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ASCO slams federal cuts in its annual report
Genomics and personalized medicine are transforming approaches to cancer therapy, but continuing federal budget cuts threaten to derail progress in cancer treatment, according to an annual report issued by the American Society of Clinical Oncology.
The report, "Clinical Cancer Advances 2013: Annual Report on Progress Against Cancer From the American Society of Clinical Oncology," was published online Dec. 10 in the Journal of Clinical Oncology (doi:10.1200/JCO.2013.53.7076) and represents the 9th year in a row that ASCO has documented the successes and challenges facing oncology.
"The insights described in this report, such as how cancers hide from the immune system and why cancers may become resistant to targeted drugs, enable us to envision a future in which cancer will be even more controllable and preventable," ASCO President Clifford A. Hudis said in a message accompanying the report.
In good news, overall cancer-related death rates declined 1.5% per year from 2000 to 2009. Cancer is still the second-leading cause of death, however. In 2013, there will be 1.6 million new cancer cases in the United States, and cancer will claim 580,000 American lives, according to the report’s executive summary. The incidence of cancer is declining in men, stable in women, and on the rise in African American and Hispanic children.
The report highlighted the work of The Cancer Genome Atlas (TCGA) research network, launched in 2009 by the National Institutes of Health, and its role in charting genomic changes in more than 20 different cancer types, including reporting results of comprehensive molecular analyses of kidney and endometrial cancers as well as acute myeloid leukemia. Additionally, results from the federally funded Lung Cancer Research Consortium gave rise to genomic testing that matches lung cancer patients with the most appropriate therapies.
The approvals of nine new cancer therapies – and expanded indications for six existing therapies – by the Food and Drug Administration through Oct. 2013 reflect the agency’s efforts to bring cancer drugs to market quickly, the report said.
Yet "our position as a world leader in advancing medical knowledge and our ability to attract the most promising and talented investigators are now threatened by an acute problem: Federal funding for cancer research has steadily eroded over the past decade, and only 15% of the ever-shrinking budget is actually spent on clinical trials," Dr. Hudis said in his accompanying message. "This dismal reality threatens the pace of progress against cancer and undermines our ability to address the continuing needs of our patients."
On top of continuing cuts to the NIH budget, automatic budget cuts known as sequestration went into effect in March. Those across-the-board cuts were required by the Budget Control Act of 2011, and are due to continue through 2021, unless Congress can come up with an alternative way to reduce the deficit.
The National Cancer Institute cut its budget by 6%. According to the ASCO report, "the number of new grants supported by NIH is at its lowest level since 1998, with only one in six highly ranked grant proposals currently receiving funding." At institutions that rely on NCI funding, employees are being laid off, there are delays in translational research, and clinical trials are being postponed. Based on an August survey of ASCO members, 75% who responded said that the funding crunch is curbing their ability to do research.
ASCO is petitioning for increases in the NIH and NCI budgets for 2014, for more funding for the NCI National Clinical Trials Network, and to exempt the agencies from sequestration.
The Cancer Advances report was developed by an 18-person editorial board of prominent oncologists who reviewed peer-reviewed research published in journals or presented at major scientific meetings from Oct. 2012 to Sept. 2013. A group of expert advisers provided an additional round of review within their practice specialties. The report features 76 studies, covering prevention, screening, treatment, patient and survivor care, biomarkers, tumor biology, and cancer disparities.
On Twitter @aliciaault
Genomics and personalized medicine are transforming approaches to cancer therapy, but continuing federal budget cuts threaten to derail progress in cancer treatment, according to an annual report issued by the American Society of Clinical Oncology.
The report, "Clinical Cancer Advances 2013: Annual Report on Progress Against Cancer From the American Society of Clinical Oncology," was published online Dec. 10 in the Journal of Clinical Oncology (doi:10.1200/JCO.2013.53.7076) and represents the 9th year in a row that ASCO has documented the successes and challenges facing oncology.
"The insights described in this report, such as how cancers hide from the immune system and why cancers may become resistant to targeted drugs, enable us to envision a future in which cancer will be even more controllable and preventable," ASCO President Clifford A. Hudis said in a message accompanying the report.
In good news, overall cancer-related death rates declined 1.5% per year from 2000 to 2009. Cancer is still the second-leading cause of death, however. In 2013, there will be 1.6 million new cancer cases in the United States, and cancer will claim 580,000 American lives, according to the report’s executive summary. The incidence of cancer is declining in men, stable in women, and on the rise in African American and Hispanic children.
The report highlighted the work of The Cancer Genome Atlas (TCGA) research network, launched in 2009 by the National Institutes of Health, and its role in charting genomic changes in more than 20 different cancer types, including reporting results of comprehensive molecular analyses of kidney and endometrial cancers as well as acute myeloid leukemia. Additionally, results from the federally funded Lung Cancer Research Consortium gave rise to genomic testing that matches lung cancer patients with the most appropriate therapies.
The approvals of nine new cancer therapies – and expanded indications for six existing therapies – by the Food and Drug Administration through Oct. 2013 reflect the agency’s efforts to bring cancer drugs to market quickly, the report said.
Yet "our position as a world leader in advancing medical knowledge and our ability to attract the most promising and talented investigators are now threatened by an acute problem: Federal funding for cancer research has steadily eroded over the past decade, and only 15% of the ever-shrinking budget is actually spent on clinical trials," Dr. Hudis said in his accompanying message. "This dismal reality threatens the pace of progress against cancer and undermines our ability to address the continuing needs of our patients."
On top of continuing cuts to the NIH budget, automatic budget cuts known as sequestration went into effect in March. Those across-the-board cuts were required by the Budget Control Act of 2011, and are due to continue through 2021, unless Congress can come up with an alternative way to reduce the deficit.
The National Cancer Institute cut its budget by 6%. According to the ASCO report, "the number of new grants supported by NIH is at its lowest level since 1998, with only one in six highly ranked grant proposals currently receiving funding." At institutions that rely on NCI funding, employees are being laid off, there are delays in translational research, and clinical trials are being postponed. Based on an August survey of ASCO members, 75% who responded said that the funding crunch is curbing their ability to do research.
ASCO is petitioning for increases in the NIH and NCI budgets for 2014, for more funding for the NCI National Clinical Trials Network, and to exempt the agencies from sequestration.
The Cancer Advances report was developed by an 18-person editorial board of prominent oncologists who reviewed peer-reviewed research published in journals or presented at major scientific meetings from Oct. 2012 to Sept. 2013. A group of expert advisers provided an additional round of review within their practice specialties. The report features 76 studies, covering prevention, screening, treatment, patient and survivor care, biomarkers, tumor biology, and cancer disparities.
On Twitter @aliciaault
Genomics and personalized medicine are transforming approaches to cancer therapy, but continuing federal budget cuts threaten to derail progress in cancer treatment, according to an annual report issued by the American Society of Clinical Oncology.
The report, "Clinical Cancer Advances 2013: Annual Report on Progress Against Cancer From the American Society of Clinical Oncology," was published online Dec. 10 in the Journal of Clinical Oncology (doi:10.1200/JCO.2013.53.7076) and represents the 9th year in a row that ASCO has documented the successes and challenges facing oncology.
"The insights described in this report, such as how cancers hide from the immune system and why cancers may become resistant to targeted drugs, enable us to envision a future in which cancer will be even more controllable and preventable," ASCO President Clifford A. Hudis said in a message accompanying the report.
In good news, overall cancer-related death rates declined 1.5% per year from 2000 to 2009. Cancer is still the second-leading cause of death, however. In 2013, there will be 1.6 million new cancer cases in the United States, and cancer will claim 580,000 American lives, according to the report’s executive summary. The incidence of cancer is declining in men, stable in women, and on the rise in African American and Hispanic children.
The report highlighted the work of The Cancer Genome Atlas (TCGA) research network, launched in 2009 by the National Institutes of Health, and its role in charting genomic changes in more than 20 different cancer types, including reporting results of comprehensive molecular analyses of kidney and endometrial cancers as well as acute myeloid leukemia. Additionally, results from the federally funded Lung Cancer Research Consortium gave rise to genomic testing that matches lung cancer patients with the most appropriate therapies.
The approvals of nine new cancer therapies – and expanded indications for six existing therapies – by the Food and Drug Administration through Oct. 2013 reflect the agency’s efforts to bring cancer drugs to market quickly, the report said.
Yet "our position as a world leader in advancing medical knowledge and our ability to attract the most promising and talented investigators are now threatened by an acute problem: Federal funding for cancer research has steadily eroded over the past decade, and only 15% of the ever-shrinking budget is actually spent on clinical trials," Dr. Hudis said in his accompanying message. "This dismal reality threatens the pace of progress against cancer and undermines our ability to address the continuing needs of our patients."
On top of continuing cuts to the NIH budget, automatic budget cuts known as sequestration went into effect in March. Those across-the-board cuts were required by the Budget Control Act of 2011, and are due to continue through 2021, unless Congress can come up with an alternative way to reduce the deficit.
The National Cancer Institute cut its budget by 6%. According to the ASCO report, "the number of new grants supported by NIH is at its lowest level since 1998, with only one in six highly ranked grant proposals currently receiving funding." At institutions that rely on NCI funding, employees are being laid off, there are delays in translational research, and clinical trials are being postponed. Based on an August survey of ASCO members, 75% who responded said that the funding crunch is curbing their ability to do research.
ASCO is petitioning for increases in the NIH and NCI budgets for 2014, for more funding for the NCI National Clinical Trials Network, and to exempt the agencies from sequestration.
The Cancer Advances report was developed by an 18-person editorial board of prominent oncologists who reviewed peer-reviewed research published in journals or presented at major scientific meetings from Oct. 2012 to Sept. 2013. A group of expert advisers provided an additional round of review within their practice specialties. The report features 76 studies, covering prevention, screening, treatment, patient and survivor care, biomarkers, tumor biology, and cancer disparities.
On Twitter @aliciaault
FROM THE JOURNAL OF CLINICAL ONCOLOGY
ACA enrollment grows, but still less than expected
Even with a burst of activity on the state and federal health insurance exchanges during November, numbers released Dec. 11 by the Health and Human Services department indicate that the Obama administration may not be on track to meet the goal set by the Congressional Budget Office – insuring 7 million individuals by Mar. 31, 2014, the end of the current open enrollment for health insurance under the Affordable Care Act.
But Michael Hash, director of the HHS Office of Health Reform, said in a briefing with reporters, "We’re on track." Americans still have 6 months to enroll, he noted, and the expectation is that most people will sign up towards the end of that period.
According to HHS’s mid-December enrollment report, 364,682 individuals selected a health insurance plan from a state or federal exchange in October and November. The bulk of those (227,478) used a state-based exchange, while 137,204 signed up via the federal exchange, which operates in 36 states. The biggest proportion of overall sign-ups came in November, with 258,497 selecting a plan in the state or federal exchanges.
The numbers include consumers who have paid their first health insurance premium as well as those who have not.
About 2.3 million Americans have been determined to be eligible to enroll in a marketplace plan, but only 364,000 have actually selected a plan. Of the 2.3 million, 41% (944,531) are eligible for financial assistance. That number includes people who didn’t apply for financial assistance, who applied for financial assistance and were found ineligible, or those whose applications for financial assistance are pending, according to the HHS report.
Further, just over 803,000 consumers have been determined to be eligible for coverage from Medicaid or the Children’s Health Insurance Program (CHIP).
Enrollment has increased in part because of improvements to the federal exchange website, healthcare.gov. Mr. Hash said. "Healthcare.gov is night and day from where it was on October the first," he said in comments made in advance of testimony by HHS Secretary Kathleen Sebelius at a hearing called by the House Energy and Commerce Committee’s Health Subcommittee.
Overall, 83% of completed applications were done electronically, either through healthcare.gov or a state exchange website, or online when individuals applied at a community center or some other assistance location.
Mr. Hash also said that demand for exchange plans continues to grow, citing increasing visits to the federal and state websites and calls to the call centers.
Since Oct. 1, there have been 10.6 million visits to state exchanges and 1.7 million calls to state call centers. There have been 28.4 million visits to healthcare.gov and 3.4 million calls.
On Twitter @aliciaault
Even with a burst of activity on the state and federal health insurance exchanges during November, numbers released Dec. 11 by the Health and Human Services department indicate that the Obama administration may not be on track to meet the goal set by the Congressional Budget Office – insuring 7 million individuals by Mar. 31, 2014, the end of the current open enrollment for health insurance under the Affordable Care Act.
But Michael Hash, director of the HHS Office of Health Reform, said in a briefing with reporters, "We’re on track." Americans still have 6 months to enroll, he noted, and the expectation is that most people will sign up towards the end of that period.
According to HHS’s mid-December enrollment report, 364,682 individuals selected a health insurance plan from a state or federal exchange in October and November. The bulk of those (227,478) used a state-based exchange, while 137,204 signed up via the federal exchange, which operates in 36 states. The biggest proportion of overall sign-ups came in November, with 258,497 selecting a plan in the state or federal exchanges.
The numbers include consumers who have paid their first health insurance premium as well as those who have not.
About 2.3 million Americans have been determined to be eligible to enroll in a marketplace plan, but only 364,000 have actually selected a plan. Of the 2.3 million, 41% (944,531) are eligible for financial assistance. That number includes people who didn’t apply for financial assistance, who applied for financial assistance and were found ineligible, or those whose applications for financial assistance are pending, according to the HHS report.
Further, just over 803,000 consumers have been determined to be eligible for coverage from Medicaid or the Children’s Health Insurance Program (CHIP).
Enrollment has increased in part because of improvements to the federal exchange website, healthcare.gov. Mr. Hash said. "Healthcare.gov is night and day from where it was on October the first," he said in comments made in advance of testimony by HHS Secretary Kathleen Sebelius at a hearing called by the House Energy and Commerce Committee’s Health Subcommittee.
Overall, 83% of completed applications were done electronically, either through healthcare.gov or a state exchange website, or online when individuals applied at a community center or some other assistance location.
Mr. Hash also said that demand for exchange plans continues to grow, citing increasing visits to the federal and state websites and calls to the call centers.
Since Oct. 1, there have been 10.6 million visits to state exchanges and 1.7 million calls to state call centers. There have been 28.4 million visits to healthcare.gov and 3.4 million calls.
On Twitter @aliciaault
Even with a burst of activity on the state and federal health insurance exchanges during November, numbers released Dec. 11 by the Health and Human Services department indicate that the Obama administration may not be on track to meet the goal set by the Congressional Budget Office – insuring 7 million individuals by Mar. 31, 2014, the end of the current open enrollment for health insurance under the Affordable Care Act.
But Michael Hash, director of the HHS Office of Health Reform, said in a briefing with reporters, "We’re on track." Americans still have 6 months to enroll, he noted, and the expectation is that most people will sign up towards the end of that period.
According to HHS’s mid-December enrollment report, 364,682 individuals selected a health insurance plan from a state or federal exchange in October and November. The bulk of those (227,478) used a state-based exchange, while 137,204 signed up via the federal exchange, which operates in 36 states. The biggest proportion of overall sign-ups came in November, with 258,497 selecting a plan in the state or federal exchanges.
The numbers include consumers who have paid their first health insurance premium as well as those who have not.
About 2.3 million Americans have been determined to be eligible to enroll in a marketplace plan, but only 364,000 have actually selected a plan. Of the 2.3 million, 41% (944,531) are eligible for financial assistance. That number includes people who didn’t apply for financial assistance, who applied for financial assistance and were found ineligible, or those whose applications for financial assistance are pending, according to the HHS report.
Further, just over 803,000 consumers have been determined to be eligible for coverage from Medicaid or the Children’s Health Insurance Program (CHIP).
Enrollment has increased in part because of improvements to the federal exchange website, healthcare.gov. Mr. Hash said. "Healthcare.gov is night and day from where it was on October the first," he said in comments made in advance of testimony by HHS Secretary Kathleen Sebelius at a hearing called by the House Energy and Commerce Committee’s Health Subcommittee.
Overall, 83% of completed applications were done electronically, either through healthcare.gov or a state exchange website, or online when individuals applied at a community center or some other assistance location.
Mr. Hash also said that demand for exchange plans continues to grow, citing increasing visits to the federal and state websites and calls to the call centers.
Since Oct. 1, there have been 10.6 million visits to state exchanges and 1.7 million calls to state call centers. There have been 28.4 million visits to healthcare.gov and 3.4 million calls.
On Twitter @aliciaault
States take different paths in Medicaid expansion
When the Supreme Court upheld the constitutionality of the Affordable Care Act in 2012, it also ruled that states could choose whether to substantially expand their Medicaid programs. That decision has created a split across the country, with about half of the states choosing to take federal dollars to expand their programs and the others opting out.
There’s no deadline on Medicaid expansion, so those states that have opted out so far can always choose to expand at a later date.
Here’s a look at two bellwether states: California, which has accepted federal money to expand its Medi-Cal program, and Texas, which has opted out of the expansion.
California Gov. Jerry Brown (D), a strong supporter of the ACA, announced that his state would expand Medicaid to include low-income individuals up to 138% of the federal poverty level starting on Jan. 1, 2014. All of the new enrollees – likely 1 million Californians – will be added to the state’s growing Medicaid managed care program.
Conversely, Texas Gov. Rick Perry (R) deemed Medicaid expansion "a misguided, and ultimately doomed, attempt to mask the shortcomings of Obamacare."
California: Pay cuts complicate expansion
Physicians in California are bracing for a significant Medicaid pay cut at the same time as about a million residents are set to join the program.
The pending cuts are just one part of a complex health care picture in California, where experts are far from certain about what the expansion of Medi-Cal will mean for physicians and patients.
"I think we’re going to have a real problem in California with all the new Medi-Cal patients," said Dr. Mark Dressner, who works at a federally qualified health center in Long Beach and is the president of the California Academy of Family Physicians. "Who is going to see them when there’s going to be so many other people in the system?"
The Kaiser Family Foundation estimates that between 990,000 and 1.4 million individuals, mostly single adults, will enter Medi-Cal by 2019 because of the ACA-permitted expansion. Currently, about 8.5 million residents are enrolled. Newly eligible individuals will be enrolled in the program’s managed care health plans.
These new patients could have a hard time finding a doctor. Medi-Cal is one of the lowest payers in the nation, paying between $18 and $24 for an office visit, according to the California Medical Association.
That’s about to be compounded by a pay cut approved by the state and the Centers for Medicare and Medicaid Services in 2011. Physicians tried unsuccessfully to fight the cut in court. Now the state is implementing it retroactively, which means that Medi-Cal payments could be cut 15%-20% over the next few years.
"It really undermines efforts to successfully implement the Affordable Care Act in California," said Lisa Folberg, vice president of medical and regulatory policy at the California Medical Association.
There are broad exceptions to the cut. It does not apply to most primary care services in either managed care plans or fee-for-service Medi-Cal, or to specialty services provided through managed care plans, Ms. Folberg said. And some managed care companies have announced that they will use their discretion in setting payment rates to shield their contracted physicians from the cuts.
"Unfortunately, that doesn’t help the cancer patient on Medi-Cal in Bakersfield who has fee-for-service Medi-Cal and can’t find an oncologist," Ms. Folberg said.
Dr. Darin Latimore, president of the California chapter of the American College of Physicians, said large health systems likely will be able to work around the cuts, using group visits and physician extenders. But small physician practices in rural areas aren’t equipped to make those changes, he said.
"They are not in a position to move work on to others in order to be more efficient and see more Medi-Cal patients," said Dr. Latimore, associate dean of medicine at the University of California Davis.
The result will be that physicians who work outside of the state’s safety net system will be less likely to participate in the Medi-Cal program or will strictly limit the number of patients they see. That will translate to longer waits to get an appointment and shorter visits for Medi-Cal patients.
Another concern: Patients entering Medi-Cal managed care plans might not have access to a broad network of physicians. While California has network adequacy laws, state oversight is inadequate, according to Ms. Folberg. For the most part, the plans are on an honor system.
There are some bright spots for the Medi-Cal expansion. The ACA includes an increase in Medicaid payments to physicians for 146 primary care services provided in 2013 and 2014. The provision temporarily raises payments up to Medicare rates, which for California physicians means a 136% hike on average, according to an analysis from the Kaiser Family Foundation.
But those payments were delayed, with the first checks going out to physicians in November 2013. That delay could cost the state in physician participation.
"I think the longer it takes to implement that, the less likely it is that it will affect any decisions about whether to participate more fully in the program than you would have otherwise," said Christopher Perrone, deputy director of the health reform and public programs initiative at the California HealthCare Foundation.
And the temporary nature of the pay increase adds to the problem, Mr. Perrone said. "I don’t see California sustaining that increase on its own and I haven’t heard anyone suggest that the federal government would sustain it after the 2 years."
Mr. Perrone said it’s more likely that physicians who are already committed to participating in Medi-Cal will use the money to invest in electronic health records and other telemedicine features, and hire medical assistants.
But with so many small and solo physicians shying away from Medi-Cal because of low payments, community clinics and health centers will have to pick up the slack.
"All these issues together really point to the importance of the community health centers and the role we are going to be playing in ensuring access," said Carmela Castellano-Garcia, president and CEO of the California Primary Care Association.
Federally qualified health centers are in a better position financially because they are paid an enhanced Medicaid rate and won’t be subject to the coming Medi-Cal cuts, Ms. Castellano-Garcia said. And the ACA has directed an influx of cash to these centers as well – more than $500 million in California alone to establish new sites, expand services, and support major capital improvement projects, according to the Health and Human Services department.
Texas: No expansion means doctors will keep feeling pressure
Texas has the highest number of uninsured residents in the United States – a quarter of its 26 million residents lacking coverage – but Gov. Rick Perry (R) refused to expand Medicaid, which could cover as many as 500,000 to 1 million Texans.
The governor’s decision will stay in place at least until 2015, when the state legislature reconvenes.
Some physicians in Texas are not upset by the decision – they consider Medicaid to be low-paying program and full of bureaucratic hassles.
Others – including many of the primary care organizations – disagree.
The Texas Medical Association, the Texas Academy of Family Physicians, and the Texas chapter of the American Congress of Obstetricians and Gynecologists all support the expansion of Medicaid allowed by the ACA.
In April, Gov. Perry reiterated his position. "Medicaid expansion is a misguided, and ultimately doomed, attempt to mask the shortcomings of Obamacare," he said in a statement. Instead of expansion, he favors flexibility for the state to manage its Medicaid program.
State Rep. John Zerwas (R-Simonton), an anesthesiologist, introduced H.B. 3791 that would give that flexibility, but it did not get consideration by the full House before the legislature adjourned in May.
The TMA supported Dr. Zerwas’ proposal, but also is in favor of expanding Medicaid, said Dr. Stephen L. Brotherton, TMA president. More people would have some type of insurance, but they might not necessarily have good access to care, he said.
That’s because Texas has a shortage of primary care physicians. The number of primary care physicians per capita is lower than the national average – at about 70/100,000 in 2011, compared with 80/100,000 nationally, according to the Texas Department of State Health Services, in the publication "Supply Trends Among Licensed Health Professions, Texas, 1980-2011. In rural areas, it’s even lower – about 50/100,000.
Then there’s the question of just how many physicians will take Medicaid. A 2012 TMA survey found that only 31% of doctors in the state were accepting new Medicaid patients.
Medicaid payment rates are so low that Dr. Brotherton, who practices in Ft. Worth, said that he treats Medicaid patients as charity care. "It’s much less expensive for me to do it for nothing as donated time," he said.
Dr. Moss Hampton, chairman of District XI of ACOG, added, "Medicaid doesn’t cover the cost of taking care of the patient."
For Medicaid expansion to eventually be successful, "there would have to be a better payment rate and less of a hassle factor," said Dr. Hampton, chairman of the obstetrics and gynecology department at Texas Tech Health Sciences Center at the Permian Basin in Odessa.
"It’s hard to get doctors to accept Medicaid because of the rates they pay," agreed Dr. Clare Hawkins, TAFP president, who added that Texas physicians also feel that it’s hard to comply with differing rules among various Medicaid managed care programs.
Even so, expansion will mean getting more patients into preventive care, and a reduction in emergency department visits and more expensive hospital care – costs that are being borne by all Texans, including physicians, said Dr. Hawkins, who is program director of the San Jacinto Methodist Hospital Family Medicine Residency Program in Baytown, Texas.
Although uninsured Texas residents are already receiving care – in emergency departments and at clinics – Medicaid expansion could bring a big uptick in office visits, especially to ob.gyn. practices, Dr. Hampton said. The need for those services is growing with a state law that went into effect on Oct. 29 that makes it prohibitive for most Planned Parenthood clinics and other community clinics that provide abortion services to stay open.
"What that’s done is cut out a very large group of providers, and now we’re trying to find providers to help take care of those folks," who normally use those clinics, she said.
In the absence of Medicaid expansion, Texas physicians are hoping to start receiving higher Medicaid payments that were due to start in Jan. 2013. An estimated 25,000 Texas doctors are eligible for Medicaid pay that will be on par with Medicare. But Texas has not begun to distribute that money and will not likely do so until March, according to the TMA.
When the Supreme Court upheld the constitutionality of the Affordable Care Act in 2012, it also ruled that states could choose whether to substantially expand their Medicaid programs. That decision has created a split across the country, with about half of the states choosing to take federal dollars to expand their programs and the others opting out.
There’s no deadline on Medicaid expansion, so those states that have opted out so far can always choose to expand at a later date.
Here’s a look at two bellwether states: California, which has accepted federal money to expand its Medi-Cal program, and Texas, which has opted out of the expansion.
California Gov. Jerry Brown (D), a strong supporter of the ACA, announced that his state would expand Medicaid to include low-income individuals up to 138% of the federal poverty level starting on Jan. 1, 2014. All of the new enrollees – likely 1 million Californians – will be added to the state’s growing Medicaid managed care program.
Conversely, Texas Gov. Rick Perry (R) deemed Medicaid expansion "a misguided, and ultimately doomed, attempt to mask the shortcomings of Obamacare."
California: Pay cuts complicate expansion
Physicians in California are bracing for a significant Medicaid pay cut at the same time as about a million residents are set to join the program.
The pending cuts are just one part of a complex health care picture in California, where experts are far from certain about what the expansion of Medi-Cal will mean for physicians and patients.
"I think we’re going to have a real problem in California with all the new Medi-Cal patients," said Dr. Mark Dressner, who works at a federally qualified health center in Long Beach and is the president of the California Academy of Family Physicians. "Who is going to see them when there’s going to be so many other people in the system?"
The Kaiser Family Foundation estimates that between 990,000 and 1.4 million individuals, mostly single adults, will enter Medi-Cal by 2019 because of the ACA-permitted expansion. Currently, about 8.5 million residents are enrolled. Newly eligible individuals will be enrolled in the program’s managed care health plans.
These new patients could have a hard time finding a doctor. Medi-Cal is one of the lowest payers in the nation, paying between $18 and $24 for an office visit, according to the California Medical Association.
That’s about to be compounded by a pay cut approved by the state and the Centers for Medicare and Medicaid Services in 2011. Physicians tried unsuccessfully to fight the cut in court. Now the state is implementing it retroactively, which means that Medi-Cal payments could be cut 15%-20% over the next few years.
"It really undermines efforts to successfully implement the Affordable Care Act in California," said Lisa Folberg, vice president of medical and regulatory policy at the California Medical Association.
There are broad exceptions to the cut. It does not apply to most primary care services in either managed care plans or fee-for-service Medi-Cal, or to specialty services provided through managed care plans, Ms. Folberg said. And some managed care companies have announced that they will use their discretion in setting payment rates to shield their contracted physicians from the cuts.
"Unfortunately, that doesn’t help the cancer patient on Medi-Cal in Bakersfield who has fee-for-service Medi-Cal and can’t find an oncologist," Ms. Folberg said.
Dr. Darin Latimore, president of the California chapter of the American College of Physicians, said large health systems likely will be able to work around the cuts, using group visits and physician extenders. But small physician practices in rural areas aren’t equipped to make those changes, he said.
"They are not in a position to move work on to others in order to be more efficient and see more Medi-Cal patients," said Dr. Latimore, associate dean of medicine at the University of California Davis.
The result will be that physicians who work outside of the state’s safety net system will be less likely to participate in the Medi-Cal program or will strictly limit the number of patients they see. That will translate to longer waits to get an appointment and shorter visits for Medi-Cal patients.
Another concern: Patients entering Medi-Cal managed care plans might not have access to a broad network of physicians. While California has network adequacy laws, state oversight is inadequate, according to Ms. Folberg. For the most part, the plans are on an honor system.
There are some bright spots for the Medi-Cal expansion. The ACA includes an increase in Medicaid payments to physicians for 146 primary care services provided in 2013 and 2014. The provision temporarily raises payments up to Medicare rates, which for California physicians means a 136% hike on average, according to an analysis from the Kaiser Family Foundation.
But those payments were delayed, with the first checks going out to physicians in November 2013. That delay could cost the state in physician participation.
"I think the longer it takes to implement that, the less likely it is that it will affect any decisions about whether to participate more fully in the program than you would have otherwise," said Christopher Perrone, deputy director of the health reform and public programs initiative at the California HealthCare Foundation.
And the temporary nature of the pay increase adds to the problem, Mr. Perrone said. "I don’t see California sustaining that increase on its own and I haven’t heard anyone suggest that the federal government would sustain it after the 2 years."
Mr. Perrone said it’s more likely that physicians who are already committed to participating in Medi-Cal will use the money to invest in electronic health records and other telemedicine features, and hire medical assistants.
But with so many small and solo physicians shying away from Medi-Cal because of low payments, community clinics and health centers will have to pick up the slack.
"All these issues together really point to the importance of the community health centers and the role we are going to be playing in ensuring access," said Carmela Castellano-Garcia, president and CEO of the California Primary Care Association.
Federally qualified health centers are in a better position financially because they are paid an enhanced Medicaid rate and won’t be subject to the coming Medi-Cal cuts, Ms. Castellano-Garcia said. And the ACA has directed an influx of cash to these centers as well – more than $500 million in California alone to establish new sites, expand services, and support major capital improvement projects, according to the Health and Human Services department.
Texas: No expansion means doctors will keep feeling pressure
Texas has the highest number of uninsured residents in the United States – a quarter of its 26 million residents lacking coverage – but Gov. Rick Perry (R) refused to expand Medicaid, which could cover as many as 500,000 to 1 million Texans.
The governor’s decision will stay in place at least until 2015, when the state legislature reconvenes.
Some physicians in Texas are not upset by the decision – they consider Medicaid to be low-paying program and full of bureaucratic hassles.
Others – including many of the primary care organizations – disagree.
The Texas Medical Association, the Texas Academy of Family Physicians, and the Texas chapter of the American Congress of Obstetricians and Gynecologists all support the expansion of Medicaid allowed by the ACA.
In April, Gov. Perry reiterated his position. "Medicaid expansion is a misguided, and ultimately doomed, attempt to mask the shortcomings of Obamacare," he said in a statement. Instead of expansion, he favors flexibility for the state to manage its Medicaid program.
State Rep. John Zerwas (R-Simonton), an anesthesiologist, introduced H.B. 3791 that would give that flexibility, but it did not get consideration by the full House before the legislature adjourned in May.
The TMA supported Dr. Zerwas’ proposal, but also is in favor of expanding Medicaid, said Dr. Stephen L. Brotherton, TMA president. More people would have some type of insurance, but they might not necessarily have good access to care, he said.
That’s because Texas has a shortage of primary care physicians. The number of primary care physicians per capita is lower than the national average – at about 70/100,000 in 2011, compared with 80/100,000 nationally, according to the Texas Department of State Health Services, in the publication "Supply Trends Among Licensed Health Professions, Texas, 1980-2011. In rural areas, it’s even lower – about 50/100,000.
Then there’s the question of just how many physicians will take Medicaid. A 2012 TMA survey found that only 31% of doctors in the state were accepting new Medicaid patients.
Medicaid payment rates are so low that Dr. Brotherton, who practices in Ft. Worth, said that he treats Medicaid patients as charity care. "It’s much less expensive for me to do it for nothing as donated time," he said.
Dr. Moss Hampton, chairman of District XI of ACOG, added, "Medicaid doesn’t cover the cost of taking care of the patient."
For Medicaid expansion to eventually be successful, "there would have to be a better payment rate and less of a hassle factor," said Dr. Hampton, chairman of the obstetrics and gynecology department at Texas Tech Health Sciences Center at the Permian Basin in Odessa.
"It’s hard to get doctors to accept Medicaid because of the rates they pay," agreed Dr. Clare Hawkins, TAFP president, who added that Texas physicians also feel that it’s hard to comply with differing rules among various Medicaid managed care programs.
Even so, expansion will mean getting more patients into preventive care, and a reduction in emergency department visits and more expensive hospital care – costs that are being borne by all Texans, including physicians, said Dr. Hawkins, who is program director of the San Jacinto Methodist Hospital Family Medicine Residency Program in Baytown, Texas.
Although uninsured Texas residents are already receiving care – in emergency departments and at clinics – Medicaid expansion could bring a big uptick in office visits, especially to ob.gyn. practices, Dr. Hampton said. The need for those services is growing with a state law that went into effect on Oct. 29 that makes it prohibitive for most Planned Parenthood clinics and other community clinics that provide abortion services to stay open.
"What that’s done is cut out a very large group of providers, and now we’re trying to find providers to help take care of those folks," who normally use those clinics, she said.
In the absence of Medicaid expansion, Texas physicians are hoping to start receiving higher Medicaid payments that were due to start in Jan. 2013. An estimated 25,000 Texas doctors are eligible for Medicaid pay that will be on par with Medicare. But Texas has not begun to distribute that money and will not likely do so until March, according to the TMA.
When the Supreme Court upheld the constitutionality of the Affordable Care Act in 2012, it also ruled that states could choose whether to substantially expand their Medicaid programs. That decision has created a split across the country, with about half of the states choosing to take federal dollars to expand their programs and the others opting out.
There’s no deadline on Medicaid expansion, so those states that have opted out so far can always choose to expand at a later date.
Here’s a look at two bellwether states: California, which has accepted federal money to expand its Medi-Cal program, and Texas, which has opted out of the expansion.
California Gov. Jerry Brown (D), a strong supporter of the ACA, announced that his state would expand Medicaid to include low-income individuals up to 138% of the federal poverty level starting on Jan. 1, 2014. All of the new enrollees – likely 1 million Californians – will be added to the state’s growing Medicaid managed care program.
Conversely, Texas Gov. Rick Perry (R) deemed Medicaid expansion "a misguided, and ultimately doomed, attempt to mask the shortcomings of Obamacare."
California: Pay cuts complicate expansion
Physicians in California are bracing for a significant Medicaid pay cut at the same time as about a million residents are set to join the program.
The pending cuts are just one part of a complex health care picture in California, where experts are far from certain about what the expansion of Medi-Cal will mean for physicians and patients.
"I think we’re going to have a real problem in California with all the new Medi-Cal patients," said Dr. Mark Dressner, who works at a federally qualified health center in Long Beach and is the president of the California Academy of Family Physicians. "Who is going to see them when there’s going to be so many other people in the system?"
The Kaiser Family Foundation estimates that between 990,000 and 1.4 million individuals, mostly single adults, will enter Medi-Cal by 2019 because of the ACA-permitted expansion. Currently, about 8.5 million residents are enrolled. Newly eligible individuals will be enrolled in the program’s managed care health plans.
These new patients could have a hard time finding a doctor. Medi-Cal is one of the lowest payers in the nation, paying between $18 and $24 for an office visit, according to the California Medical Association.
That’s about to be compounded by a pay cut approved by the state and the Centers for Medicare and Medicaid Services in 2011. Physicians tried unsuccessfully to fight the cut in court. Now the state is implementing it retroactively, which means that Medi-Cal payments could be cut 15%-20% over the next few years.
"It really undermines efforts to successfully implement the Affordable Care Act in California," said Lisa Folberg, vice president of medical and regulatory policy at the California Medical Association.
There are broad exceptions to the cut. It does not apply to most primary care services in either managed care plans or fee-for-service Medi-Cal, or to specialty services provided through managed care plans, Ms. Folberg said. And some managed care companies have announced that they will use their discretion in setting payment rates to shield their contracted physicians from the cuts.
"Unfortunately, that doesn’t help the cancer patient on Medi-Cal in Bakersfield who has fee-for-service Medi-Cal and can’t find an oncologist," Ms. Folberg said.
Dr. Darin Latimore, president of the California chapter of the American College of Physicians, said large health systems likely will be able to work around the cuts, using group visits and physician extenders. But small physician practices in rural areas aren’t equipped to make those changes, he said.
"They are not in a position to move work on to others in order to be more efficient and see more Medi-Cal patients," said Dr. Latimore, associate dean of medicine at the University of California Davis.
The result will be that physicians who work outside of the state’s safety net system will be less likely to participate in the Medi-Cal program or will strictly limit the number of patients they see. That will translate to longer waits to get an appointment and shorter visits for Medi-Cal patients.
Another concern: Patients entering Medi-Cal managed care plans might not have access to a broad network of physicians. While California has network adequacy laws, state oversight is inadequate, according to Ms. Folberg. For the most part, the plans are on an honor system.
There are some bright spots for the Medi-Cal expansion. The ACA includes an increase in Medicaid payments to physicians for 146 primary care services provided in 2013 and 2014. The provision temporarily raises payments up to Medicare rates, which for California physicians means a 136% hike on average, according to an analysis from the Kaiser Family Foundation.
But those payments were delayed, with the first checks going out to physicians in November 2013. That delay could cost the state in physician participation.
"I think the longer it takes to implement that, the less likely it is that it will affect any decisions about whether to participate more fully in the program than you would have otherwise," said Christopher Perrone, deputy director of the health reform and public programs initiative at the California HealthCare Foundation.
And the temporary nature of the pay increase adds to the problem, Mr. Perrone said. "I don’t see California sustaining that increase on its own and I haven’t heard anyone suggest that the federal government would sustain it after the 2 years."
Mr. Perrone said it’s more likely that physicians who are already committed to participating in Medi-Cal will use the money to invest in electronic health records and other telemedicine features, and hire medical assistants.
But with so many small and solo physicians shying away from Medi-Cal because of low payments, community clinics and health centers will have to pick up the slack.
"All these issues together really point to the importance of the community health centers and the role we are going to be playing in ensuring access," said Carmela Castellano-Garcia, president and CEO of the California Primary Care Association.
Federally qualified health centers are in a better position financially because they are paid an enhanced Medicaid rate and won’t be subject to the coming Medi-Cal cuts, Ms. Castellano-Garcia said. And the ACA has directed an influx of cash to these centers as well – more than $500 million in California alone to establish new sites, expand services, and support major capital improvement projects, according to the Health and Human Services department.
Texas: No expansion means doctors will keep feeling pressure
Texas has the highest number of uninsured residents in the United States – a quarter of its 26 million residents lacking coverage – but Gov. Rick Perry (R) refused to expand Medicaid, which could cover as many as 500,000 to 1 million Texans.
The governor’s decision will stay in place at least until 2015, when the state legislature reconvenes.
Some physicians in Texas are not upset by the decision – they consider Medicaid to be low-paying program and full of bureaucratic hassles.
Others – including many of the primary care organizations – disagree.
The Texas Medical Association, the Texas Academy of Family Physicians, and the Texas chapter of the American Congress of Obstetricians and Gynecologists all support the expansion of Medicaid allowed by the ACA.
In April, Gov. Perry reiterated his position. "Medicaid expansion is a misguided, and ultimately doomed, attempt to mask the shortcomings of Obamacare," he said in a statement. Instead of expansion, he favors flexibility for the state to manage its Medicaid program.
State Rep. John Zerwas (R-Simonton), an anesthesiologist, introduced H.B. 3791 that would give that flexibility, but it did not get consideration by the full House before the legislature adjourned in May.
The TMA supported Dr. Zerwas’ proposal, but also is in favor of expanding Medicaid, said Dr. Stephen L. Brotherton, TMA president. More people would have some type of insurance, but they might not necessarily have good access to care, he said.
That’s because Texas has a shortage of primary care physicians. The number of primary care physicians per capita is lower than the national average – at about 70/100,000 in 2011, compared with 80/100,000 nationally, according to the Texas Department of State Health Services, in the publication "Supply Trends Among Licensed Health Professions, Texas, 1980-2011. In rural areas, it’s even lower – about 50/100,000.
Then there’s the question of just how many physicians will take Medicaid. A 2012 TMA survey found that only 31% of doctors in the state were accepting new Medicaid patients.
Medicaid payment rates are so low that Dr. Brotherton, who practices in Ft. Worth, said that he treats Medicaid patients as charity care. "It’s much less expensive for me to do it for nothing as donated time," he said.
Dr. Moss Hampton, chairman of District XI of ACOG, added, "Medicaid doesn’t cover the cost of taking care of the patient."
For Medicaid expansion to eventually be successful, "there would have to be a better payment rate and less of a hassle factor," said Dr. Hampton, chairman of the obstetrics and gynecology department at Texas Tech Health Sciences Center at the Permian Basin in Odessa.
"It’s hard to get doctors to accept Medicaid because of the rates they pay," agreed Dr. Clare Hawkins, TAFP president, who added that Texas physicians also feel that it’s hard to comply with differing rules among various Medicaid managed care programs.
Even so, expansion will mean getting more patients into preventive care, and a reduction in emergency department visits and more expensive hospital care – costs that are being borne by all Texans, including physicians, said Dr. Hawkins, who is program director of the San Jacinto Methodist Hospital Family Medicine Residency Program in Baytown, Texas.
Although uninsured Texas residents are already receiving care – in emergency departments and at clinics – Medicaid expansion could bring a big uptick in office visits, especially to ob.gyn. practices, Dr. Hampton said. The need for those services is growing with a state law that went into effect on Oct. 29 that makes it prohibitive for most Planned Parenthood clinics and other community clinics that provide abortion services to stay open.
"What that’s done is cut out a very large group of providers, and now we’re trying to find providers to help take care of those folks," who normally use those clinics, she said.
In the absence of Medicaid expansion, Texas physicians are hoping to start receiving higher Medicaid payments that were due to start in Jan. 2013. An estimated 25,000 Texas doctors are eligible for Medicaid pay that will be on par with Medicare. But Texas has not begun to distribute that money and will not likely do so until March, according to the TMA.
FDA approves sofosbuvir for chronic hepatitis C
The Food and Drug Administration has approved sofosbuvir, a first-in-its-class antiviral, to treat chronic hepatitis C infection.
Sofosbuvir is a nucleotide analogue inhibitor of the hepatitis C virus (HCV) NS5B polymerase enzyme, which plays an important role in HCV replication. It is taken orally once a day at a 400-mg dose. It will be marketed as Sovaldi by Gilead Sciences.
The drug is approved for two chronic hepatitis C indications: In combination with pegylated interferon and ribavirin for treatment-naïve adults with genotype 1 and 4 infections, and in combination with ribavirin for adults with genotypes 2 and 3 infection.
The second indication is the first approval of an interferon-free regimen for the treatment for chronic hepatitis C.
"Today’s approval represents a significant shift in the treatment paradigm for some patients with chronic hepatitis C," Dr. Edward Cox, director of the Office of Antimicrobial Products in the FDA Center for Drug Evaluation and Research, said in a statement.
This is "truly a historic moment," Dr. Demetre Daskalakis, medical director of the HIV program at Mt. Sinai School of Medicine, New York, said at an FDA advisory committee meeting on the drug held Oct. 25. "I can’t wait to get this drug into the clinic. We are all excited," he added. The Antiviral Drugs Advisory Committee voted unanimously that day to recommend approval for sofosbuvir.
Sofosbuvir was approved based on data from six clinical trials consisting of 1,947 patients – both treatment-naïve and treatment experienced – some of whom were also HIV positive.
The most common side effects reported in clinical study participants treated with sofosbuvir and ribavirin were fatigue and headache. In participants treated with sofosbuvir, ribavirin, and peginterferon-alfa, the most common side effects reported were fatigue, headache, nausea, insomnia, and anemia, according to the FDA.
According to Gilead, sofosbuvir is also on the verge of receiving marketing approval in the European Union. Sofosbuvir is the second drug approved by the FDA in the past two weeks to treat chronic HCV infection. Simeprevir was approved Nov. 22.
Elizabeth Mechcatie contributed to this report.
The Food and Drug Administration has approved sofosbuvir, a first-in-its-class antiviral, to treat chronic hepatitis C infection.
Sofosbuvir is a nucleotide analogue inhibitor of the hepatitis C virus (HCV) NS5B polymerase enzyme, which plays an important role in HCV replication. It is taken orally once a day at a 400-mg dose. It will be marketed as Sovaldi by Gilead Sciences.
The drug is approved for two chronic hepatitis C indications: In combination with pegylated interferon and ribavirin for treatment-naïve adults with genotype 1 and 4 infections, and in combination with ribavirin for adults with genotypes 2 and 3 infection.
The second indication is the first approval of an interferon-free regimen for the treatment for chronic hepatitis C.
"Today’s approval represents a significant shift in the treatment paradigm for some patients with chronic hepatitis C," Dr. Edward Cox, director of the Office of Antimicrobial Products in the FDA Center for Drug Evaluation and Research, said in a statement.
This is "truly a historic moment," Dr. Demetre Daskalakis, medical director of the HIV program at Mt. Sinai School of Medicine, New York, said at an FDA advisory committee meeting on the drug held Oct. 25. "I can’t wait to get this drug into the clinic. We are all excited," he added. The Antiviral Drugs Advisory Committee voted unanimously that day to recommend approval for sofosbuvir.
Sofosbuvir was approved based on data from six clinical trials consisting of 1,947 patients – both treatment-naïve and treatment experienced – some of whom were also HIV positive.
The most common side effects reported in clinical study participants treated with sofosbuvir and ribavirin were fatigue and headache. In participants treated with sofosbuvir, ribavirin, and peginterferon-alfa, the most common side effects reported were fatigue, headache, nausea, insomnia, and anemia, according to the FDA.
According to Gilead, sofosbuvir is also on the verge of receiving marketing approval in the European Union. Sofosbuvir is the second drug approved by the FDA in the past two weeks to treat chronic HCV infection. Simeprevir was approved Nov. 22.
Elizabeth Mechcatie contributed to this report.
The Food and Drug Administration has approved sofosbuvir, a first-in-its-class antiviral, to treat chronic hepatitis C infection.
Sofosbuvir is a nucleotide analogue inhibitor of the hepatitis C virus (HCV) NS5B polymerase enzyme, which plays an important role in HCV replication. It is taken orally once a day at a 400-mg dose. It will be marketed as Sovaldi by Gilead Sciences.
The drug is approved for two chronic hepatitis C indications: In combination with pegylated interferon and ribavirin for treatment-naïve adults with genotype 1 and 4 infections, and in combination with ribavirin for adults with genotypes 2 and 3 infection.
The second indication is the first approval of an interferon-free regimen for the treatment for chronic hepatitis C.
"Today’s approval represents a significant shift in the treatment paradigm for some patients with chronic hepatitis C," Dr. Edward Cox, director of the Office of Antimicrobial Products in the FDA Center for Drug Evaluation and Research, said in a statement.
This is "truly a historic moment," Dr. Demetre Daskalakis, medical director of the HIV program at Mt. Sinai School of Medicine, New York, said at an FDA advisory committee meeting on the drug held Oct. 25. "I can’t wait to get this drug into the clinic. We are all excited," he added. The Antiviral Drugs Advisory Committee voted unanimously that day to recommend approval for sofosbuvir.
Sofosbuvir was approved based on data from six clinical trials consisting of 1,947 patients – both treatment-naïve and treatment experienced – some of whom were also HIV positive.
The most common side effects reported in clinical study participants treated with sofosbuvir and ribavirin were fatigue and headache. In participants treated with sofosbuvir, ribavirin, and peginterferon-alfa, the most common side effects reported were fatigue, headache, nausea, insomnia, and anemia, according to the FDA.
According to Gilead, sofosbuvir is also on the verge of receiving marketing approval in the European Union. Sofosbuvir is the second drug approved by the FDA in the past two weeks to treat chronic HCV infection. Simeprevir was approved Nov. 22.
Elizabeth Mechcatie contributed to this report.
Six percent of adolescents report psychotropic use in past month
Six percent of adolescents aged 12-19 years self-reported that they had taken a psychotropic medication in the past month, but only half had seen a mental health professional in the last year.
That’s according to data extracted from the National Health and Nutrition Examination Survey (NHANES), which is partly based on interviews conducted with the subjects in their homes.
This particular report looked at psychotropic medication use among noninstitutionalized adolescents aged 12-19 years from 2005 to 2010. The estimates in the report are conservative because they do not include the homeless or adolescents who might be incarcerated or receiving inpatient treatment, according to the Bruce S. Jonas, Ph.D., Dr. Qiuping Gu, and Juan Albertorio-Diaz, all of whom are affiliated with the National Center for Health Statistics at the Centers for Disease Control and Prevention.
Among drug categories, antidepressants and medications for attention-deficit/hyperactivity disorder (ADHD) were the most common, with 3.2% of all adolescents reporting taking drugs for those two conditions. About 1% of adolescents reported using antipsychotics, and 0.5% reported use of anxiolytics, sedatives, or hypnotics. The rate of antimanic medication use – 0.2% – was considered to be an unreliable statistic, according to the authors.
Females were more likely to use antidepressants, while ADHD drug use was more common among males. Use of any psychotropic drug was highest among non-Hispanic white adolescents, with 8% reporting use, compared with 3% of non-Hispanic black adolescents and just under 3% of Mexican-American adolescents.
Some 5% of non-Hispanic white adolescents used antidepressants, compared with only 0.5% of non-Hispanic blacks and 0.7% of Mexican Americans. Four percent of non-Hispanic whites reported taking ADHD medications, while only about 2% of non-Hispanic blacks and Mexican Americans said they used drugs for that condition.
Survey participants also were asked whether they had seen or talked to a psychologist, psychiatrist, psychiatric nurse, or clinical social worker about their health in the past year. Overall, 53% said they had consulted such a professional. For those taking more than one medication, the figure rose to almost 80%.
The report, Data Brief No. 135, Psychotropic Medication Use Among Adolescents: United States, 2005–2010, can be found at the National Center for Health Statistics website.
On Twitter @aliciaault
Six percent of adolescents aged 12-19 years self-reported that they had taken a psychotropic medication in the past month, but only half had seen a mental health professional in the last year.
That’s according to data extracted from the National Health and Nutrition Examination Survey (NHANES), which is partly based on interviews conducted with the subjects in their homes.
This particular report looked at psychotropic medication use among noninstitutionalized adolescents aged 12-19 years from 2005 to 2010. The estimates in the report are conservative because they do not include the homeless or adolescents who might be incarcerated or receiving inpatient treatment, according to the Bruce S. Jonas, Ph.D., Dr. Qiuping Gu, and Juan Albertorio-Diaz, all of whom are affiliated with the National Center for Health Statistics at the Centers for Disease Control and Prevention.
Among drug categories, antidepressants and medications for attention-deficit/hyperactivity disorder (ADHD) were the most common, with 3.2% of all adolescents reporting taking drugs for those two conditions. About 1% of adolescents reported using antipsychotics, and 0.5% reported use of anxiolytics, sedatives, or hypnotics. The rate of antimanic medication use – 0.2% – was considered to be an unreliable statistic, according to the authors.
Females were more likely to use antidepressants, while ADHD drug use was more common among males. Use of any psychotropic drug was highest among non-Hispanic white adolescents, with 8% reporting use, compared with 3% of non-Hispanic black adolescents and just under 3% of Mexican-American adolescents.
Some 5% of non-Hispanic white adolescents used antidepressants, compared with only 0.5% of non-Hispanic blacks and 0.7% of Mexican Americans. Four percent of non-Hispanic whites reported taking ADHD medications, while only about 2% of non-Hispanic blacks and Mexican Americans said they used drugs for that condition.
Survey participants also were asked whether they had seen or talked to a psychologist, psychiatrist, psychiatric nurse, or clinical social worker about their health in the past year. Overall, 53% said they had consulted such a professional. For those taking more than one medication, the figure rose to almost 80%.
The report, Data Brief No. 135, Psychotropic Medication Use Among Adolescents: United States, 2005–2010, can be found at the National Center for Health Statistics website.
On Twitter @aliciaault
Six percent of adolescents aged 12-19 years self-reported that they had taken a psychotropic medication in the past month, but only half had seen a mental health professional in the last year.
That’s according to data extracted from the National Health and Nutrition Examination Survey (NHANES), which is partly based on interviews conducted with the subjects in their homes.
This particular report looked at psychotropic medication use among noninstitutionalized adolescents aged 12-19 years from 2005 to 2010. The estimates in the report are conservative because they do not include the homeless or adolescents who might be incarcerated or receiving inpatient treatment, according to the Bruce S. Jonas, Ph.D., Dr. Qiuping Gu, and Juan Albertorio-Diaz, all of whom are affiliated with the National Center for Health Statistics at the Centers for Disease Control and Prevention.
Among drug categories, antidepressants and medications for attention-deficit/hyperactivity disorder (ADHD) were the most common, with 3.2% of all adolescents reporting taking drugs for those two conditions. About 1% of adolescents reported using antipsychotics, and 0.5% reported use of anxiolytics, sedatives, or hypnotics. The rate of antimanic medication use – 0.2% – was considered to be an unreliable statistic, according to the authors.
Females were more likely to use antidepressants, while ADHD drug use was more common among males. Use of any psychotropic drug was highest among non-Hispanic white adolescents, with 8% reporting use, compared with 3% of non-Hispanic black adolescents and just under 3% of Mexican-American adolescents.
Some 5% of non-Hispanic white adolescents used antidepressants, compared with only 0.5% of non-Hispanic blacks and 0.7% of Mexican Americans. Four percent of non-Hispanic whites reported taking ADHD medications, while only about 2% of non-Hispanic blacks and Mexican Americans said they used drugs for that condition.
Survey participants also were asked whether they had seen or talked to a psychologist, psychiatrist, psychiatric nurse, or clinical social worker about their health in the past year. Overall, 53% said they had consulted such a professional. For those taking more than one medication, the figure rose to almost 80%.
The report, Data Brief No. 135, Psychotropic Medication Use Among Adolescents: United States, 2005–2010, can be found at the National Center for Health Statistics website.
On Twitter @aliciaault
Major finding: The top drug psychotropic drug classes adolescents report using are antidepressants and attention-deficit/hyperactivity disorder medications. The adolescents reported using medications in those two drug classes at the same rate: 3.2%.
Data source: The findings are based on self-reported data of U.S. noninstitutionalized adolescents, aged 12-19 years, during 2005-2010, from the National Health and Nutrition Examination Survey.
Disclosures: Dr. Jonas, Dr. Gu, and Mr. Albertorio-Diaz are affiliated with the National Center for Health Statistics at the CDC.
Sequester continuing to hit cancer research hard
Federal budget cuts continue to take a toll on cancer research and, unless a budget agreement is reached within a few weeks, will continue to have far-reaching impact into next year, according to the leaders of several cancer centers.
Since they went into effect March 1, the cuts mandated by the Budget Control Act of 2011 – better known as sequestration – mean that fewer clinical studies have started and fewer patients have been enrolled in existing trials.
The cuts also have led to the submission of less-innovative grant applications in hopes that they will be more easily approved by the budget-hamstrung National Cancer Institute, the directors of three NCI-designated cancer centers said at a press briefing Dec. 3.
Sequestration required the National Institutes of Health to cut 5%, or $1.55 billion of its fiscal year 2013 budget, applied evenly across all programs, projects, and activities. NCI officials estimated in June that they would be able to fund 326 fewer grants in 2013, for a savings of about $200 million.
The final impact on NCI-designated centers during fiscal 2013 – which ended on Sept. 30 – is still being calculated, in part because the government shutdown in October delayed that work, said David Pugach, director of federal relations for the American Cancer Society Cancer Action Network (ACS CAN).
Individual cancer centers, however, have already tallied the effects.
Dr. Walter J. Curran, executive director of the Winship Cancer Institute of Emory University, Atlanta, said that the center will have $5 million less from March 2013 to March 2014. With potentially another 5% cut in the NIH budget due next year, Winship is looking at another $4 million reduction for 2014, he said.
Winship has been growing steadily since its NCI designation in 2008, said Dr. Curran. Because of sequestration, the growth trajectory has slowed dramatically. "We’re working very hard just to keep a stable cadre of faculty and staff," he said.
Sequestration is having a "chilling effect" on investigators, who are pursuing less risky research "in favor of safer bets" and are either giving up on their field or moving overseas, where government-backed research is more plentiful, according to Dr. Chi Van Dang, director of the Abramson Cancer Center at the University of Pennsylvania, Philadelphia. He said that the 12,000 patients Abramson sees daily are "looking for hope every day and I think this cutback is taking away their hope," said Dr. Van Dang.
Thomas Sellers, Ph.D., director of the Moffitt Cancer Center and Research Institute in Tampa, agreed, noting that many cancer patients seek out NCI-designated centers because they can get into NCI-sponsored trials. But at Moffitt, the sequester is wreaking havoc. One major grant was allowing 250 patients a year to enroll in a particular study. Enrollment has now been capped at 100 patients a year – a 60% decrease.
Moffitt has lost $2 million from the NCI cutback and expects to lose $4 million in 2014. Dr. Sellers said that the result will be fewer employees, fewer supplies purchased, fewer animal models created, and less tissue culturing, among other reductions. Like other institutions, Moffitt researchers also are seeking grants for smaller projects and projects that the NCI might be likelier to approve.
"We’re going for marginal science, safe science, just to keep the labs going," he said.
John Seffrin, Ph.D., chief executive officer of ACS CAN, said that the entire cancer community is frustrated. "Sequestration is not a policy. It is actually an abdication of Congress’ obligation," he said.
ACS CAN and other cancer groups have been urging Congress to exempt cancer care and research from sequestration.
A bipartisan, bicameral group of legislators led by House Budget Committee Chairman Paul Ryan (R-Wis.) and Senate Budget Committee Chairman Patty Murray (D-Wash.) have been meeting to come up with a federal spending plan that also replaces the sequester. They aim to present a plan by Dec. 13.
On Twitter @aliciaault
Federal budget cuts continue to take a toll on cancer research and, unless a budget agreement is reached within a few weeks, will continue to have far-reaching impact into next year, according to the leaders of several cancer centers.
Since they went into effect March 1, the cuts mandated by the Budget Control Act of 2011 – better known as sequestration – mean that fewer clinical studies have started and fewer patients have been enrolled in existing trials.
The cuts also have led to the submission of less-innovative grant applications in hopes that they will be more easily approved by the budget-hamstrung National Cancer Institute, the directors of three NCI-designated cancer centers said at a press briefing Dec. 3.
Sequestration required the National Institutes of Health to cut 5%, or $1.55 billion of its fiscal year 2013 budget, applied evenly across all programs, projects, and activities. NCI officials estimated in June that they would be able to fund 326 fewer grants in 2013, for a savings of about $200 million.
The final impact on NCI-designated centers during fiscal 2013 – which ended on Sept. 30 – is still being calculated, in part because the government shutdown in October delayed that work, said David Pugach, director of federal relations for the American Cancer Society Cancer Action Network (ACS CAN).
Individual cancer centers, however, have already tallied the effects.
Dr. Walter J. Curran, executive director of the Winship Cancer Institute of Emory University, Atlanta, said that the center will have $5 million less from March 2013 to March 2014. With potentially another 5% cut in the NIH budget due next year, Winship is looking at another $4 million reduction for 2014, he said.
Winship has been growing steadily since its NCI designation in 2008, said Dr. Curran. Because of sequestration, the growth trajectory has slowed dramatically. "We’re working very hard just to keep a stable cadre of faculty and staff," he said.
Sequestration is having a "chilling effect" on investigators, who are pursuing less risky research "in favor of safer bets" and are either giving up on their field or moving overseas, where government-backed research is more plentiful, according to Dr. Chi Van Dang, director of the Abramson Cancer Center at the University of Pennsylvania, Philadelphia. He said that the 12,000 patients Abramson sees daily are "looking for hope every day and I think this cutback is taking away their hope," said Dr. Van Dang.
Thomas Sellers, Ph.D., director of the Moffitt Cancer Center and Research Institute in Tampa, agreed, noting that many cancer patients seek out NCI-designated centers because they can get into NCI-sponsored trials. But at Moffitt, the sequester is wreaking havoc. One major grant was allowing 250 patients a year to enroll in a particular study. Enrollment has now been capped at 100 patients a year – a 60% decrease.
Moffitt has lost $2 million from the NCI cutback and expects to lose $4 million in 2014. Dr. Sellers said that the result will be fewer employees, fewer supplies purchased, fewer animal models created, and less tissue culturing, among other reductions. Like other institutions, Moffitt researchers also are seeking grants for smaller projects and projects that the NCI might be likelier to approve.
"We’re going for marginal science, safe science, just to keep the labs going," he said.
John Seffrin, Ph.D., chief executive officer of ACS CAN, said that the entire cancer community is frustrated. "Sequestration is not a policy. It is actually an abdication of Congress’ obligation," he said.
ACS CAN and other cancer groups have been urging Congress to exempt cancer care and research from sequestration.
A bipartisan, bicameral group of legislators led by House Budget Committee Chairman Paul Ryan (R-Wis.) and Senate Budget Committee Chairman Patty Murray (D-Wash.) have been meeting to come up with a federal spending plan that also replaces the sequester. They aim to present a plan by Dec. 13.
On Twitter @aliciaault
Federal budget cuts continue to take a toll on cancer research and, unless a budget agreement is reached within a few weeks, will continue to have far-reaching impact into next year, according to the leaders of several cancer centers.
Since they went into effect March 1, the cuts mandated by the Budget Control Act of 2011 – better known as sequestration – mean that fewer clinical studies have started and fewer patients have been enrolled in existing trials.
The cuts also have led to the submission of less-innovative grant applications in hopes that they will be more easily approved by the budget-hamstrung National Cancer Institute, the directors of three NCI-designated cancer centers said at a press briefing Dec. 3.
Sequestration required the National Institutes of Health to cut 5%, or $1.55 billion of its fiscal year 2013 budget, applied evenly across all programs, projects, and activities. NCI officials estimated in June that they would be able to fund 326 fewer grants in 2013, for a savings of about $200 million.
The final impact on NCI-designated centers during fiscal 2013 – which ended on Sept. 30 – is still being calculated, in part because the government shutdown in October delayed that work, said David Pugach, director of federal relations for the American Cancer Society Cancer Action Network (ACS CAN).
Individual cancer centers, however, have already tallied the effects.
Dr. Walter J. Curran, executive director of the Winship Cancer Institute of Emory University, Atlanta, said that the center will have $5 million less from March 2013 to March 2014. With potentially another 5% cut in the NIH budget due next year, Winship is looking at another $4 million reduction for 2014, he said.
Winship has been growing steadily since its NCI designation in 2008, said Dr. Curran. Because of sequestration, the growth trajectory has slowed dramatically. "We’re working very hard just to keep a stable cadre of faculty and staff," he said.
Sequestration is having a "chilling effect" on investigators, who are pursuing less risky research "in favor of safer bets" and are either giving up on their field or moving overseas, where government-backed research is more plentiful, according to Dr. Chi Van Dang, director of the Abramson Cancer Center at the University of Pennsylvania, Philadelphia. He said that the 12,000 patients Abramson sees daily are "looking for hope every day and I think this cutback is taking away their hope," said Dr. Van Dang.
Thomas Sellers, Ph.D., director of the Moffitt Cancer Center and Research Institute in Tampa, agreed, noting that many cancer patients seek out NCI-designated centers because they can get into NCI-sponsored trials. But at Moffitt, the sequester is wreaking havoc. One major grant was allowing 250 patients a year to enroll in a particular study. Enrollment has now been capped at 100 patients a year – a 60% decrease.
Moffitt has lost $2 million from the NCI cutback and expects to lose $4 million in 2014. Dr. Sellers said that the result will be fewer employees, fewer supplies purchased, fewer animal models created, and less tissue culturing, among other reductions. Like other institutions, Moffitt researchers also are seeking grants for smaller projects and projects that the NCI might be likelier to approve.
"We’re going for marginal science, safe science, just to keep the labs going," he said.
John Seffrin, Ph.D., chief executive officer of ACS CAN, said that the entire cancer community is frustrated. "Sequestration is not a policy. It is actually an abdication of Congress’ obligation," he said.
ACS CAN and other cancer groups have been urging Congress to exempt cancer care and research from sequestration.
A bipartisan, bicameral group of legislators led by House Budget Committee Chairman Paul Ryan (R-Wis.) and Senate Budget Committee Chairman Patty Murray (D-Wash.) have been meeting to come up with a federal spending plan that also replaces the sequester. They aim to present a plan by Dec. 13.
On Twitter @aliciaault
Physician networks, formularies now viewable on healthcare.gov
Visitors to healthcare.gov now can view physician networks, deductibles, copayments, and formularies as "window shoppers" before they sign up for a health insurance plan – information that both doctors and patients have been seeking.
The new functionality was announced Dec. 2 by the Centers for Medicare and Medicaid Services.
At a Nov. 26 White House meeting on Affordable Care Act concerns, representatives of several physician organizations voiced concern that patients could not see whether their physician or preferred hospital was in a plan’s network during the shopping process, according to Bob Doherty, senior vice president for governmental affairs and public policy for the American College of Physicians.
Mr. Doherty, who attended the White House meeting, said that physician groups also told administration officials that patients and physicians needed information on formularies. Pharmaceuticals – at least one medication from each therapeutic class – must be covered by health exchange plans as an essential health benefit.
"But that doesn’t mean necessarily that your own particular drugs are on that plan’s formulary," Mr. Doherty said. The physician groups argued that more transparency was needed.
The same is true for provider networks. "From a consumer point of view, you may decide that if you can get a plan with lower premium and a deductible you can afford, you may choose to forgo your doctor or hospital," Mr. Doherty said. "That’s okay as long as you make an informed choice," he said, adding that without the ability to see networks, it was impossible to make such a choice.
Now, the networks are visible, but the question is whether the lists are up-to-date, he said. Physician groups also want "more transparency from the insurance industry, disclosing decisions on why they include or don’t include doctors in their networks and why they delist" physicians, Mr. Doherty said.
Physicians are getting help from Rep. Darrell Issa (R-Calif.), chairman of the House Oversight and Government Reform Committee. Rep. Issa sent a letter to 15 insurance companies on Nov. 29, asking for documents "related to the reevaluation of provider networks and payment rates, as well as communications with the administration about potential changes to health plans limiting or changing health care access," according to a statement.
"Even among the individuals fortunate enough to keep their plans, many Americans are finding that access to their preferred doctor(s) is being abruptly terminated," wrote Rep. Issa, adding, "Some health insurers have acknowledged that they are slashing provider payment rates for plans offered on Obamacare exchanges."
The letter requested a response from the insurers by Dec. 13.
[email protected]
On Twitter @aliciaault
Visitors to healthcare.gov now can view physician networks, deductibles, copayments, and formularies as "window shoppers" before they sign up for a health insurance plan – information that both doctors and patients have been seeking.
The new functionality was announced Dec. 2 by the Centers for Medicare and Medicaid Services.
At a Nov. 26 White House meeting on Affordable Care Act concerns, representatives of several physician organizations voiced concern that patients could not see whether their physician or preferred hospital was in a plan’s network during the shopping process, according to Bob Doherty, senior vice president for governmental affairs and public policy for the American College of Physicians.
Mr. Doherty, who attended the White House meeting, said that physician groups also told administration officials that patients and physicians needed information on formularies. Pharmaceuticals – at least one medication from each therapeutic class – must be covered by health exchange plans as an essential health benefit.
"But that doesn’t mean necessarily that your own particular drugs are on that plan’s formulary," Mr. Doherty said. The physician groups argued that more transparency was needed.
The same is true for provider networks. "From a consumer point of view, you may decide that if you can get a plan with lower premium and a deductible you can afford, you may choose to forgo your doctor or hospital," Mr. Doherty said. "That’s okay as long as you make an informed choice," he said, adding that without the ability to see networks, it was impossible to make such a choice.
Now, the networks are visible, but the question is whether the lists are up-to-date, he said. Physician groups also want "more transparency from the insurance industry, disclosing decisions on why they include or don’t include doctors in their networks and why they delist" physicians, Mr. Doherty said.
Physicians are getting help from Rep. Darrell Issa (R-Calif.), chairman of the House Oversight and Government Reform Committee. Rep. Issa sent a letter to 15 insurance companies on Nov. 29, asking for documents "related to the reevaluation of provider networks and payment rates, as well as communications with the administration about potential changes to health plans limiting or changing health care access," according to a statement.
"Even among the individuals fortunate enough to keep their plans, many Americans are finding that access to their preferred doctor(s) is being abruptly terminated," wrote Rep. Issa, adding, "Some health insurers have acknowledged that they are slashing provider payment rates for plans offered on Obamacare exchanges."
The letter requested a response from the insurers by Dec. 13.
[email protected]
On Twitter @aliciaault
Visitors to healthcare.gov now can view physician networks, deductibles, copayments, and formularies as "window shoppers" before they sign up for a health insurance plan – information that both doctors and patients have been seeking.
The new functionality was announced Dec. 2 by the Centers for Medicare and Medicaid Services.
At a Nov. 26 White House meeting on Affordable Care Act concerns, representatives of several physician organizations voiced concern that patients could not see whether their physician or preferred hospital was in a plan’s network during the shopping process, according to Bob Doherty, senior vice president for governmental affairs and public policy for the American College of Physicians.
Mr. Doherty, who attended the White House meeting, said that physician groups also told administration officials that patients and physicians needed information on formularies. Pharmaceuticals – at least one medication from each therapeutic class – must be covered by health exchange plans as an essential health benefit.
"But that doesn’t mean necessarily that your own particular drugs are on that plan’s formulary," Mr. Doherty said. The physician groups argued that more transparency was needed.
The same is true for provider networks. "From a consumer point of view, you may decide that if you can get a plan with lower premium and a deductible you can afford, you may choose to forgo your doctor or hospital," Mr. Doherty said. "That’s okay as long as you make an informed choice," he said, adding that without the ability to see networks, it was impossible to make such a choice.
Now, the networks are visible, but the question is whether the lists are up-to-date, he said. Physician groups also want "more transparency from the insurance industry, disclosing decisions on why they include or don’t include doctors in their networks and why they delist" physicians, Mr. Doherty said.
Physicians are getting help from Rep. Darrell Issa (R-Calif.), chairman of the House Oversight and Government Reform Committee. Rep. Issa sent a letter to 15 insurance companies on Nov. 29, asking for documents "related to the reevaluation of provider networks and payment rates, as well as communications with the administration about potential changes to health plans limiting or changing health care access," according to a statement.
"Even among the individuals fortunate enough to keep their plans, many Americans are finding that access to their preferred doctor(s) is being abruptly terminated," wrote Rep. Issa, adding, "Some health insurers have acknowledged that they are slashing provider payment rates for plans offered on Obamacare exchanges."
The letter requested a response from the insurers by Dec. 13.
[email protected]
On Twitter @aliciaault
Outpatient rule bundles pay, consolidates codes
Payments for outpatient services and those provided at ambulatory surgical centers will be bundled in the same way as inpatient procedures, with exceptions for some cardiology-related services, under the final rule for Medicare’s 2014 Hospital Outpatient Prospective Payment System.
Further, five levels of outpatient codes for both new and established patients will be replaced with a single code for all visits, according to the final rule.
Having a single code and a single payment "is more administratively simple for hospitals and better reflects hospital resources involved in supporting an outpatient visit," according to a statement from the Centers for Medicare and Medicaid Services.
Under the final rule, supporting items and services associated with a procedure are bundled into a single payment, including drugs, biologicals, and radiopharmaceuticals that function as supplies when used in a diagnostic test or procedure; drugs and biologicals that function as supplies when used in a surgical procedure, including skin substitutes; certain clinical diagnostic laboratory services; certain procedures that are never done without a primary procedure, and device removal procedures.
The bundling of these services and supplies will create efficiencies and lower costs, CMS Principal Deputy Administrator Jon Blum, said in a statement. The final rule "gives hospitals a stake in managing their resources to generate better coordinated and, ultimately, more affordable outpatient care," he added.
Officials at the American College of Cardiology said they were pleased to see that the CMS did not bundle imaging services such as echocardiography, as had been initially proposed. The organization says this is because of "significant lobbying work" by the ACC and the American Society of Echocardiography.
Cardiologists also got a reprieve when the agency delayed until 2015 bundled payment for percutaneous coronary interventions and placement of implantable cardioverter defibrillators.
The final rule was not so favorable for oncologists. The rule continues the practice of paying average sales price plus 6% for drugs and biologics that are administered on an outpatient basis. When the effects of federal budget sequestration are factored in, that pay rate drops by 2%, which means that oncologists are often barely able to cover the cost of a drug, according to an American Society of Clinical Oncology policy expert who spoke on background.
The final rule also requires outpatient departments to collect data on several new performance measures, including influenza vaccination among health care personnel, appropriate follow-up intervals for normal colonoscopy in average-risk patients, avoidance of inappropriate use of colonoscopy follow-up in patients with a history of polyps, and improvement in visual function within 90 days of cataract surgery.
Ambulatory surgical centers (ASCs)will have to collect data on the two colonoscopy measures and the cataract measure. The data will be used to set payments in 2016.
The CMS removed the requirement that hospitals document referrals from the outpatient setting to cardiac rehabilitation, saying that it was too burdensome.
The final rule also established the performance period (all of 2014) and baseline period (all of 2012) for measuring catheter-associated urinary tract infection, central line-associated bloodstream infection, and surgical site infection measures for the Hospital Value-Based Purchasing Program in 2016.
The final Hospital Outpatient Prospective Payment System (OPPS) rule applies to more than 4,000 hospitals, including general acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, long-term acute care hospitals, children’s hospitals, and cancer hospitals, and also 5,000 Medicare-participating ASCs. The OPPS covers most outpatient services, and partial hospitalization at outpatient departments and community mental health centers. The CMS estimates that in 2014, the agency will pay $50 billion for outpatient procedures and about $4 billion for ASC procedures.
The rule is open for comment at www.regulations.gov until Jan. 27, 2014.
On Twitter @aliciaault
Payments for outpatient services and those provided at ambulatory surgical centers will be bundled in the same way as inpatient procedures, with exceptions for some cardiology-related services, under the final rule for Medicare’s 2014 Hospital Outpatient Prospective Payment System.
Further, five levels of outpatient codes for both new and established patients will be replaced with a single code for all visits, according to the final rule.
Having a single code and a single payment "is more administratively simple for hospitals and better reflects hospital resources involved in supporting an outpatient visit," according to a statement from the Centers for Medicare and Medicaid Services.
Under the final rule, supporting items and services associated with a procedure are bundled into a single payment, including drugs, biologicals, and radiopharmaceuticals that function as supplies when used in a diagnostic test or procedure; drugs and biologicals that function as supplies when used in a surgical procedure, including skin substitutes; certain clinical diagnostic laboratory services; certain procedures that are never done without a primary procedure, and device removal procedures.
The bundling of these services and supplies will create efficiencies and lower costs, CMS Principal Deputy Administrator Jon Blum, said in a statement. The final rule "gives hospitals a stake in managing their resources to generate better coordinated and, ultimately, more affordable outpatient care," he added.
Officials at the American College of Cardiology said they were pleased to see that the CMS did not bundle imaging services such as echocardiography, as had been initially proposed. The organization says this is because of "significant lobbying work" by the ACC and the American Society of Echocardiography.
Cardiologists also got a reprieve when the agency delayed until 2015 bundled payment for percutaneous coronary interventions and placement of implantable cardioverter defibrillators.
The final rule was not so favorable for oncologists. The rule continues the practice of paying average sales price plus 6% for drugs and biologics that are administered on an outpatient basis. When the effects of federal budget sequestration are factored in, that pay rate drops by 2%, which means that oncologists are often barely able to cover the cost of a drug, according to an American Society of Clinical Oncology policy expert who spoke on background.
The final rule also requires outpatient departments to collect data on several new performance measures, including influenza vaccination among health care personnel, appropriate follow-up intervals for normal colonoscopy in average-risk patients, avoidance of inappropriate use of colonoscopy follow-up in patients with a history of polyps, and improvement in visual function within 90 days of cataract surgery.
Ambulatory surgical centers (ASCs)will have to collect data on the two colonoscopy measures and the cataract measure. The data will be used to set payments in 2016.
The CMS removed the requirement that hospitals document referrals from the outpatient setting to cardiac rehabilitation, saying that it was too burdensome.
The final rule also established the performance period (all of 2014) and baseline period (all of 2012) for measuring catheter-associated urinary tract infection, central line-associated bloodstream infection, and surgical site infection measures for the Hospital Value-Based Purchasing Program in 2016.
The final Hospital Outpatient Prospective Payment System (OPPS) rule applies to more than 4,000 hospitals, including general acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, long-term acute care hospitals, children’s hospitals, and cancer hospitals, and also 5,000 Medicare-participating ASCs. The OPPS covers most outpatient services, and partial hospitalization at outpatient departments and community mental health centers. The CMS estimates that in 2014, the agency will pay $50 billion for outpatient procedures and about $4 billion for ASC procedures.
The rule is open for comment at www.regulations.gov until Jan. 27, 2014.
On Twitter @aliciaault
Payments for outpatient services and those provided at ambulatory surgical centers will be bundled in the same way as inpatient procedures, with exceptions for some cardiology-related services, under the final rule for Medicare’s 2014 Hospital Outpatient Prospective Payment System.
Further, five levels of outpatient codes for both new and established patients will be replaced with a single code for all visits, according to the final rule.
Having a single code and a single payment "is more administratively simple for hospitals and better reflects hospital resources involved in supporting an outpatient visit," according to a statement from the Centers for Medicare and Medicaid Services.
Under the final rule, supporting items and services associated with a procedure are bundled into a single payment, including drugs, biologicals, and radiopharmaceuticals that function as supplies when used in a diagnostic test or procedure; drugs and biologicals that function as supplies when used in a surgical procedure, including skin substitutes; certain clinical diagnostic laboratory services; certain procedures that are never done without a primary procedure, and device removal procedures.
The bundling of these services and supplies will create efficiencies and lower costs, CMS Principal Deputy Administrator Jon Blum, said in a statement. The final rule "gives hospitals a stake in managing their resources to generate better coordinated and, ultimately, more affordable outpatient care," he added.
Officials at the American College of Cardiology said they were pleased to see that the CMS did not bundle imaging services such as echocardiography, as had been initially proposed. The organization says this is because of "significant lobbying work" by the ACC and the American Society of Echocardiography.
Cardiologists also got a reprieve when the agency delayed until 2015 bundled payment for percutaneous coronary interventions and placement of implantable cardioverter defibrillators.
The final rule was not so favorable for oncologists. The rule continues the practice of paying average sales price plus 6% for drugs and biologics that are administered on an outpatient basis. When the effects of federal budget sequestration are factored in, that pay rate drops by 2%, which means that oncologists are often barely able to cover the cost of a drug, according to an American Society of Clinical Oncology policy expert who spoke on background.
The final rule also requires outpatient departments to collect data on several new performance measures, including influenza vaccination among health care personnel, appropriate follow-up intervals for normal colonoscopy in average-risk patients, avoidance of inappropriate use of colonoscopy follow-up in patients with a history of polyps, and improvement in visual function within 90 days of cataract surgery.
Ambulatory surgical centers (ASCs)will have to collect data on the two colonoscopy measures and the cataract measure. The data will be used to set payments in 2016.
The CMS removed the requirement that hospitals document referrals from the outpatient setting to cardiac rehabilitation, saying that it was too burdensome.
The final rule also established the performance period (all of 2014) and baseline period (all of 2012) for measuring catheter-associated urinary tract infection, central line-associated bloodstream infection, and surgical site infection measures for the Hospital Value-Based Purchasing Program in 2016.
The final Hospital Outpatient Prospective Payment System (OPPS) rule applies to more than 4,000 hospitals, including general acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, long-term acute care hospitals, children’s hospitals, and cancer hospitals, and also 5,000 Medicare-participating ASCs. The OPPS covers most outpatient services, and partial hospitalization at outpatient departments and community mental health centers. The CMS estimates that in 2014, the agency will pay $50 billion for outpatient procedures and about $4 billion for ASC procedures.
The rule is open for comment at www.regulations.gov until Jan. 27, 2014.
On Twitter @aliciaault
Can Congress fix the SGR this year?
WASHINGTON – Once again, Congress will likely scramble at year’s end to make a last-minute decision on the Medicare Sustainable Growth Rate formula, Rep. Michael Burgess (R-Texas) said at a forum on physician payment.
Although the House Energy and Commerce committee passed an SGR replacement bill in July, the Senate Finance committee is slated to make final changes its proposal by early December, said Rep. Burgess, an ob.gyn.
Rep. Burgess is the lead sponsor of the Energy and Commerce Committee bill, the Medicare Patient Access and Quality Improvement Act of 2013. If enacted, that legislation would replace the SGR with a 0.5% payment increase for physicians from 2014 through 2018. It would continue to support fee-for-service medicine, but also encourage the formation of new delivery models and reward reporting of quality data.
The December timeline in the Senate "is going to push us pretty close to the deadline, and that’s once again a very uncomfortable place to be," he said, adding that the House is scheduled to recess on Dec. 13.
Even if the Finance Committee approves its proposal, which was developed with the House Ways and Means Committee, the legislation would have to be reconciled with the Energy and Commerce bill. One key difference: The Finance/Ways and Means proposal would freeze physician payments for 10 years, which physician groups oppose.
Any final bill would then have to be approved by both the full House and full Senate – all of which would have to be accomplished before year’s end, since the SGR calls for a 25% cut in Medicare fees on Jan. 1. The tight timeframe raises the specter of a temporary deal – or a patch – to avoid the cut.
"A patch would look a lot like the opposite of success to me," Rep. Burgess said. He added that "as long as we are moving in the right direction, I won’t say no to a patch."
He said that he would not approve of such a deal if it was struck solely because Congress had not worked hard enough to achieve a meaningful SGR replacement.
Rep. Burgess noted that the cost of repeal – estimated at $150 billion to $200 billion over 10 years – is about the same as is already being spent each year just to avoid the statutory cuts.
Congressional leaders have yet to discuss how to pay for an SGR fix, he said, because they want to first develop a policy on which legislators, doctors, and the Centers for Medicare and Medicaid Services can agree. He acknowledged that finding a funding mechanism would be painful but should not derail SGR replacement efforts.
Figuring out how to reform physician payment going forward remains a thorny issue, according to congressional staff members at the forum.
Legislators understand from their constituents that many physicians aren’t ready to move away from fee-for-service medicine, so they have been wrestling with how to create incentives to embrace alternative payment systems and quality measures.
Staff members urged physicians to unify around the proposals in front of Congress now. "It’s awfully important for the physician community to say ‘we actually like this, we think this works, we think we should do this,’ " said Dan Todd, who works on the Senate Finance Committee’s Republican staff.
Getting the final bill right is critically important as well, said Amy Hall, who works on the House Ways and Means Committee’s Democratic staff. "We don’t want to be back here in 5 years repealing the SGR repeal bill."
On Twitter @aliciaault
WASHINGTON – Once again, Congress will likely scramble at year’s end to make a last-minute decision on the Medicare Sustainable Growth Rate formula, Rep. Michael Burgess (R-Texas) said at a forum on physician payment.
Although the House Energy and Commerce committee passed an SGR replacement bill in July, the Senate Finance committee is slated to make final changes its proposal by early December, said Rep. Burgess, an ob.gyn.
Rep. Burgess is the lead sponsor of the Energy and Commerce Committee bill, the Medicare Patient Access and Quality Improvement Act of 2013. If enacted, that legislation would replace the SGR with a 0.5% payment increase for physicians from 2014 through 2018. It would continue to support fee-for-service medicine, but also encourage the formation of new delivery models and reward reporting of quality data.
The December timeline in the Senate "is going to push us pretty close to the deadline, and that’s once again a very uncomfortable place to be," he said, adding that the House is scheduled to recess on Dec. 13.
Even if the Finance Committee approves its proposal, which was developed with the House Ways and Means Committee, the legislation would have to be reconciled with the Energy and Commerce bill. One key difference: The Finance/Ways and Means proposal would freeze physician payments for 10 years, which physician groups oppose.
Any final bill would then have to be approved by both the full House and full Senate – all of which would have to be accomplished before year’s end, since the SGR calls for a 25% cut in Medicare fees on Jan. 1. The tight timeframe raises the specter of a temporary deal – or a patch – to avoid the cut.
"A patch would look a lot like the opposite of success to me," Rep. Burgess said. He added that "as long as we are moving in the right direction, I won’t say no to a patch."
He said that he would not approve of such a deal if it was struck solely because Congress had not worked hard enough to achieve a meaningful SGR replacement.
Rep. Burgess noted that the cost of repeal – estimated at $150 billion to $200 billion over 10 years – is about the same as is already being spent each year just to avoid the statutory cuts.
Congressional leaders have yet to discuss how to pay for an SGR fix, he said, because they want to first develop a policy on which legislators, doctors, and the Centers for Medicare and Medicaid Services can agree. He acknowledged that finding a funding mechanism would be painful but should not derail SGR replacement efforts.
Figuring out how to reform physician payment going forward remains a thorny issue, according to congressional staff members at the forum.
Legislators understand from their constituents that many physicians aren’t ready to move away from fee-for-service medicine, so they have been wrestling with how to create incentives to embrace alternative payment systems and quality measures.
Staff members urged physicians to unify around the proposals in front of Congress now. "It’s awfully important for the physician community to say ‘we actually like this, we think this works, we think we should do this,’ " said Dan Todd, who works on the Senate Finance Committee’s Republican staff.
Getting the final bill right is critically important as well, said Amy Hall, who works on the House Ways and Means Committee’s Democratic staff. "We don’t want to be back here in 5 years repealing the SGR repeal bill."
On Twitter @aliciaault
WASHINGTON – Once again, Congress will likely scramble at year’s end to make a last-minute decision on the Medicare Sustainable Growth Rate formula, Rep. Michael Burgess (R-Texas) said at a forum on physician payment.
Although the House Energy and Commerce committee passed an SGR replacement bill in July, the Senate Finance committee is slated to make final changes its proposal by early December, said Rep. Burgess, an ob.gyn.
Rep. Burgess is the lead sponsor of the Energy and Commerce Committee bill, the Medicare Patient Access and Quality Improvement Act of 2013. If enacted, that legislation would replace the SGR with a 0.5% payment increase for physicians from 2014 through 2018. It would continue to support fee-for-service medicine, but also encourage the formation of new delivery models and reward reporting of quality data.
The December timeline in the Senate "is going to push us pretty close to the deadline, and that’s once again a very uncomfortable place to be," he said, adding that the House is scheduled to recess on Dec. 13.
Even if the Finance Committee approves its proposal, which was developed with the House Ways and Means Committee, the legislation would have to be reconciled with the Energy and Commerce bill. One key difference: The Finance/Ways and Means proposal would freeze physician payments for 10 years, which physician groups oppose.
Any final bill would then have to be approved by both the full House and full Senate – all of which would have to be accomplished before year’s end, since the SGR calls for a 25% cut in Medicare fees on Jan. 1. The tight timeframe raises the specter of a temporary deal – or a patch – to avoid the cut.
"A patch would look a lot like the opposite of success to me," Rep. Burgess said. He added that "as long as we are moving in the right direction, I won’t say no to a patch."
He said that he would not approve of such a deal if it was struck solely because Congress had not worked hard enough to achieve a meaningful SGR replacement.
Rep. Burgess noted that the cost of repeal – estimated at $150 billion to $200 billion over 10 years – is about the same as is already being spent each year just to avoid the statutory cuts.
Congressional leaders have yet to discuss how to pay for an SGR fix, he said, because they want to first develop a policy on which legislators, doctors, and the Centers for Medicare and Medicaid Services can agree. He acknowledged that finding a funding mechanism would be painful but should not derail SGR replacement efforts.
Figuring out how to reform physician payment going forward remains a thorny issue, according to congressional staff members at the forum.
Legislators understand from their constituents that many physicians aren’t ready to move away from fee-for-service medicine, so they have been wrestling with how to create incentives to embrace alternative payment systems and quality measures.
Staff members urged physicians to unify around the proposals in front of Congress now. "It’s awfully important for the physician community to say ‘we actually like this, we think this works, we think we should do this,’ " said Dan Todd, who works on the Senate Finance Committee’s Republican staff.
Getting the final bill right is critically important as well, said Amy Hall, who works on the House Ways and Means Committee’s Democratic staff. "We don’t want to be back here in 5 years repealing the SGR repeal bill."
On Twitter @aliciaault
AT THE BROOKINGS INSTITUTION
AMA delegates take on SGR, ICD-10, grace period for exchange plans
NATIONAL HARBOR, MD. – Money issues, notably the Medicare Sustainable Growth Rate formula and ICD-10, dominated deliberations at the American Medical Association Interim House of Delegates meeting.
"The AMA has heard the nation’s physicians, and we’re pulling out the stops to get Congress to act and take a fiscally responsible course that will stop the annual cycle of draconian Medicare cuts and short-term patches," Dr. Ardis Dee Hoven, AMA president, said in a statement after the delegates voted on Nov. 18.
There was some dissent over what the AMA should ask for in terms of a replacement for the Sustainable Growth Rate (SGR) formula, but most resolutions relating to alternative approaches were struck down, with one exception: a request that the organization continue to push for annual increases in physician fees going forward.
The AMA previously had indicated its opposition to a provision in the proposal by the Senate Finance Committee and the House Ways and Means Committee to freeze payments for 10 years.
"This year, we have the opportunity to speak with a voice that will actually resonate across the country," said Dr. Richard E. Thorp,president of the California Medical Association. He noted that the House of Delegates had "spent a significant amount of time trying to develop a unified message," which it now had done. "The SGR needs to be put to bed, buried, pour concrete in it. We’ve got to get an end to this thing," said Dr. Thorp.
Dr. Corey Howard, chair of the Florida delegation, agreed. "This is absolutely the right time, with the right message, and it needs to be done now."
AMA delegates also reiterated their concerns about the implementation of the latest iteration of the International Classification of Diseases – ICD-10 – calling for a delay. The coding system is set to launch on Oct. 1, 2014.
"If you like the implementation of the ACA on Oct. 1, 2013, you’re going to love the implementation of ICD-10 on Oct. 1, 2014," said Dr. Gary Bryant, a delegate from the American College of Rheumatology.
The ACR sought a permanent delay to ICD-10 implementation at the House of Delegates annual meeting in June. The House instead approved a resolution calling for the AMA to seek legislation to delay the implementation by 2 years.
The AMA has estimated that it will cost from $83,290 to $2.7 million per practice, depending on size, to implement ICD-10.
The House of Delegates also expressed concern about an Affordable Care Act provision that allows insurers to deny payment for medical care if the patient does not pay his or her health insurance premiums. Under the law, patients can take up to 90 days to pay premiums on policies bought through the health insurance exchanges, yet still get covered services. If the patient skips out on premiums all together, insurers do not have to pay for care that has been provided.
The California delegation offered a resolution to require insurers to pay for services rendered if a patient had eligibility and authorized coverage. The resolution also called on the AMA to oppose efforts to mandate physician participation in exchange plans.
The House voted to support most of the resolution, but in a modification, asked the AMA to advocate that health plans be required to notify physicians that a patient is in the grace period, and which month the patient is in. If physicians are not notified, it would result in a binding eligibility determination for the insurer.
Finally, the delegates called on the Centers for Disease Control and Prevention to collect more detailed data on prescription drug abuse.
"The AMA will urge the CDC to take the lead in promoting a standard approach for documenting and assessing unintentional poisonings and deaths involving controlled substances for pain relief," Dr. Patrice Harris, an AMA board member, said in a statement. "If we are to effectively fight this public health epidemic, we must have a system of data collection and analysis that provides more detailed information on the contributing factors."
On Twitter @aliciaault
NATIONAL HARBOR, MD. – Money issues, notably the Medicare Sustainable Growth Rate formula and ICD-10, dominated deliberations at the American Medical Association Interim House of Delegates meeting.
"The AMA has heard the nation’s physicians, and we’re pulling out the stops to get Congress to act and take a fiscally responsible course that will stop the annual cycle of draconian Medicare cuts and short-term patches," Dr. Ardis Dee Hoven, AMA president, said in a statement after the delegates voted on Nov. 18.
There was some dissent over what the AMA should ask for in terms of a replacement for the Sustainable Growth Rate (SGR) formula, but most resolutions relating to alternative approaches were struck down, with one exception: a request that the organization continue to push for annual increases in physician fees going forward.
The AMA previously had indicated its opposition to a provision in the proposal by the Senate Finance Committee and the House Ways and Means Committee to freeze payments for 10 years.
"This year, we have the opportunity to speak with a voice that will actually resonate across the country," said Dr. Richard E. Thorp,president of the California Medical Association. He noted that the House of Delegates had "spent a significant amount of time trying to develop a unified message," which it now had done. "The SGR needs to be put to bed, buried, pour concrete in it. We’ve got to get an end to this thing," said Dr. Thorp.
Dr. Corey Howard, chair of the Florida delegation, agreed. "This is absolutely the right time, with the right message, and it needs to be done now."
AMA delegates also reiterated their concerns about the implementation of the latest iteration of the International Classification of Diseases – ICD-10 – calling for a delay. The coding system is set to launch on Oct. 1, 2014.
"If you like the implementation of the ACA on Oct. 1, 2013, you’re going to love the implementation of ICD-10 on Oct. 1, 2014," said Dr. Gary Bryant, a delegate from the American College of Rheumatology.
The ACR sought a permanent delay to ICD-10 implementation at the House of Delegates annual meeting in June. The House instead approved a resolution calling for the AMA to seek legislation to delay the implementation by 2 years.
The AMA has estimated that it will cost from $83,290 to $2.7 million per practice, depending on size, to implement ICD-10.
The House of Delegates also expressed concern about an Affordable Care Act provision that allows insurers to deny payment for medical care if the patient does not pay his or her health insurance premiums. Under the law, patients can take up to 90 days to pay premiums on policies bought through the health insurance exchanges, yet still get covered services. If the patient skips out on premiums all together, insurers do not have to pay for care that has been provided.
The California delegation offered a resolution to require insurers to pay for services rendered if a patient had eligibility and authorized coverage. The resolution also called on the AMA to oppose efforts to mandate physician participation in exchange plans.
The House voted to support most of the resolution, but in a modification, asked the AMA to advocate that health plans be required to notify physicians that a patient is in the grace period, and which month the patient is in. If physicians are not notified, it would result in a binding eligibility determination for the insurer.
Finally, the delegates called on the Centers for Disease Control and Prevention to collect more detailed data on prescription drug abuse.
"The AMA will urge the CDC to take the lead in promoting a standard approach for documenting and assessing unintentional poisonings and deaths involving controlled substances for pain relief," Dr. Patrice Harris, an AMA board member, said in a statement. "If we are to effectively fight this public health epidemic, we must have a system of data collection and analysis that provides more detailed information on the contributing factors."
On Twitter @aliciaault
NATIONAL HARBOR, MD. – Money issues, notably the Medicare Sustainable Growth Rate formula and ICD-10, dominated deliberations at the American Medical Association Interim House of Delegates meeting.
"The AMA has heard the nation’s physicians, and we’re pulling out the stops to get Congress to act and take a fiscally responsible course that will stop the annual cycle of draconian Medicare cuts and short-term patches," Dr. Ardis Dee Hoven, AMA president, said in a statement after the delegates voted on Nov. 18.
There was some dissent over what the AMA should ask for in terms of a replacement for the Sustainable Growth Rate (SGR) formula, but most resolutions relating to alternative approaches were struck down, with one exception: a request that the organization continue to push for annual increases in physician fees going forward.
The AMA previously had indicated its opposition to a provision in the proposal by the Senate Finance Committee and the House Ways and Means Committee to freeze payments for 10 years.
"This year, we have the opportunity to speak with a voice that will actually resonate across the country," said Dr. Richard E. Thorp,president of the California Medical Association. He noted that the House of Delegates had "spent a significant amount of time trying to develop a unified message," which it now had done. "The SGR needs to be put to bed, buried, pour concrete in it. We’ve got to get an end to this thing," said Dr. Thorp.
Dr. Corey Howard, chair of the Florida delegation, agreed. "This is absolutely the right time, with the right message, and it needs to be done now."
AMA delegates also reiterated their concerns about the implementation of the latest iteration of the International Classification of Diseases – ICD-10 – calling for a delay. The coding system is set to launch on Oct. 1, 2014.
"If you like the implementation of the ACA on Oct. 1, 2013, you’re going to love the implementation of ICD-10 on Oct. 1, 2014," said Dr. Gary Bryant, a delegate from the American College of Rheumatology.
The ACR sought a permanent delay to ICD-10 implementation at the House of Delegates annual meeting in June. The House instead approved a resolution calling for the AMA to seek legislation to delay the implementation by 2 years.
The AMA has estimated that it will cost from $83,290 to $2.7 million per practice, depending on size, to implement ICD-10.
The House of Delegates also expressed concern about an Affordable Care Act provision that allows insurers to deny payment for medical care if the patient does not pay his or her health insurance premiums. Under the law, patients can take up to 90 days to pay premiums on policies bought through the health insurance exchanges, yet still get covered services. If the patient skips out on premiums all together, insurers do not have to pay for care that has been provided.
The California delegation offered a resolution to require insurers to pay for services rendered if a patient had eligibility and authorized coverage. The resolution also called on the AMA to oppose efforts to mandate physician participation in exchange plans.
The House voted to support most of the resolution, but in a modification, asked the AMA to advocate that health plans be required to notify physicians that a patient is in the grace period, and which month the patient is in. If physicians are not notified, it would result in a binding eligibility determination for the insurer.
Finally, the delegates called on the Centers for Disease Control and Prevention to collect more detailed data on prescription drug abuse.
"The AMA will urge the CDC to take the lead in promoting a standard approach for documenting and assessing unintentional poisonings and deaths involving controlled substances for pain relief," Dr. Patrice Harris, an AMA board member, said in a statement. "If we are to effectively fight this public health epidemic, we must have a system of data collection and analysis that provides more detailed information on the contributing factors."
On Twitter @aliciaault
AT THE AMA INTERIM HOUSE OF DELEGATES
