Every January, new billing rules and rates go into place for physicians’ services as part of the annual update to Medicare’s Physician Fee Schedule. Dominating DC health policy concerns in this arena are the medical community’s efforts with Congress to address Medicare’s cost-of-living adjuster, known as the “sustainable growth rate” (SGR), which would have lowered 2010 fees across-the-board by 21 percent, if not for a last-minute temporary stay through the end of February. Negotiations with Congress are on-going to provide a long term or multi-year solution—a costly “fix” that I believe is well worth the price to keep physicians in the Medicare program, and seems to have widespread support.

Getting much less attention is a unilateral policy pronouncement made by the Centers for Medicare and Medicaid (CMS) that Medicare will no longer pay specialists a higher rate for consultations—services often provided by specialists like cardiologists and neurologists. Instead, all physician visit services, whether defined as “evaluation and management” (E&M) services or consultations, will be reimbursed at the same E&M rates. (more…)

In the midst of furious showdowns on health care reform at town hall meetings, a moment of peace surfaced in Montana when President Obama drew bipartisan applause after calling a mother heroic.  This mother of two had voiced her concern about the Medicaid program she relied on for her child who has multiple chronic conditions.  The president reassured her and went on to discuss how our disease-care system does not proactively manage chronic conditions.

Children and young adults with chronic medical conditions and disabilities (CMCD) need proactive management now and for their entire lives.  Our health care system fails to serve the young people who need it the most.

Children with CMCD are completely dependent on adults for their health care.  Poor health management negatively affects their growth and development, education, and socialization – and drags the entire family down.  As the mother of a young adult with CMCD and the founder of a non-profit created because of our experiences with poor quality health care, I cannot understand why this population is not a major focus of health care reform.

One path to start on is to build on successful programs to create a comprehensive system of care.  Take a look at the 35% of children with CMCD covered by SCHIP/Medicaid. Medicaid provides a specialized set of comprehensive services known as EPSDT, Early Periodic Screening, Diagnosis, and Treatment Program. The current model of care in favor for chronic conditions is the medical home. First conceptualized by the American Academy of Pediatrics for children with CMCD in the 1960s, the medical home has yet to become the standard of care for children with CMCD in Medicaid.  Pairing EPSDT with the medical home would be a step forward in developing a system of care for children covered by Medicaid.    Another step is to expand EPSDT and medical homes to cover the remaining publicly covered children with CMCD enrolled in SCHIP.

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On the New Health Dialogue blog, Paul Testa analyzed the ongoing public debate about comparative effectiveness research:

The New York Times‘ Robert Pear examines the content and contentiousness of the comparative effectiveness provisions of the $787 billion stimulus package. HR 1 provides $1.1 billion (pdf starting on page 156) to AHRQ, NIH and the HHS to evaluate the relative effectiveness of different health care services and treatment options. The goal is to create a process of funding and disseminating comparative effectiveness research that is transparent, professional and free from conflicts of interests. As the Dartmouth Atlas’ Elliott S. Fisher, MD, tells Pear, the funding would be used to try to answer questions such as:

… What is the best combination of “talk therapy” and prescription drugs to treat mild depression?
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Is it better to treat chronic heart failure by medications alone or by drugs and home monitoring of a patient’s blood pressure and weight?

In health care, though, simple questions rarely have simple answers. Nor will answers be static; biomedical science changes at a pretty astonishing clip. We wrote about this topic twice last week, and we expect to hear more about it as the health reform debate intensifies. Last week Kyle Noonan wrote about some of the alarmist rhetoric surrounding the issue, and Joanne Kenen wrote a longer piece about how comparative effectiveness fits into “health” as well as health care reform. We also want to point out Bob Laszewski’s posts at the Health Care Policy and Market Place Review, which has provided interesting coverage on this topic.
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Beginning to measure what works best for what patients or populations under what circumstances can provide a baseline. Providers and patients will have access to information that will help them better understand their choices and the likely consequences. Providing that information in a manner that is transparent, credible, and easily understood will go a long way to ensuring that all Americans receive the most effective care whether they live in Florida or Nebraska or California.

At Science-Based Medicine, Peter Lipson shared his perspective on comparative effectiveness research: (more…)

One of the best things about blogging is the opportunity it provides to “meet” some incredible people. I’d like to introduce you to one of them, Carrie Ostrea, Hannah’s mom. Hannah was born with Gaucher’s Disease—a rare disease. Carrie is on a mission—she shared the following with me and asked if I would help “get the word out” about her efforts, her Hannah, and her hope to make change. A Disruptive Woman in every sense of the word.

To learn more, read on:

It is so important to me that awareness be created regarding the Ryan Dant bill as well as rare diseases such as Gaucher’s Disease. That is why I’ve dedicated my blog not only to sharing updates with family and friends, but to create awareness for rare diseases, legislation, and other life experiences raising a child and family with unique special needs.

Here are some details regarding the Ryan Dant bill. I have actually been emailing with Mark Dant, Ryan’s Dad, about getting Hannah very much involved.

Basically, the bill will remove the income requirement for Medicaid if the applicant’s medical treatment would cost more than $250,000 a year (Hannah’s medication will cost about $250,000 to $300,000 a year as an adult, and that doesn’t include doctor’s fees, other procedures, therapies, and surgeries). If Hannah was a young adult, she would have to get a low-paying job (poverty level) in order to get Medicaid for her treatments because there are very few insurance companies that would accept an adult with that kind of insurance cost.

Here is a copy of my letter.

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The holidays are upon us, and we all know what that means for health issues — besides higher sugar and alcohol intake. That’s right, healthcare reform house parties! Check out the message from HHS Secretary nominee Tom Daschle below, and learn more about hosting or attending a healthcare community discussion over the holidays.

Meanwhile, four issues dominating discussions around the web this week are the future of the FDA, the new Nursing Home Compare rating system and web site, physicians and health IT, and of course, healthcare reform issues.

At the Center for Medicine in the Public Interest DrugWonks blog, Peter Pitts shared his recommendations for reforming the Food and Drug Administration:

I was honored when the Obama FDA transition team called and asked for my advice on how the incoming administration could make the agency a more robust and forward-looking regulatory instrument.
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My suggested areas of focus are

1. A strong, science-based FDA
2. The Reagan/Udall Foundation — a Partnership of Unequals
3. Clarity vs. Ambiguity
4. Information Management
5. Food Safety and Security
6. Risk Communications
7. The Drug Label and the “Safe Use” of Drugs

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There are, obviously, many, many other important issues … and I look forward to working with the transition team to ensure that the new commissioner can hit the ground running… And kudos to the Obama transition team for reaching out to a wide variety of groups.

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Given the historic opportunity to lead the nation as it transforms to a nation that is about to become a majority of current minority populations, President Elect Obama and his Transition Team, announced this week, should consider identifying a diverse leadership among the political appointees in the health related positions–not just HHS, VA, DOD, but at the White House-–to develop a realistic transformation in the health care reform policy making process. There is a critical need to consider health care reform that allows the health system to become more responsive to the new America with cultural competence and literacy as well as including issues based on the social determinants of health. The President-Elect plan for access to care and quality health care that addresses health disparities is a vision needed sooner than later in order to prepare for the changing population. And of course, the health of minority women and their families needs to become a priority item as the policy making starts after January with the attention to helping them through SCHIP, Medicaid and Medicare.