Dual Eligible Demonstration Project: Unknown Impact On Access to Physicians

CMS is working with states across the country to coordinate the care of dual eligible beneficiaries in a series of state-based demonstrations.   CMS explains that the goal of the program is to coordinate care for beneficiaries in both Medicare and Medicaid, resulting in improved health delivery.  However, this population includes the frail and elderly and there are many questions yet to be answered.  Many are concerned that most states plan to automatically enroll dual eligible beneficiaries in Medicaid managed care – removing them from the Medicare program.  One of the unanswered questions is how or if physicians and patients will be notified before a dual eligible beneficiary is passively enrolled in a Medicaid managed care program.At least 37 states and the District of Columbia are currently planning demonstrations and many states expect to begin enrolling beneficiaries before the end of the year.  These proposed demonstrations will be a significant change for Medicare beneficiaries, enrolling up to two million dual eligible beneficiaries in the Medicaid program. MedPAC Chairman Glenn Hackbarth stated recently that he was concerned that the duals initiative could be more focused on the potential savings to the states and health programs than on the patient. “We’re talking about these significant changes, which could limit choices available to dual eligible beneficiaries,” Hackbarth said. “It’s untoward to focus on how everybody else is going to benefit financially from changes in care other than the patient.”

PPACA Physician Value Payments

CMS has sent out so-called resource use reports to 20,000 physicians showing their patients’ average health care costs and quality of care.  The reports, part of the Physician Value-Based Payment Modifier program set by the PPACA to start in 2015, also provided cost and quality comparisons with other physicians.  Payments made in 2015 are intended to be based on care provided in 2013.  By 2017 the program is expected to include most Medicare participating physicians.

Medicare DME Bidding Renewed

CMS announced that it will renew bidding for the nine First Round areas of the durable medical equipment competitive bidding program this summer.  The bidding will include some new items and there will be new product category groupings of similar items and accessories.  The bidding will not include retail diabetic supplies.  Round Two and national mail order contracts and prices are scheduled to go into effect July 1, 2013.

FDA Fee Reauthorization Markups Scheduled

The House Energy and Commerce Health Subcommittee announced that, pending further agreement, it intends to mark up legislation this week to reauthorize the Prescription Drug User Fee Act (PDUFA) and the Medical Device User Fee Act (MDUFA).  The draft bill also includes language from H.R. 4274, Rogers-Eshoo-Markey legislation that would permanently authorize the Best Pharmaceuticals for Children Act (BPCA) and the Pediatric Research Equity Act (PREA).  The omnibus bill would also create new user fee programs for generic drugs, called the Generic Drug User Fee Act (GDUFA), and for biosimilar drugs, called the Biosimilars User Fee Act (BSUFA).  Rep. Henry Waxman said the draft bill includes the proposed Generating Antibiotic Incentives Now (GAIN) Act, H.R. 2182, which would extend the exclusivity period for new prescription antibiotics from 10 years to 15 years and add an additional six-month period of exclusivity if the new antibiotic identifies a companion diagnostic test.  He also said the draft legislation should include a provision to preserve the effectiveness of new antibiotics once they are on the market.  The Senate HELP Committee announced it intends to mark up similar legislation on April 25th.  The House E&C Committee would like to see the bill passed by the end of June in order to give guidance to the FDA and affected parties before the expiration of the current law on September 30.

HAI National Action Plan

HHS announced an updated National Action plan to help eliminate health care-associated infections (HAIs).  The plan was developed by the HHS Partnership for Patients: Better Care, Lower Costs, a public-private initiative designed to improve the quality, safety and affordability of health care.  The plan details specific goals for decreasing the following types of infections in the future: a 50% reduction in bloodstream infections; 100% adherence to central line insertion practices; a 25% percent reduction in urinary tract infections; and a 50% reduction in Methicillin-resistant Staphylococcus aureus (MRSA) invasive infections in the general population.  HHS requested comments on the revised plan.

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