Thursday, April 30, 2015

Teladoc Fights Back

This blog noted a few weeks ago that telehealth is facing headwinds. Teladoc, a Texas-based provider of telemedicine services, was being stifled by the Texas Medical Board.

Now, Teladoc has filed both an Initial Public Offering (IPO) and a lawsuit against the Texas Medical Board on antitrust grounds.

Read the entire entry at NCPA's Health Policy Blog.

House & Senate Budget Committees Agree on Balanced Budget Resolution

The House and Senate Budget Committees have announced that their conference committee has agreed on a balanced budget resolution. The conference report is 106 pages, so it will take me a few days to complete an analysis.

Read the entire entry at NCPA's Health Policy Blog.

Wednesday, April 29, 2015

Health Spending Crushing A Stalled Economy

March’s estimate of last year’s fourth quarter Gross Domestic Product (GDP) showed that health spending was chewing through a weak economy. Today’s release of the advanced estimate of this year’s first quarter GDP might best be described as health spending crushing a stalled economy.

Read the entire entry at NCPA's Health Policy Blog.

Banned From Medicare; Still Billing Medicaid

Yahoo! News has a special report about physicians who have been banned from billing Medicare or some state Medicaid programs because of fraud, but are still billing other states’ Medicaid programs.

The costs could reach hundreds of millions of dollars.

Read the entire entry at NCPA's Health Policy Blog.

Intellectual Property Rights for Global Health

Republican congressional leaders are eager to give President Obama Trade Promotion Authority, or “Fast Track”. Proponents argue that Fast Track will break the logjam holding up important international trade agreements like the Trans Pacific Partnership (TPP), which includes countries as diverse as Australia, Canada, Peru and Vietnam.

Fast Track would allow the president to finalize the agreement before sending it to Congress for a straightforward up-or-down vote within a limited time. However, the likelihood of Fast Track resulting in TPP getting a “thumbs up” from Congress is limited by potential differences between the president and the congressional majority on intellectual property rights.

Read the entire column at Forbes.

Monday, April 27, 2015

Digital Health Funding Maturing Quickly

Startup Health has released the latest issue of its excellent quarterly digital health funding report.

Read the entire entry at NCPA's Health Policy Blog.

Senator Johnson Introduces King vs. Burwell Alternative

Senator Ron Johnson (R-WI) has introduced the Preserving Freedom and Choice in Health Care bill, which he frames as a response to the Supreme Court deciding for the plaintiffs in King vs. Burwell. This lawsuit seeks to force the administration to obey the law by not paying tax credits to health plans that operate in states using a federal health insurance exchange (i.e.

Victory for the plaintiffs would cause massive disruption in health insurance in the 36 states using because beneficiaries’ premiums would increase significantly. Up to nine million people would experience this effect.

It is necessary for Congress to have an alternative to Obamacare ready in case the Supreme Court decides in favor of King because President Obama will immediately propose an amendment to change the law to accord with how he is executing it. That is, let tax credits flow through It would be a very simple amendment – just a few sentences. The risk of Congress panicking and simply voting for that amendment, and finally surrendering to Obamacare, is unacceptable.

Read the entire Health Alert at NCPA's Health Policy Blog.

Friday, April 24, 2015

Medicaid Block Grants = Unconstitutional Coercion?

Professors Sara Rosenbaum and Timothy Westmoreland have an interesting opinion piece in the New England Journal of Medicine with a curious response to the proposal that federal Medicaid funding should be re-structured as block grants (via the Patient CARE Act, proposed by some Congressional Republicans).

I’m no lawyer, but this seems to be a real stretch. Ms. Rosennbaum and Mr. Westmoreland misconstrue Medicaid as a federal-state “compact”, indicating the current Medicaid system is some kind of right that states can claim from Congress; and that Congress does not have the right to decide how federal money is spent.

Read the entire column at NCPA's Health Policy Blog.

Naturopaths Beat Real Doctors in Online Reviews

According to a new study by Vanguard Communcations, people rank naturopaths higher than real physicians.

Read the entire entry at NCPA's Health Policy Blog.

Why Would Health Insurers Learn From Life or Auto Insurers?

Dori Zweig at FierceHealthPayer has written a good article with examples of how life and auto insurers provide excellent customer service, and encouraging health insurers to do the same. It would be a great idea and there are no shortage of consultants providing advice on health insurers to do exactly that. There are entire conferences dedicated to the topic.

Unfortunately, there are significant differences between health, life, and auto insurance that mitigate health plans’ interest in replicating the excellent service we’ve seen from other types of insurer.

Read the entire entry at NCPA's Health Policy Blog.

Churn: Data Lacking on Critical Question

The media and most health policy wonks focus only on the number of insured versus uninsured people. They don’t really care if people are enrolled in Medicaid, Medicare, Obamacare plans, employer-based benefits, or whatever. As long as the percentage insured goes up, they are satisfied.

One of the problems this disguises is “churn” – people moving between different types of coverage, which leads to disrupted care. It is something that Obamacare surely makes worse, by introducing a new type of coverage for people within a certain range of income.

However, the people in charge of the new system are almost completely ignoring this problem,

Read the entire entry at NCPA's Health Policy Blog.

Obamacare Cuts IRS Customer Service

According to the New York Times, Obamacare is to blame for the Internal Revenue Service’s decline in customer service.

What is sadly funny about this new disclosure is that when Obamacare opponents pointed out that Obamacare funded new IRS tax inspectors instead of doctors and nurses, its supporters alleged that the new bureaucrats were going to help ensure people who were owed tax credits got them.

Read the entire entry at NCPA's Health Policy Blog.

Is Patient Scheduling Software Valuable To Doctors?

I am a huge fan of entrepreneurs who want to make medical care more productive and consumer friendly. I wish all of them the best of success. Unfortunately, I am concerned that one of the trends attracting venture capital is chasing a shrinking market. That trend is patient-scheduling software in physicians’ offices.

Read the entire entry at NCPA's Health Policy Blog.

Thursday, April 23, 2015

Republicans Reach for Redemption on Medicare "Doc Fix"

Politico reports that Congressional Republicans might be having second thoughts about the extremely flawed, so-called Medicare “doc fix” legislation that they sent to President Obama a few days ago. One of those flaws was that the spending in the bill was not offset by cuts to other federal spending – which is why almost every Democrat in Congress voted for it too.

Read the entire entry at NCPA's Health Policy Blog.

Obamacare Increases Food Stamp Dependency

An investigation by the Associated Press has turned up an interesting outcome from Obamacare: It increases dependency on food stamps.

Read the entire entry at NCPA's Health Policy Blog.

Wednesday, April 22, 2015

Obamacare Exchanges Still A Bad Consumer Experience

The media have cheered the fact that Obamacare exchanges in 2015 operated better than 2014. It is one of the “achievements” that led them do declare “Mission Accomplished” for Obamacare.

Improvement over 2014 is a very low bar. Indeed, it is hard to imagine how the exchanges could possibly have performed worse this year. New research from the Wharton Business School at the University of Pennsylvania concludes that the exchanges are still ineffective.

Read the entire entry at NCPA's Health Policy Blog.

Barack Obama Has the Last Word on the Medicare "Doc Fix"

I thought that I had given the last word on the flawed Medicare “doc fix” last Monday. Nope: That honor goes to President Obama.

Read the entire entry at NCPA's Health Policy Blog.

Health Plans' Mastery of Obamacare Poses Challenge to Repeal

Can Obamacare still be repealed? Well, that depends. If the politicians will legislate according to the people’s preferences, Obamacare is a jump-ball.

The real obstacle to advancing an alternative to Obamacare will be interests in the health sector, which has mastered Obamacare remarkably. The latest evidence is the first quarter earnings reported by UnitedHealth Group and Hospital Corporation of America, both of which Forbes colleague Bruce Japsen describes as having had the “best Obamacare quarter yet.”

Read the entire column at

Tuesday, April 21, 2015

Administration Plays Hardball with "Medicaid Holdout" States

Obamacare was supposed to dramatically increase Medicaid dependency in exchange for reducing some direct federal funding of hospitals. Now, some governors of states that rejected Obamacare’s Medicaid expansion are reacting negatively to the federal government’s cutting back hospital funding.

Read the entire entry at NCPA's Health Policy Blog.

Monday, April 20, 2015

Obamacare's Hospital Monopolies

Obamacare induces significant consolidation among providers, which the Federal Trade Commissioner has long recognized can be anti-competitive. State antitrust overseers are also pushing back against this effect.

Read more at NCPA's Health Policy Blog.

Obama's Medicaid Expansion Does Less Than It Claims

I am still playing whack-a-mole with journalists and others who keep confusing Medicaid with health insurance. The latest is the coverage of the Urban Institute’s latest Health Reform Monitoring Survey. The Hill reported it as” “Uninsured rate falls by half in states that expanded Medicaid”.

Imagine if a state expanded cash welfare payments versus its neighbors. The media would report that the number of people reporting no cash income had dropped faster in that state, despite creating no jobs.

Read the entire column at NCPA's Health Policy Blog.

Obamacare and Employment (Again)

Vox’s Mattew Yglesias, an undaunted Obamacare supporter, has listed “7 charts that show what Obamacare critics are getting wrong”. The first is, you guessed it, that chart from the Gallup survey of health insurance that this blog has been analyzing and criticizing pretty relentlessly.

I’m not going to go through all seven, but focus on his claim that Obamacare is not causing part-time work at the expense of full-time work.

Read the entire column at NCPA's Health Policy Blog.

Bipartisan Medicare Reform: Debt and Deficits, All the Way Down

The extremely flawed so-called Medicare “doc fix” has passed.  Its direct consequences include increasing federal government control of the practice of medicine and increasing deficits by at least $141 billion through 2025. However, it also has implications far beyond Medicare’s physician fee schedule, to post-Obamacare reform and general governance.

Let’s tackle the fee schedule first. This “doc fix” was promoted as solving the problem that Congress has to increase Medicare’s physician fees at least once a year beyond the rate of growth originally legislated in 1997. If this did not happen, physicians’ fees would drop by about 20 percent, and they would reduce Medicare beneficiaries’ access. This “doc fix” abolishes the 1997 formula in favor of fixed, nominal rates of growth.

As a consequence, the fee schedule is not “fixed” in the sense that it is “solved”. It is “fixed” in the sense that Congress has dictated the total amount that will be paid to physicians in future years. It will go up 0.5 percent per year from 2016 through 2019. Then, the amount freezes, and doctors enter a war of all against all, competing against each other for shares of an amount that will inexorably shrink in inflation-adjusted terms. It gets even more bureaucratized after 2025, but there is no point thinking about that because the whole thing is almost certain to unravel before then.

Read the entire Health Alert at NCPA's Health Policy Blog.

Friday, April 17, 2015

Is FDA Reporting Drug Shortages Adequately?

For a number of years, there have been critical shortages of certain generic drugs for injection. These are often important cancer drugs. In 2012, I wrote a report that concluded over regulation by the Food and Drug Administration (FDA) was the primary cause of the shortages.

The President and Congress acted, but their actions did not result in improvement for over a year.

Today, the FDA claims to have improved the situation. However, an article in Health Affairs points out that the number of drug shortages reported by the FDA and the number reported by the University of Utah Drug Information Service (UUDIS), the leading private source of this data is diverging dramatically.

Read the entire column at NCPA's Health Policy Blog.

Hospitals "Turbocharge" Medicare claims

Today’s Consumer Price Index release shows a big jump in prices for hospital services. The Wall Street Journal has an exemplary piece of investigative journalism discussing one way hospitals gouge Medicare.

Read the entire column at NCPA's Health Policy Blog.

Health Prices Outpace Other Consumer Prices

Today’s release of the Consumer Price Index (CPI) indicates that prices of health services are outpacing other consumer goods and services by a multiple. From February to March, the seasonally adjusted CPI increased 0.2 percent. Medical care services overall increased at twice that rate, 0.4 percent, while physicians’ and hospital services both increased by 0.6 percent.

Read the entire column at NCPA's Health Policy Blog,

One State Leads the Fight for Health Freedom

When it comes to no-holds-barred, patient-centered health reform, one state is absolutely crushing it: Arizona.

Governor Doug Ducey, a businessman with no direct healthcare experience, has recently signed (at least) three path breaking pieces of legislation.

Read the entire article at NCPA's Health Policy Blog.

Thursday, April 16, 2015

28 Percent of Federal Taxes Go To Health Care

27.49 percent, actually. Weekly Standard’s Jeryl Bier used the White House’s own calculator to figure this out. The trend is not our friend.

Read the entire column at NCPA's Health Policy Blog.

Means Testing Medicare Premiums

Soon after House Speaker John Boehner and Minority Leader Nancy Pelosi surprised the House of Representatives with a so-called Medicare “doc fix” that would cement important Obamacare gains, NCPA sprang into action and proposed an alternative.

Since March 25, this blog has been heavily loaded with articles addressing the topic. Unfortunately, we were not able to overcome the Obamacare coalition this time, and the legislation passed without amendments.

Many readers have asked why I did not address means-testing Medicare premiums, which account for about $34 billion of the revenue raised in the bill.

Read the entire column at NCPA's Health Policy Blog.

Wednesday, April 15, 2015

Tax Day: Obamacare Comes Home To Roost

The National Taxpayers Union Foundation (NTUF) has released its latest analysis of  “tax complexity”:

3,322 pages of legal guidance for Obamacare (or the ACA) added to (1,077 pages of regulations, 1,377 pages of Treasury decisions, 669 notices, 100 revenue procedures, and 12 revenue rulings).
 Essentially, Obamacare is coming home to roost.
Read the entire column at NCPA's Health Policy Blog.

Medicare "Doc Fix": The War of All Against All Begins!

The U.S. Senate passed H.R. 2, the so-called Medicare “doc fix,” 92-8 last night.  By the time you read this, President Obama will likely already have signed it. He’s eager to do so, because it locks in Obamacare’s vision of the relationship between physicians and the state.

This was a seriously flawed bill, as NCPA has discussed exhaustively. Now, doctors and patients will have to get used to a new reality where the federal government and beltway lobbyists’ priorities are more deeply embedded in physicians’ offices than ever.

Billy Wynne at the Health Affairs blog has a very good, dispassionate response to the bill’s passage.

Read the entire column at NCPA's Health Policy Blog.

Tuesday, April 14, 2015

Why Are So Many Working-Age People On Medicare Since Obamacare Started?

Gallup has released the full results of its first quarter survey of health insurance. It concludes that the proportion of uninsured Americans has collapsed to the lowest level ever - 11.9 percent.

The early release of the estimate had predicted 12.3 percent, and it got a little better as the dust has settled on the second open season.

Read the entire column at NCPA's Health Policy Blog.

Who's To Blame for Doctors' Cash Flow Crisis?

Doctors never cease from complaining about insurers’ bureaucracy. It’s one reason why they cannot stand the repeated Medicare “doc fixes” that have occurred at least once a year for over a decade: When Congress does not increase the physician fee schedule before the previous fix runs out, they fear that Medicare contractors will slow roll their claims, creating a big cash flow problem.

(That’s one reason why the lobbyists supporting today’s fiscally irresponsible “doc fix” waited until March 19 to let us know it was coming to the House of Representatives. Last year’s fix expired on March 31. Delaying until the last minute means the lobbyists can more easily drive politicians into a panicked herd and head them off a fiscal cliff.)

The cash flows can be observed by patients, who receive physicians’ invoices and insurers’ Explanation of Benefits (EOBs). One reader went to the doctor on July 31, 2014. As shown in the graphic below, the health plan processed the claim on August 25 and mailed it to the beneficiary on August 29.

There it sat, in a manila file folder at the beneficiary’s home, until a few days go. As the graphic below shows, the doctor’s office finalized the claim with the insurer on March 31, and printed a statement on April 2.

Read the entire column at NCPA's Health Policy Blog.

More Criticism of the Medicare "Doc Fix"

Paul Winfree of the Heritage Foundation and David Hogberg of the National Center for Public Policy Research each have interesting perspectives on the so-called Medicare "doc fix."

Read the entire column at NCPA's Health Policy Blog.

Chief Actuary Blows Away Make-Believe Medicare "Doc Fix"

On March 25, the U.S. House of Representatives voted for a fiscally irresponsible so–called Medicare “doc fix” that will add $141 billion to the deficit over the next ten years, according to the Congressional Budget Office (CBO). The U.S. Senate will likely vote on the bill later today, and the same lobbyists who dragged Obamacare into the end zone in 2010 are hoping for another win. This one will be even better, because it will be bipartisan.

Nobody denies the way Medicare pays doctors today is flawed. Every year, Congress has to increase the scheduled amount of money because if it did not, fees would drop by about one fifth. Many doctors would stop seeing Medicare beneficiaries.

There are two major differences between this so-called “fix” and previous ones. The first one is real: Previous increases have been offset by cuts to other government spending, and this one is not. The second one is fiction: That this doc fix is a permanent solution to the fee problem.

That fiction was debunked last week in a report published by Medicare’s Chief Actuary.

Read the entire column at Forbes.

Monday, April 13, 2015

Rushed Medicare "Doc Fix" Suffers from Exposure to Sunlight

Remember that one of the complaints about Obamacare was that nobody (including those who had voted for it) had enough time to read and understand the bill?

It looks like the same could be said about the so-called Medicare doc fix that passed the House of Representatives with no debate on March 26, only one week after the world learned that Speaker John Boehner and Minority Leader Nancy Pelosi had been secretly negotiating a bill for two months. We did not see the text until March 24. Then, before you knew it, within two days it was rushed through the House.

Lobbyists were hoping a sleepless Senate (which had been voting on the budget resolution until about 3 a.m.) would simply wave the legislation through. Fortunately, some Senators demanded time to read the bill.

Read the entire column at NCPA's Health Policy Blog.

Federal Rules Create Obstacles for Health IT Entrepreneurs

This blog has long noted the painful consequences of the federal government’s intervention in health information technology (HIT).  Last February, NCPA published an Issue Brief recommending that the federal government’s ambitions in HIT be rolled back. The major problem is the government’s undue influence in Electronic Health Records (EHRs).

Last month, the Administration published the regulations for stage 3 of the Meaningful Use incentives, which both pay and fine doctors for their use of EHRs in accordance with the rules. Margalit Gur-Arie describes the new rules:

Read the entire column at NCPA's Health Policy Blog.

From Left and Right, Opposition to Flawed Medicare Doc Fix

The U.S. Senate will have to deal with the flawed so-called Medicare “doc fix” Wednesday at the latest, if doctors are not to suffer a significant drop in their payments from Medicare.

Voices from both right and left have discovered serious problems with the bill, and proposing solutions. Here are three examples.

Read the entire column at NCPA's Health Policy Blog.

Fix the Flawed Medicare Doc Fix

For over a decade, Congress has struggled with an inadequate formula to calculate Medicare payments to physicians.  The formula results in an amount too low to ensure physicians will continue to see Medicare beneficiaries.  At least once a year, Congress has to pass a short-term increase to Medicare physician payments to prevent fees dropping about 20 percent.  The current boost expired on March 31, 2015, necessitating a rapid response.

MACRA is a poor doc fix for two major reasons:
  • Less than four percent of its spending is offset by cuts to other government spending, resulting in an estimated $141 billion increase in cumulative budget deficits over 10 years, and $500 billion over 20 years.  This is the first time since Congress began to struggle with the physician payment formula that it has abandoned budget neutrality, a commitment made previously by both parties.
  • MACRA significantly increases federal control of the practice of medicine, in line with the ambitions of Obamacare.  Doctors will face increasing requirements to comply with federal regulation in order to get paid.  These will likely include greater reliance on government-certified Electronic Health Records, which have already proven to frustrate doctors and do nothing to benefit patient care, despite an investment of $30 billion taxpayer dollars.

Three options are available to reduce the shortcomings of MACRA and keep the door open to effective Medicare reform:
  • A two-year doc fix, paralleling the extension of the Children’s Health Insurance Plan in MACRA.
  • Including MACRA in the pay-as-you-go (PAYGO) scorecards, requiring the president to pay for it with other funds.
  • Finding offsets to pay for the $141 billion in MACRA spending that is not yet offset.
Read more at NCPA.

Saturday, April 11, 2015

Telehalth Faces Headwinds

We’ve cheered the telemedicine compact written by the Federation of State Medical Boards, and hoped that it would lead to a rapid collapse of the barriers facing telehealth providers’ ability to provide services across state lines.

Unfortunately, some medical societies and states are unwilling to move with the times.

Read the entire column at NCPA's Health Policy Blog.

Health IT Juggernaut Is Stumbling

The gold rush in Health Information Technology (HIT) appears to be winding down. Mercom Capital Group, LLC, reported that venture funding in HIT dropped 35 percent in the first quarter to just $785 million. Well, no trend lasts forever. Still, I have to wonder if investors aren’t getting a little concerned about putting so much capital into a space so dominated by government.

Read the entire column at NCPA's Health Policy Blog.

Friday, April 10, 2015

Medicaid Managed Care Pharmacy Costs 15 Percent Less Than Fee-For Service

America’s Health Insurance Plans (AHIP), the main trade association for health plans, has released research comparing pharmacy costs in states where Medicaid pharmacy benefits are “carved in” versus “carved out.”

“Carved in” means that a managed care organization manages the benefit. “Carved out” means the Medicaid bureaucracy manages it directly. The latter costs a lot more.

Read the entire column at NCPA's Health Policy Blog.

Seven of 10 Doctors See Effects of Climate Change on Patients!

Just within the last couple of weeks, we’ve seen Congressional Republicans join with Democrats to buy into the idea that the federal government knows how to pay doctors for “quality” and “value.” It is the main concept behind the misconceived Medicare “doc fix” bill that the Senate will consider next week.

So, if we are going to surrender even more of this power to the federal government, it might be interesting to see what the Administration thinks is important:
“The challenges we face are real, and they are clear and present in people’s daily lives,” said senior presidential adviser Brian Deese in a telephone conference call with reporters on Tuesday. Seven in 10 doctors are seeing effects on their patients’ health from climate change that is “posing a threat to more people in more places,” Deese said. (Bloomberg Politics).
Read the entire column at NCPA's Health Policy Blog.

Thursday, April 9, 2015

Medicare Advantage Becomes Entrenched

The Centers for Medicare & Medicaid Services (CMS) has announced that payments to Medicare Advantage plans will increase by 1.25 percent next year. Less than a month ago, the plan was to cut payments by 0.95 percent.

Medicare Advantage plans are comprehensive plans that seniors can chose instead of the traditional Medicare Fee-For-Service (FFS) model.Because they are offered by private insurers, Obamacare was supposed to crush Medicare Advantage.

However, this is the third year the Administration has flinched from cuts that would deny people access to these plans. More seniors are in Medicare Advantage today than when Obamacare was passed.

What happened?

Read the entire column at NCPA's Health Policy Blog.

Paying For the Medicare Doc Fix is Easy

Late last month, an overwhelming bipartisan majority in the House of Representatives approved the Medicare Reauthorization and CHIP Extension Act (MACRA), a fiscally irresponsible approach to increasing the amount the federal government spends on Medicare’s physicians’ services. Medicare’s Physician Fee Schedule is tied to an inflation formula that is inadequate to pay physicians enough to keep seeing Medicare patients. While Congress has had to increase this amount every year, those increases have always been funded by offsets from other federal spending.

This is the first time politicians of both parties have ignored this rule, increasing Medicare’s physicians’ payments perpetually and not paying for it. Worse, gimmicks obscure the true cost of the bill. Further, the bill would centralize federal control of the practice of medicine along the lines of Obamacare. The bill faces a lot of pressure to pass the Senate next week, especially because Medicare will have to start paying doctors according to a significantly lower fee schedule on April 15. So, the Senate needs to fix the bill very quickly before approving it.

Read the entire column at Forbes.

More Than One in Five Obamacare Enrollees Have Not Re-Enrolled

Avalere Health has released a new analysis of exchange enrollment, emphasizing that states with the federal Obamacare exchange ( retained more 2014 Obamacare beneficiaries than states with their own exchanges:

Federally-facilitated exchange states reenrolled 78 percent of their 2014 enrollees in 2015, on average. In state-run exchange states , that percentage drops to 69 percent of 2014 enrollees. California, the state with the highest enrollment in 2014, only retained 65 percent of their 2014 enrollees.
Read the entire column at NCPA's Health Policy Blog.

Tuesday, April 7, 2015

Medicare "Doc Fix" A Tribute to Big Spender Henry Waxman

Doug Badger, former Deputy Assistant to President Bush on Legislative Affairs, Staff Director of the Senate Policy Committee, and senior official at the U.S. Department of Health & Human Services has harsh words for the so-called Medicare “doc fix” that was rushed through the House of Representatives last month:

The $141 billion health care bill that cleared the House last month and that is expected to win Senate approval next week is a tribute from the GOP-controlled Congress to former Congressman Henry Waxman, a man who worked tirelessly – and with great success – to expand health care-related welfare spending.

The bill (H.R. 2) increases Medicare payments to physicians, largely by replacing one complicated and flawed formula with another.  It directs the army of bureaucrats who populate CMS cube farms to soldier on with their futile, half-century-long quest to implement a workable system of administered pricing.
Read my entire column at NCPA's Health Policy Blog.

Arizona: Blood Tests Without Physician's Order

Governor Doug Ducey has signed a law that will allow patients to order lab tests directly from a lab, without physician intermediation. It will be self pay: No government nor private health plan has to pay for the tests.

Read the entire article at NCPA's Health Policy Blog.

Health Jobs Grow Steadily in Weak Jobs Report

Last Friday’s very weak jobs report from the Bureau of Labor Statistics (BLS) was greeted as bad news, but it disguised more good news for the heath sector: Job growth in March kept its steady pace. Obamacare’s healthcare jobs boost appears to be confirmed from February and January.

Almost one in five of the 126,000 jobs added in March were in health care. Ambulatory facilities continued to add jobs at a faster rate than hospitals, while nursing and residential care facilities lost jobs.

Read the entire column at NCPA's Health Policy Blog.

Monday, April 6, 2015

Fixing the Medicare Doc Fix Fiasco

On March 26, an overwhelming bipartisan majority voted for H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), by 392-37. This bill is the so-called Medicare “doc fix,” a prize that has been chased for many years but never caught by politicians eager to break out of the fiscal discipline a previous Congress had imposed on them.

In 1997, similarly large bipartisan majorities passed the Balanced Budget Act, which introduced the way Medicare pays doctors today. Payments are supposed to be based on the Sustainable Growth Rate (SGR). The SGR was designed to contribute to a balanced budget by linking Medicare’s payments to physicians with a measurement of the nation’s ability to pay for the entitlement: Real Gross Domestic Product (GDP) per capita.

Unfortunately, the rate of growth indicated by the SGR was not adequate to pay physicians enough to see Medicare beneficiaries. So, within a few years, Congress had to find more money. Importantly, Congress always paid for these increased payments by cutting spending in other areas.

This has become increasingly painful for politicians, who now revile the SGR as “broken” and “unworkable.” They act as though the fiscal discipline brought about by the SGR was imposed on them by alien invaders instead of Congress itself.

Read the entire article at NCPA's Health Policy Blog.

60 Percent of Top Ten VC IPOs Are Health Deals

PitchBook has compiled a  list of Initial Public Offerings (IPOs) from the top 25 venture capital partnerships over the last ten years. The results for health care are impressive, accounting for 46 percent of the IPOs. Sixty percent of the IPOs for the top ten VCs were healthcare businesses.

Read the entire column at NCPA's Health Policy Blog.

Saturday, April 4, 2015

Administration Fears Rejection of Boehner-Pelosi-Obama Medicare "Doc Fix"

As we ease into Easter weekend, the Administration is losing confidence that the Senate will uncritically swallow the Boehner-Pelosi-Obama so-called Medicare “doc fix”.

According to The Hill, the Administration is pleading with the Senate to pass the Medicare Access and CHIP Reauthorization Act (MACRA) immediately when the Senate reconvenes on April 13. If not, the Administration will have to start processing doctors’ claims at a significantly lower rate of payment on April 15.

This pressure mirrors that of Obamacare supporters such as AARP and the American Hospital Association, which are lobbying hard towards the same goal: Recruiting Republican legislators onto Obamacare’s B-Team by getting them to vote for this perpetual extension of the current theory governing Medicare payments, which Obamacare made worse by centralizing decisions about “quality” and “value” in the federal government.

Read the entire column at NCPA's Health Policy Blog.

Friday, April 3, 2015

Will Obamacare's Tax dodgers Take Advantage of Special Enrollment?

Those of us who take the time to understand the burdens that the federal government increasingly impose on us might be excused for envying the Obamacare tax dodgers, who got a special enrollment period to sign up for Obamacare if they let the February 15 deadline for enrollment whizz by.

From the Administration on February 20:
For those who were unaware or didn’t understand the implications of the fee for not enrolling in coverage, CMS will provide consumers with an opportunity to purchase health insurance coverage from March 15 to April 30. If consumers do not purchase coverage for 2015 during this special enrollment period, they may have to pay a fee when they file their 2015 income taxes.
Read the entire column at NCPA's Health Policy Blog.

Accountable Care Enrollees To Triple By 2020

David Muhlestein of Leavitt Partners predicts that the number of patients enrolled in Accountable Care Organizations (ACOs) will rise from 23.5 million today to 72 million in 2020.

What is an ACO? I am becoming less sure that it is a meaningful term. I mean, really, are you in favor of unaccountable care?

The term appears to have originated in the federal government, which encouraged providers to create ACOs to improve the quality of care and move away from the Fee-For-Service (FFS) model under which Medicare has traditionally operated.  However, the term is now being used in the commercial and Medicaid market.

Read the entire column at NCPA's Health Policy Blog.

Patent Policy Cost India $10 Billion Investment

Legal support for intellectual-property rights is essential to innovation. In health care, patents protect intellectual property in pharmaceutical innovation. Not all countries respect pharma IP equally, according the Global IP Index.

India has long been a problem because of its successful generic drug industry. Generic drug makers make copies of brand-name drugs once their patents have expired. This means that they have an incentive to lobby for weaker patents. If the political economy of a country’s pharmaceutical industry is dominated by generic competitors, it is difficult for innovative companies to gain a foothold.

One Indian innovative drug maker is speaking out.

Read the entire article at NCPA's Health Policy Blog.