Monday, July 14, 2008
The Wall Street Journal reports that auditors have recovered nearly $700 million in Medicare overpayments to hospitals and other medical providers. Theo Francis writes,
Auditors have recovered nearly $700 million in Medicare overpayments to hospitals and other medical providers in a half-dozen states under a controversial program that pays the auditing firms a portion of amounts they identify.
The program has drawn fire from health-care providers, and hospitals in particular, who call it overly aggressive and too confrontational. But the federal Centers for Medicare and Medicaid Services has supported the move and is in the process of expanding it nationally.
In all, the agency's recovery audit contractor program caught $1.03 billion of improper payments over about three years, primarily in New York, California and Florida, about $992.7 million of which was overpayments by Medicare. The audits also identified about $38 million that providers should have received but didn't. (Three states were added toward the end of the trial program, but accounted for only a small part of the recoveries, Medicare officials said.)
Criticism of the recent Medicare Bill approval continues as New York Times' writer, Robert Pear, reports that although cuts in Medicare payments to doctors have been blocked, nothing has been done to solve the problem that caused the cut in the first place. Pear writes,
Congress has voted to block a cut in Medicare payments to doctors but has done nothing to solve the fundamental problem that caused the cut, and the issue will come back to haunt the next president and the next Congress, lawmakers and health policy experts say.
Democrats and Republicans agree that the formula for paying doctors is broken, but fixing it would be phenomenally expensive, they say. So Congress provides temporary relief from year to year, the same way it takes care of the Alternative Minimum Tax, which snares more middle-income families every year.
Older Americans are directly affected because they pay higher premiums when Medicare spends more on doctors.
Barack Obama proposes to give tax credits to small businesses that provide health insurance plans. Small businesses would get a refundable credit of up to 50 percent on premiums paid on behalf of their employees, but will have to offer a quality health plan to all of their employees and cover a meaningful share of the cost of employee health premiums. The Washington Post reports,
In a speech to Latino voters of the National Council of La Raza in San Diego, Obama gave credit for the idea to Sen. Hillary Clinton, whom he defeated in a hard-fought primary for the Democratic nomination for November's election.
"Today, I'm announcing my plan to provide real relief for small business owners crushed by rising costs, an idea by the way that was championed by my friend Hillary Clinton, who's been leading the way in our battle to insure every American," Obama said.
Today, in part because of his contributions, it routinely saves thousands of lives each day.
DeBakey, a world-famous cardiovascular surgeon who pioneered such now-common procedures as bypass surgery and invented a host of devices to help heart patients, died Friday night [July 11, 2008] in Houston. He was 99.
Sunday, July 13, 2008
The New York Times reports on the uneasiness felt by many regarding paid consulting arrangements between doctors and drug companies. Many people fear that these arrangements lead to bias within the industry and impede advancement. The American Psychiatric Association is being demanded to give an accounting of its financing and university officials are monitoring payments by drug companies to doctors more closely. Benedict Carey and Gardiner Harris write,
It seemed an ideal marriage, a scientific partnership that would attack mental illness from all sides. Psychiatrists would bring to the union their expertise and clinical experience, drug makers would provide their products and the money to run rigorous studies, and patients would get better medications, faster.
But now the profession itself is under attack in Congress, accused of allowing this relationship to become too cozy. After a series of stinging investigations of individual doctors’ arrangements with drug makers, Senator Charles E. Grassley, Republican of Iowa, is demanding that the American Psychiatric Association, the field’s premier professional organization, give an accounting of its financing...
“I have come to understand that money from the pharmaceutical industry can shape the practices of nonprofit organizations that purport to be independent in their viewpoints and actions,” Mr. Grassley said Thursday in a letter to the association.
In 2006, the latest year for which numbers are available, the drug industry accounted for about 30 percent of the association’s $62.5 million in financing. About half of that money went to drug advertisements in psychiatric journals and exhibits at the annual meeting, and the other half to sponsor fellowships, conferences and industry symposiums at the annual meeting.
This weekend in Chicago, the psychiatry association’s board will meet behind closed doors, in part to discuss how to respond to the increasingly intense scrutiny and questions about conflicts of interest.
The New York Times reports on the nation's salmonella outbreak and the urge for better laws that will allow people to trace contamination. Bina Venkataraman writes,
More than 1,000 people in 41 states and the District of Columbia have now been sickened in the nation’s salmonella outbreak, in what officials said Wednesday [July 9, 2008] was the largest food-borne outbreak in the last decade. And some food safety experts this week tied problems in tracing the source of the contamination to what they say are shortcomings in the Bioterrorism Act of 2002.
Federal investigators have now linked at least some of the outbreak to fresh jalapeños, Dr. Robert Tauxe of the Centers for Disease Control and Prevention said, though they have not ruled out tomatoes.
But officials have still not pinpointed the source of the contamination. Nor do they know the country or state where the tainted produce was grown, despite a rule issued by the Food and Drug Administration under the bioterrorism law that was intended to give federal officials a way to respond immediately to threats to the nation’s food supply.
The rule requires importers, processors and distributors to keep track of where they buy produce and where it goes. A major hurdle facing investigators in this outbreak, however, is that processors frequently repack boxes of tomatoes to meet a buyer’s demands. In doing so, officials said, they are not required to record the tomatoes’ farm, state or even country of origin.
“The purpose of the recordkeeping provision of the Bioterrorism Act was to support going back to the origin of food after people have gotten sick when you are trying to find out how the biological agent got there,” said Michael Taylor, a professor at the George Washington University and a former F.D.A. official. “But the provisions are of little or no value with respect to trace-backs of fresh produce because of the amount of shoe leather and time it would take.”
The rule requires only that produce handlers keep track of food one step back and one step forward in the supply chain and does not apply to retailers or growers. Because the rule does not specify the format for records, investigators are sifting through a hodgepodge of paper trails to identify the source of the contaminated produce.
“It’s clear that the F.D.A. is not equipped to deal with a trace-back of the magnitude that they are dealing with right now,” said Mike Doyle, director of the center for food safety at the University of Georgia.
Several lawmakers and consumer advocates are calling for a system that requires the industry to track the entire history of food products. Some groups, like the Produce Marketing Association, said they would support national regulation.