Insight, analysis & opinion from Joe Paduda
The latest shot in the battle against drug costs comes from the Centers for Medicaid and Medicare Services, which is reported to be denying coverage for off-label use of drugs such as Actiq and Fentora.
Whenever CMS moves, the healthcare world shakes, and this is no exception. There are a host of possible ‘downstream implications’ in areas as diverse as workers comp, formulary management, and hospice.
I’m on a brief vacation mountain biking in Moab, Utah. A gorgeous place, great people, great riding. And upon return from a long and tiring but very fun ride this am, I open up the latest from Fierce Healthcare to read reports about not one, but two reimbursement scams and one piece on docs who don’t disclose when they make mistakes.
That just crushed the hard-earned buzz.
I’ve been following Bob Laszewski’s views on Medicare Advantage with some interest. My take is the program is about to embark on a financial bread-and-water diet, a regimen prescribed by the Democratic Congress seeking funds to offset physician reimbursement increases (or more accurately to prevent decreases) and fund the S-CHIP program.
Bob’s view is that the rural programs will not suffer too much, while MA plans located in urban areas may well have their subsidies reduced. The MA program sponsors are now pulling out the lobbying stops, employing a variety of questionable and downright distasteful marketing.
The latest descent-to-previously-unplumbed-depths is their manipulation of minority groups as “victims” of the heartless Dems.
Two timely topics are in the news; the likelihood of cuts in the additional payments for Medicare Advantage programs and reductions in Medicare reimbursement rates for physicians.
The juxtaposition is just too…obvious to pass without comment.
Pundits and experts on the right side of the political spectrum are claiming that giving CMS the authority to negotiate drug prices will cost Americans $500 billion in lost productivity due to an annual loss of five million life years.
There are so many flaws in their arguments it’s hard to know where to start, but let’s plunge in.
Coventry CEO Dale Wolf presented at the JPMorgan Healthcare Investment Conference earlier this week; I was particularly interested in his comments re the business opportunity in Medicare and Medicaid.
Medicare Advantage (MA) programs are likely to suffer a significant cut in funding this year as the Democrats, led by Rep. Pete Stark (D CA) take a chain saw to the subsidies paid to MA plans.
Coventry will be close to a $9 billion business in 2007.
The loss of a good chunk of the subsidy will make the MA business less attractive for many health plans; Wolf believes there is a significant opportunity for Coventry as it has successfully become the low cost producer in their markets, an achievement of which Wolf is quite proud.
Continue reading Medicare as a business – Coventry’s perspective
Bob says it better than I could.
Boston’s Mayor is outraged at Humana’s decision to raise premiums on it’s basic Part D plan by 130%. Humana’s stockholders should be equally upset.
Among the health reform plans likely to be considered is an expansion of Medicare, allowing non-seniors to “buy in” to Medicare.
This is a bad idea.
In what will come as no surprise to anyone, Congress will eliminate the pending cut in Medicare physician reimbursement. Not only that, but docs who agree to report certain data to CMS will actually get a 1.5% increase in reimbursement from the Feds.
If you listen very closely, you can almost hear the medical community’s resounding “yippee”.
The reasons docs are not exactly ecstatic about the news are two-fold.