors to give it to children in families where those families already earn $82,600 a year?" he asked.
That's not exactly how it would work. That $82,000 represents four times the poverty level for a family of four. Only a few families who earn that much could qualify.
And the money being taken from the private Medicare plans is what budget analysts agree are overpayments. The cuts would simply pay the plans what the average Medicare patient costs.
But the disputes underscore what has become an unfortunate fact that seems to hold true no matter which party controls Congress, says Patrick Morrissey, a health care lawyer and lobbyist and former congressional staffer.
"Unfortunately, nothing is simple in health care these days," he says.
Part of the difficulty is how the Democrats are trying to pay for their health care expansion — using not only the controversial Medicare changes, but an even more controversial 45-cents-per-pack increase in the cigarette tax.
Morrissey says that over the past several years, Congress has also created its own problem in health care, by making Medicare payment policies that last for just a few years at a time:
"So you have this amazing amount of pressure, funneling in to one or two health care bills a year, which means that any one bill, even if it should be noncontroversial, ends up becoming bigger and bigger and bigger," he says. "You literally have dozens and dozens or hundreds of groups lining up saying 'we would like more money, because our payment policy expires at the end of the year.'"
This year, the big money problem is a 10-percent cut in Medicare payments to doctors starting next January. The House bill cancels that cut.
But it comes at a cost — a big one. Eliminating the cut for just two years adds more than $100 billion to Medicare spending over the next decade.
That's considerably more than the entire expansion of the children's health insurance program. And lawmakers had to find the money by trimming payments for other health care providers, who aren't very happy about it.
Still, House Democratic leaders hope to have the bill on the floor next week, their last before the summer break. The Senate bill is expected to come up for a vote next week, as well.
Read more on NPR
On Capitol Hill, two House committees have begun work on their version of a bill to renew and expand the State Children's Health Insurance Program.
Last week, a Senate committee overwhelmingly approved a bipartisan bill to continue the popular SCHIP program. But in the House, the parties are far more polarized.
Republicans and Democrats on two panels — Energy and Commerce and Ways and Means — said they want to renew the SCHIP program, which otherwise is set to expire at the end of September. But that was about all they agreed on at simultaneous meetings that stretched late into the night on Thursday.
Republicans like former House Speaker Dennis Hastert of Illinois said the bill written by House Democrats expands the children's health program so much that it will substitute government for private coverage.
"Now we're sending messages to families across the country: Drop your private health insurance plans, the American taxpayer will foot the bill," Hastert said.
Democrats like Rep. Henry Waxman of California, however, said the Republican substitute proposal doesn't go nearly far enough.
"With the amount of money they're proposing, they won't even be able to keep pace with current enrollees," Waxman said. "They'd have to drop kids out of the program, let alone cover more of the children that need it."
But differences over how much to expand the children's insurance program are only the start of the dispute — although the expansion alone is enough to have drawn a veto threat from the Bush administration.
What angered Republicans even more is how the bill proposes to pay for the additional $50 billion that would go to the SCHIP program over the next five years. In particular, they object to cuts in spending for private HMOs and other health plans that serve Medicare patients.
Rep. John Shadegg, an Arizona Republican, said that makes no sense.
"So we're going to take money away from our seniors to give it to children in families where those families already earn $82,600 a year?" he asked.
That's not exactly how it would work. That $82,000 represents four times the poverty level for a family of four. Only a few families who earn that much could qualify.
And the money being taken from the private Medicare plans is what budget analysts agree are overpayments. The cuts would simply pay the plans what the average Medicare patient costs.
But the disputes underscore what has become an unfortunate fact that seems to hold true no matter which party controls Congress, says Patrick Morrissey, a health care lawyer and lobbyist and former congressional staffer.
"Unfortunately, nothing is simple in health care these days," he says.
Part of the difficulty is how the Democrats are trying to pay for their health care expansion — using not only the controversial Medicare changes, but an even more controversial 45-cents-per-pack increase in the cigarette tax.
Morrissey says that over the past several years, Congress has also created its own problem in health care, by making Medicare payment policies that last for just a few years at a time:
"So you have this amazing amount of pressure, funneling in to one or two health care bills a year, which means that any one bill, even if it should be noncontroversial, ends up becoming bigger and bigger and bigger," he says. "You literally have dozens and dozens or hundreds of groups lining up saying 'we would like more money, because our payment policy expires at the end of the year.'"
This year, the big money problem is a 10-percent cut in Medicare payments to doctors starting next January. The House bill cancels that cut.
But it comes at a cost — a big one. Eliminating the cut for just two years adds more than $100 billion to Medicare spending over the next decade.
That's considerably more than the entire expansion of the children's health insurance program. And lawmakers had to find the money by trimming payments for other health care providers, who aren't very happy about it.
Still, House Democratic leaders hope to have the bill on the floor next week, their last before the summer break. The Senate bill is expected to come up for a vote next week, as well.
Read more on NPR
Thursday, July 26, 2007
Medicare Disadvantage- Privatized Health Care For Seniors Can Leave Them In The Dark As Insurance Companies Reap A Windfall
CBS/AP - WEST HAVEN, Conn., July 16, 2007
CBS) It was the summer of 1965 when Medicare was created to provide government-sponsored health care for seniors. Today some $381 billion tax dollars a year are spent on Americans 65 and older.
But in recent years, more and more Americans — 8.3 million and rising — are getting Medicare through private insurance companies. Tonight, CBS News chief investigative correspondent Armen Keteyian takes a closer look at the program critics charge has turned into a disadvantage for seniors, and a windfall for the insurance industry.
It was the winter of 2003 when Congress, in the dead of night, overhauled Medicare.
"This prescription drug benefit is a good deal for all seniors," said Rep. Dennis Hastert, R-Ill.
But buried inside the bill was another deal — one that CBS News investigation has discovered was not necessarily a benefit for seniors.
A large portion of one of the most successful public programs in history was quietly placed in the hands of private insurance companies. The goal of Medicare Advantage: to provide seniors with more benefits, like vision and dental care, and control rising costs. But today, for seniors like Aaron Cohen, it's become Medicare Dis-Advantage.
"I'd rather go back to the old-fashioned Medicare," Cohen told Keteyian.
Cohen, an 86-year-old who lives in Connecticut, says he switched to an advantage plan only after a salesman assured him he would be completely covered while staying in Florida.
But after breaking his leg in that state, Cohen began to believe he had been sold a bill of goods.
"There was something radically wrong," Cohen said. "They wouldn't give me any home therapy, claiming that it wasn't covered."
But that's only part of the problem. With traditional Medicare, there's one plan for everyone, everywhere. Private Medicare Advantage offers as many as 50 different plans, causing untold confusion over coverage, premiums, co-pays, provider networks.
"These insurance benefit packages are very complicated. Almost nobody without really technical sophistication can figure out exactly what they are buying," said Robert Hayes, who runs the Medicare Rights Center.
Hayes said every year his staff fields thousands of calls from seniors scared to death they've made the wrong choice.
Not only are private plans more confusing, they are more expensive to taxpayers.
In fact, three independent reports found private insurance companies are paid, on average, 12 percent more than what it cost the federal government to run Medicare — in some cases, 50 percent more.
FYI: Find out more about private medicare and how to find help navigating the system.
The head of Medicare insists private plans give you more for your money.
"I think there is a lot more that we could do in regular Medicare that we aren't doing currently, that some of the Medicare Advantage plans are able to do because of how the payment structure works," Leslie Norwalk told Keteyian.
But how much of that money is going back into the pockets of the insurance companies?
"Well, it's required by law: 25 percent goes back to the federal treasury, 75 percent goes back to the beneficiary," Norwalk said.
So the insurance companies are doing this, what, out of the kindness of their hearts, asked Keteyian?
"There, there would be, I'm sure, some small amount to administer the additional benefits," Norwalk said.
But CBS News has found that's not always the case. An independent report found when it comes to the fastest-growing plans, known as private fee-for-service, half of that extra money goes back to the insurance companies. All these private Medicare plans are expected to cost taxpayers an additional $54 billion over the next five years.
"Taxpayers are losing; people in Medicare are losing," Hayes said. "And the structure of Medicare as a national treasure that we need to rely on moving forward, is being undermined."
So much so that key Congressional Democrats now want to cut payments to private plans. The insurance industry is fighting back with a direct mail campaign urging seniors to contact their representatives.
Ironically, Cohen got one of the letters. On the back, his very personal feelings about his Medicare Advantage plan.
"This plan is worthless," he wrote.
See broadcast and read more
© MMVII, CBS Interactive, Inc. All Rights Reserved.
CBS) It was the summer of 1965 when Medicare was created to provide government-sponsored health care for seniors. Today some $381 billion tax dollars a year are spent on Americans 65 and older.
But in recent years, more and more Americans — 8.3 million and rising — are getting Medicare through private insurance companies. Tonight, CBS News chief investigative correspondent Armen Keteyian takes a closer look at the program critics charge has turned into a disadvantage for seniors, and a windfall for the insurance industry.
Fast Fact
Three independent reports found private insurance companies are paid, on average, 12 percent more than what it would cost the federal government — in some cases, 50 percent more.
It was the winter of 2003 when Congress, in the dead of night, overhauled Medicare.
"This prescription drug benefit is a good deal for all seniors," said Rep. Dennis Hastert, R-Ill.
But buried inside the bill was another deal — one that CBS News investigation has discovered was not necessarily a benefit for seniors.
A large portion of one of the most successful public programs in history was quietly placed in the hands of private insurance companies. The goal of Medicare Advantage: to provide seniors with more benefits, like vision and dental care, and control rising costs. But today, for seniors like Aaron Cohen, it's become Medicare Dis-Advantage.
"I'd rather go back to the old-fashioned Medicare," Cohen told Keteyian.
Cohen, an 86-year-old who lives in Connecticut, says he switched to an advantage plan only after a salesman assured him he would be completely covered while staying in Florida.
But after breaking his leg in that state, Cohen began to believe he had been sold a bill of goods.
"There was something radically wrong," Cohen said. "They wouldn't give me any home therapy, claiming that it wasn't covered."
But that's only part of the problem. With traditional Medicare, there's one plan for everyone, everywhere. Private Medicare Advantage offers as many as 50 different plans, causing untold confusion over coverage, premiums, co-pays, provider networks.
"These insurance benefit packages are very complicated. Almost nobody without really technical sophistication can figure out exactly what they are buying," said Robert Hayes, who runs the Medicare Rights Center.
Hayes said every year his staff fields thousands of calls from seniors scared to death they've made the wrong choice.
Not only are private plans more confusing, they are more expensive to taxpayers.
In fact, three independent reports found private insurance companies are paid, on average, 12 percent more than what it cost the federal government to run Medicare — in some cases, 50 percent more.
FYI: Find out more about private medicare and how to find help navigating the system.
The head of Medicare insists private plans give you more for your money.
"I think there is a lot more that we could do in regular Medicare that we aren't doing currently, that some of the Medicare Advantage plans are able to do because of how the payment structure works," Leslie Norwalk told Keteyian.
But how much of that money is going back into the pockets of the insurance companies?
"Well, it's required by law: 25 percent goes back to the federal treasury, 75 percent goes back to the beneficiary," Norwalk said.
So the insurance companies are doing this, what, out of the kindness of their hearts, asked Keteyian?
"There, there would be, I'm sure, some small amount to administer the additional benefits," Norwalk said.
But CBS News has found that's not always the case. An independent report found when it comes to the fastest-growing plans, known as private fee-for-service, half of that extra money goes back to the insurance companies. All these private Medicare plans are expected to cost taxpayers an additional $54 billion over the next five years.
"Taxpayers are losing; people in Medicare are losing," Hayes said. "And the structure of Medicare as a national treasure that we need to rely on moving forward, is being undermined."
So much so that key Congressional Democrats now want to cut payments to private plans. The insurance industry is fighting back with a direct mail campaign urging seniors to contact their representatives.
Ironically, Cohen got one of the letters. On the back, his very personal feelings about his Medicare Advantage plan.
"This plan is worthless," he wrote.
See broadcast and read more
© MMVII, CBS Interactive, Inc. All Rights Reserved.
Saturday, June 23, 2007
Two FW hospitals among nation's deadliest for heart patients
Baylor All Saints, Huguley say they respect U.S. study, but numbers may mislead
By JASON ROBERSON - The Dallas Morning News -Friday, June 22, 2007
Fort Worth is home to two of the nation's deadliest hospitals for patients being treated for heart failure: Baylor's All Saints Medical Center and Huguley Health System, according to a report from the U.S. Department of Health and Human Services.
After reviewing data on 4,500 hospitals across the country the department's Centers for Medicare & Medicaid Services division released a list of hospitals it said are performing either better or worse than the nation's average mortality rate for patients treated for heart attacks or for heart failure. The report did not list the national averages, nor did it reveal how far off a hospital was from those averages.
All Texas hospitals performed at the national average for heart attacks while five Texas hospitals made the Health and Human Services list for heart failure.
Hendrick Medical Center in Abilene and Christus St. Michael Health System in Texarkana also performed worse than average.
Meanwhile, Houston's Memorial Hermann Healthcare System was the only Texas hospital to do better – with a lower mortality rate than the national average.
The mortality numbers were based on a year's worth of hospital admissions, from July 1, 2005, to June 30, 2006.
The Centers for Medicaid & Medicare Services says it will use the report to help motivate hospitals to improve their quality.
In fiscal year 2008, ending September 2008, poor performing hospitals must show improvement in order to receive full Medicare and Medicaid reimbursements. Health and Human Services will tighten the "pay for performance" incentive measures it has used since 2003.
Executives and spokespeople at Texas' losing hospitals spoke of their hopes to do better. No one disputed the findings.
"What's weird is that we just received an award from the Texas Medical Foundation two weeks ago for clinical excellence," Mr. Adamie said. He added that Huguley, by just two deaths, missed the bell curve separating average performing hospitals from those performing worse than the national average.
The largest Texas hospital with a higher mortality rate than average is Baylor All Saints.
"Patients should be reassured that there is oversight; people are concerned and we're working to make the necessary improvements," said Dr. Clyde Yancy, medical director of Baylor's Heart and Vascular Institute. "I respect the overall study. Obviously we have to take a look internally."
In a letter obtained by The Dallas Morning News, the Centers for Medicare & Medicaid Services gave hospitals the following disclaimer to its report:
In an interview, Dr. Yancy said that adjusting for patient risk factors (such as the number with complicated cases) might have altered the findings.
Still, the report helped identify which areas of heart care need improvement at All Saints, he said.
Since the Fort Worth hospital was on par with the nation for heart attack treatment, Dr. Yancy said he targeted heart failure care with comprehensive educational programs for nurses in February.
Heart failure is the result of any number of diseases that prevent the heart from pumping blood normally. A heart attack is a type of heart failure where too little blood reaches the heart, resulting in damage to the heart's muscle.
Baylor's All Saints Medical Center has scored high in some state quality rankings. According to recent data from the Texas Department of State Health Services, Baylor All Saints' overall in-hospital mortality rate is the fourth lowest among more than 60 Dallas and Fort Worth area hospitals.
At the Hendrick Medical Center in Abilene, which also performed below average, marketing director Karen Brittain said patients should look at a variety of quality indicators. She added that her hospital was recognized as a Blue Distinction Center of Cardiac Care by Blue Cross/Blue Shield of Texas.
"But we certainly welcome any data sources that help us get better," Ms. Brittain said.
Houston's Memorial Hermann Healthcare System, which the Department of Health and Human Services ranks as one of the nation's best, was the only Texas hospital to have a lower than average mortality rate for heart failure patients.
Dr. Shabot said officials at the hospital were not surprised by their high ranking, having come to expect accolades. "In some ways we're competing with ourselves," he said.
Dr. Shabot did not take issue with the report's assessments.
Read more
By JASON ROBERSON - The Dallas Morning News -Friday, June 22, 2007
Fort Worth is home to two of the nation's deadliest hospitals for patients being treated for heart failure: Baylor's All Saints Medical Center and Huguley Health System, according to a report from the U.S. Department of Health and Human Services.
After reviewing data on 4,500 hospitals across the country the department's Centers for Medicare & Medicaid Services division released a list of hospitals it said are performing either better or worse than the nation's average mortality rate for patients treated for heart attacks or for heart failure. The report did not list the national averages, nor did it reveal how far off a hospital was from those averages.
All Texas hospitals performed at the national average for heart attacks while five Texas hospitals made the Health and Human Services list for heart failure.
Hendrick Medical Center in Abilene and Christus St. Michael Health System in Texarkana also performed worse than average.
Meanwhile, Houston's Memorial Hermann Healthcare System was the only Texas hospital to do better – with a lower mortality rate than the national average.
The mortality numbers were based on a year's worth of hospital admissions, from July 1, 2005, to June 30, 2006.
The Centers for Medicaid & Medicare Services says it will use the report to help motivate hospitals to improve their quality.
In fiscal year 2008, ending September 2008, poor performing hospitals must show improvement in order to receive full Medicare and Medicaid reimbursements. Health and Human Services will tighten the "pay for performance" incentive measures it has used since 2003.
Executives and spokespeople at Texas' losing hospitals spoke of their hopes to do better. No one disputed the findings.
But a Huguley Health System spokesman said the numbers are somewhat misleading. After receiving news of their mortality ranking on June 11, Huguley hospital administrators pulled the files of deceased patients submitted for the study.
Of the 29 deaths occurring during the study, 10 people were already in hospice care before their heart failure, suggesting they were expected to die, while one was 100 years old and another 98 years old, said Huguley spokesman Kurt Adamie.
"What's weird is that we just received an award from the Texas Medical Foundation two weeks ago for clinical excellence," Mr. Adamie said. He added that Huguley, by just two deaths, missed the bell curve separating average performing hospitals from those performing worse than the national average.
The largest Texas hospital with a higher mortality rate than average is Baylor All Saints.
"Patients should be reassured that there is oversight; people are concerned and we're working to make the necessary improvements," said Dr. Clyde Yancy, medical director of Baylor's Heart and Vascular Institute. "I respect the overall study. Obviously we have to take a look internally."
In a letter obtained by The Dallas Morning News, the Centers for Medicare & Medicaid Services gave hospitals the following disclaimer to its report:
"It is important to note that while your hospital, your state and the national crude mortality rates are all reported here for your reference, they are not directly comparable as they have not been risk-adjusted to account for patient differences, nor have any hospital adjustments been made to account for differences in sample sizes."
In an interview, Dr. Yancy said that adjusting for patient risk factors (such as the number with complicated cases) might have altered the findings.
Still, the report helped identify which areas of heart care need improvement at All Saints, he said.
Since the Fort Worth hospital was on par with the nation for heart attack treatment, Dr. Yancy said he targeted heart failure care with comprehensive educational programs for nurses in February.
Heart failure is the result of any number of diseases that prevent the heart from pumping blood normally. A heart attack is a type of heart failure where too little blood reaches the heart, resulting in damage to the heart's muscle.
Baylor's All Saints Medical Center has scored high in some state quality rankings. According to recent data from the Texas Department of State Health Services, Baylor All Saints' overall in-hospital mortality rate is the fourth lowest among more than 60 Dallas and Fort Worth area hospitals.
At the Hendrick Medical Center in Abilene, which also performed below average, marketing director Karen Brittain said patients should look at a variety of quality indicators. She added that her hospital was recognized as a Blue Distinction Center of Cardiac Care by Blue Cross/Blue Shield of Texas.
"But we certainly welcome any data sources that help us get better," Ms. Brittain said.
Houston's Memorial Hermann Healthcare System, which the Department of Health and Human Services ranks as one of the nation's best, was the only Texas hospital to have a lower than average mortality rate for heart failure patients.
"We as a hospital system are so focused on clinical quality for our patients that we take every guideline endorsed by cardiology societies to heart and work on those every day, so that every patient with a heart attack, every patient with heart failure, gets every known beneficial therapy,"said Dr. Michael Shabot, chief quality officer.
Dr. Shabot said officials at the hospital were not surprised by their high ranking, having come to expect accolades. "In some ways we're competing with ourselves," he said.
Dr. Shabot did not take issue with the report's assessments.
Read more
Saturday, June 9, 2007
AARP Texas Vote News Alert; Hutchison, Cornyn Vote to Block Senate Decision
Giving Medicare Power to Negotiate Lower Drug Prices
AARP Texas - Wed, 18 Apr 2007
AARP Texas - Wed, 18 Apr 2007
AUSTIN, Texas, April 18 /PRNewswire/ -- Despite the support of a majority of the U.S. Senate and nearly 90 percent of surveyed Texans, Senators Kay Bailey Hutchison and John Cornyn voted to block consideration of legislation that would give Medicare the power to bargain for lower prescription drug prices -- S.3, The Medicare Fair Prescription Drug Price Act of 2007.
Similar legislation, H.R. 4, passed the U.S. House of Representatives earlier this year.
TEXAS VOTED TO BLOCK S.3 GIVING MEDICARE THE POWER TO BARGAIN FOR LOWER PRESCRIPTION DRUG PRICES John Cornyn X Kay Bailey Hutchison X
"Working Texans were poorly represented today in the U.S. Senate on this all
important issue," said AARP-Texas State Director Bob Jackson. "Score one for the pharmaceutical industry and the power of their lobby."
Jackson said the bill would have put downward pressure on Medicare drug prices. Given the overwhelming support in both Texas and the U.S. for giving Medicare the power to negotiate, he said AARP will continue working so that the will of the people will eventually be heard.
"We are particularly disappointed with Sen. Hutchison's vote as this is a reversal from her previous vote in support of negotiating drug prices. Nearly 11,000 Texans called her offices and another 1,400 sent e-mails or faxes urging her to support the bargaining for lower prescription drug prices," said Jackson.
David Sloane, AARP Director of Government Relations, added: "Pharmaceutical manufacturers have given more than $20 million in campaign contributions for the last two cycles alone. They followed that up over the last few months with misleading polling and disinformation aimed at scaring older Americans into preserving the exorbitant profits that pharmaceutical companies make on brand name drugs. Senators should know this issue is not going away. No amount of campaign money can trump the will of 90 percent of Americans."
AARP notified the 110th Congress that it was tracking roll call votes on key legislation important to its 38 million members, and reporting the outcomes of these votes back to its members. "We believe people make the right choices when they understand the issues and position taken by their elected officials. AARP intends to ensure that its members get that information," Jackson concluded.
BACKGROUND INFORMATION: Despite the outcome in the Senate today, prescription drug affordability remains a high priority for AARP and its members. Because an overwhelming majority of Americans support S.3, AARP is confident this issue will be back. The association will continue to fight to make prescription drugs more affordable for all Americans. While millions of older Americans and persons with disabilities have been helped by Medicare Part D drug plans, more should be done to put downward pressure on drug costs. AARP will continue to support legislation that would allow Americans to safely and legally import lower-priced prescription drugs from abroad, and legislation to help bring generic drugs to market sooner, including generic versions of biologic therapies. AARP is also working to pass legislation that would reduce the asset test that prevents low-income people from qualifying for extra help under the Medicare drug program.
AARP is a nonprofit, nonpartisan membership organization that helps people 50+ have independence, choice and control in ways that are beneficial and affordable to them and society as a whole.
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