“WASHINGTON — Ending insurance discrimination against the sick was a central goal of the nation’s health care overhaul, but leading patient groups say that promise is being undermined by new barriers from insurers.
The insurance industry responds that critics are confusing legitimate cost-control with bias. Some state regulators, however, say there’s reason to be concerned about policies that shift costs to patients and narrow their choices of hospitals and doctors.
With open enrollment for 2015 three months away, the Obama administration is being pressed to enforce the Affordable Care Act’s anti-discrimination provisions. Some regulations have been issued; others are pending after more than four years.
More than 300 patient advocacy groups recently wrote Health and Human Services Secretary Sylvia Mathews Burwell to complain about some insurer tactics that “are highly discriminatory against patients with chronic health conditions and may … violate the (law’s) nondiscrimination provisions.”
Among the groups were the AIDS Institute, the American Lung Association, Easter Seals, the Epilepsy Foundation, the Leukemia & Lymphoma Society, the National Alliance on Mental Illness, the National Kidney Foundation and United Cerebral Palsy. All supported the law.
Coverage of expensive drugs tops their concerns.”
“WASHINGTON — In a policy change, the Obama administration is planning to pay doctors to coordinate the care of Medicare beneficiaries, amid growing evidence that patients with chronic illnesses suffer from disjointed, fragmented care.
Although doctors have often performed such work between office visits by patients, they have historically not been paid for it.
Starting in January, Medicare will pay monthly fees to doctors who manage care for patients with two or more chronic conditions like heart disease, diabetes and depression.
“Paying separately for chronic care management services is a significant policy change,” said Marilyn B. Tavenner, the administrator of the Centers for Medicare and Medicaid Services. Officials said such care coordination could pay for itself by keeping patients healthier and out of hospitals.”
“Congressional Republicans investigating last fall’s botched launch of HealthCare.gov revealed Friday that a top Obamacare official had asked her spokeswoman to delete an email from a senior White House advisor that discussed problems with customer service calls about that website.
Those Republicans now want Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner to explain that deletion request, and to reveal if she has asked staff to “delete or otherwise destroy emails, communications or any other documents relating to HealthCare.gov.” The Republicans said the Obama administration has a “pattern” of being unable to preserve records.
Tavenner’s email asking the subordinate to delete an email was turned over to the House Energy and Commerce Committee last week, just a day after her staff told the committee that some copies of her email communications might have been lost.”
“New information related to physician-industry interaction is scheduled to be released to the public for the first time on September 30. The public database from the Centers for Medicare & Medicaid Services (CMS), which is part of the Sunshine Act implementation, will focus on payments that biopharmaceutical and medical technology companies have made to physicians. Although the release date is less than six weeks away, concerns about what the data will look like and its effect on medical innovation are already being brought to light by stakeholders across the board.
One of the primary concerns that PhRMA shares with more than two dozen other patient and industry organizations is that the data needs to include context to explain what the payments represent – collaborations that benefit patient health and innovation. It’s critical to note that the new database will include information on many different types of interactions. For example, the data could reflect an oncologist partnering with a biopharmaceutical company to lead a clinical trial on an innovative cancer treatment or a family practice physician’s attendance at an industry-sponsored speaking event led by a peer to further her education about geriatric care. However, if the data released includes only names and numbers, the public is likely to be confused and the information is left subject to misinterpretation.
Additionally, many physicians are not aware about the Sunshine Act, what it means for them and their ability to be part of this collaborative process. It is important for CMS to provide physicians with more information about their ability to register and review data reported on them.
To compound this lack of information, physicians also face a confusing registration process with a very short timeline. Given how instrumental relationships between companies and physicians are to driving future innovation, we want to ensure that both groups can provide input on the process of Sunshine Act reporting.”
“Next month, when the federal government releases data about payments to physicians from pharmaceutical and medical device makers, one-third of the records will be withheld because of data inconsistencies, an official told ProPublica.
The issue is the latest hurdle for the federal government as it seeks to launch the already-delayed Open Payments database mandated under the Physician Payment Sunshine Act, a provision of the 2010 Affordable Care Act. Making this information public is a crucial step in promoting greater transparency about conflicts of interest in medicine.
The Centers for Medicare and Medicaid Services first turned up flaws in the data in the past two weeks, while investigating a physician’s complaint that payments were being attributed to him even though they were made to another physician with the same name. In the process of reviewing that issue, it found “intermingled data,” meaning physicians were being linked to medical license numbers or national provider identification numbers that were not theirs.
“CMS is returning about one-third of submitted records to the manufacturers and [group purchasing organizations] because of intermingled data, and will include these records in the next reporting cycle,” CMS spokesman Aaron Albright said by email. These records won’t be posted until June 2015.”