California Healthline Highlights Recent News Related to Medicare
California Healthline examines recent news related to Medicare. Summaries appear below.
The Advanced Medical Technology Association, the largest medical device trade group, on Tuesday launched a campaign to revise the Medicare reimbursement formula for advanced diagnostics. AdvaMed cited a report prepared by the Lewin Group that found current Medicare reimbursements for new diagnostic tests "archaic, impractical and severely flawed," in part because they call for the program to pay the same amount or less for new tests as for old tests, although new tests might provide more benefits. According to the study, Medicare has not revised the fee schedule for diagnostic tests for inflation in 13 of the last 15 years and will not make additional revisions until after 2008.
The study also found that complicated Medicare coding and reimbursement processes provide physicians with no incentive to prescribe and use new diagnostic tests, a trend that has had an adverse effect on the health of beneficiaries (CQ HealthBeat , 7/26). The study is available online. Note: You must have Adobe Acrobat Reader to view the study.
Sixty-one senators and 127 House members sent a letter to CMS Administrator Mark McClellan that asked him to reject proposed revisions to a transfer policy related to Medicare reimbursements for acute hospital care.
Under the current Inpatient Prospective Payment System, Medicare beneficiaries in hospitals in 30 Diagnosis Related Groups are defined as "transfers," rather than "discharges," when their length of stay in acute care facilities is more than one day less than the national average.
Medicare reimburses hospitals less for transfers than for discharges. A proposed revision recommends that CMS expand the transfer policy to about half of the more than 500 DRG groups, a move that the lawmakers said could "reduce critical Medicare payments by almost $5 billion over fiscal year 2006-2010."
The letter also said that CMS does not have the authority to expand the number of DRG groups under the transfer policy (CQ HealthBeat , 7/26).
A group of 89 senators led by Senate Finance Committee Chair Chuck Grassley (R-Iowa) and Sen. Max Baucus (D-Mont.) on Monday sent a letter to Office of Management and Budget Director Joshua Bolten that asked him to use his administrative authority to remove Medicare Part B prescription drugs from the formula used to calculate physician reimbursements.
The letter said, "One of the most serious flaws is the inclusion of Part B drugs in the sustainable growth rate formula because the rate of growth in cost of Part B drugs is beyond the control of physicians. If Part B drugs are removed from the physician payment baseline, forecasted cuts would not be as steep or as enduring." The lawmakers added that administrative revisions to the formula "will allow Congress to concentrate on a long-term solution that will stabilize physician payments in the future."
House Ways and Means Committee Chair Bill Thomas (R-Calif.) asked McClellan to take similar action in June (CQ HealthBeat , 7/26).
Republican lawmakers plan to use the five-week congressional recess scheduled to begin in August in part to promote the new Medicare prescription drug benefit. Republican lawmakers, in conjunction with outside groups, "are preparing what likely will be a months-long effort to ensure that seniors take advantage" of the new prescription drug benefit for the 2006 election cycle, according to CongressDaily.
Deborah Pryce (R-Ohio), chair of the House Republican Conference, on Thursday will coordinate a meeting with outside groups to discuss proposals to promote the Medicare prescription drug benefit. Pryce said that HRC will "lean heavily" on physicians and pharmacists to help educate beneficiaries about the Medicare prescription drug benefit and will discuss promotional efforts with business groups.
Republican lawmakers also have begun to film public service announcements on the Medicare prescription benefit to run in their local districts, and HRC has coordinated with HHS Secretary Mike Leavitt for a "post-Thanksgiving push" to encourage families to discuss the program with older relatives, CongressDaily reports (Davis, CongressDaily, 7/27).
Health plans "are flocking" to offer plans under the Medicare prescription drug benefit, a trend that has both positive and negative implications, Emily Heil writes in a CongressDaily column.
Medicare beneficiaries will have a broad range of choices under the prescription drug benefit, which could "equal more confusion for seniors already uncertain about navigating the new drug law," Heil writes (Heil, CongressDaily, 7/27).
Additional information on the Medicare drug benefit is available online.