By Maura Farrell, on February 27th, 2009
Print This PostArticle by Paul Campbell and Maura Farrell
The President’s 2010 Budget includes a $634 billion reserve fund for health reform, funded equally by tax revenue and budget savings. The Budget outlines $316 billion in Medicare and Medicaid savings; 58 percent of which will be generated by using a competitive bidding process to set Medicare Advantage rates. Hospitals and homecare providers would share almost one-quarter of the budget reductions. The hospital savings are associated with policy changes designed to reduce readmission rates and to bundle post-acute care services. The homecare savings are associated with reducing provider payments to reflect costs.
SECTORS IMPACTED BY FEDERAL SAVINGS IN PRESIDENT’S 2010 BUDGET
The Budget does not provide any specific information on the physician payment “fix”, except to say that “the baseline reflects our best estimate of what the Congress has done in recent years”. The potential “cliff” associated with the current fix, which expires on December 31, 2009, is shown in the following chart.
MEDICARE SPENDING IN 2010 BUDGET PERCENT CHANGE FROM PRIOR YEAR
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Presumably, the Administration will wait for Congress to address physician payment. In the meantime, the $430 billion moderate fix scored by CBO is not likely to compete for heath reform funds.
By Ted Mannen, on February 19th, 2009
Print This PostThe new economic stimulus law frames immediate nuts-and-bolts issues as Federal officials prepare to roll out ambitious new initiatives on comparative effectiveness research – research aimed at identifying which of two or more health care interventions produce better results for a given patient condition.
Comparative effectiveness is nothing new; there has long been authority for it in the law, though it gained widespread prominence only in 2003, with enactment of the so-called section 1013 comparative effectiveness program at AHRQ. What’s new is that the stimulus law heaps onto these existing authorities wheelbarrows-full of new money — $1.1 billion in all — while requiring Federal officials to make haste in how they spend it. For example, the new law requires the Institute of Medicine to publish recommendations by June 30 on national comparative effectiveness priorities. A new Federal Coordinating Council will be reviewing priorities, too, and generally trying to keep the greatly expanded research activities in synch.
For drug and device developers, an immediate task will be to ensure that the process for comparative effectiveness decisions is transparent and participatory. For example, the new law requires recipients of comparative effectiveness research funding to “offer an opportunity for public comment on the research,” but only “to the extent feasible.” Stakeholder will want to work with Federal officials to convert these and other references in the new law into fair and feasible ways for promoting openness and adequate public participation. More generally, because the new research funding is spread across a sizable number of current programs, governed by disparate existing statutes, it will be important to size up the protections that exist already and identify any areas that need strengthening.
This immediate phase of comparative effectiveness – getting the process right – calls to mind similar work that resulted in the relatively transparent process that CMS now uses to make Medicare national coverage decisions. Toiling in the vineyards of process can be a slog, but, in the end, can make for more informed decisions, too.
By Paul Campbell, on February 18th, 2009
Print This PostRationing healthcare was the buzz of talk radio yesterday as Rush Limbaugh warned that the stimulus bill’s $20 billion for health IT would undermine patient privacy while Betsy McCaughey made the rounds with Laura Ingraham and Glenn Beck to warn that the $1 billion in the stimulus bill for comparative effectiveness research, coupled with the new Office of the National Coordinator of Health Information Technology, will lead to the Daschle cure for reducing healthcare costs as outlined in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis”.
Comparative effectiveness is a relatively “wonky term” to generate the type of resonance it did in the first round of media coverage, as well as the subsequent vetting of McCaughey’s statements by MSNBC and CNN. The final stimulus bill represents a win for the House Democrats who fought back the Senate’s desire to limit the research to “clinical” effectiveness research rather than the broader “comparative” effectiveness research of the cost effectiveness of a technology or service as well as evaluating differences in the clinical benefit or outcomes of two or more healthcare services.
The Agency for Healthcare Research and Quality (AHRQ) is set to receive $300 million for comparative effectiveness research; a 20 fold budget increase for these activities which were initiated as a result of the Medicare Modernization Act (MMA) of 2003, passed by a Republican led Congress. The recent AHRQ tech assessment on CT colonography compared the cost effectiveness ratios for several types of screening tests for colorectal cancer (CRC). The report figured prominently in the draft coverage decision on CT colonography, issued earlier this week by the Center for Medicare and Medicaid Services (CMS).
CMS staff appear to prefer the use of comparative effectiveness research rather than limiting itself to clinical effectiveness research. The proposed coverage decision notes that if the Agency was to determine (in the next 90 days) that CT colonography is clinically effective, it would also need to determine if CT colonography is cost effective.
The stimulus bill’s conference report notes that comparative effectiveness research is not intended to be used to “mandate coverage, reimbursement, or other policies for any public or private payer”. While the research may not “mandate” coverage policy, it is possible that it will continue “inform” coverage policy.
The health IT and comparative effectiveness provisions represent a clear win for President Obama’s commitment to make a "down payment" on healthcare reform. No wonder wonky terms are drawing such fire.
