The President’s Budget is Presented, Amid Debate Over Medicare, the Debt Limit and Spending
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
The President’s proposed budget for fiscal year 2024 (beginning 10-1-2023) will be presented to Congress today, amid debate over taxes, spending, the debt and especially the future of the Medicare program. In anticipation, the President unveiled a proposal (here) to increase the Medicare net investment income tax on those earning over $400,000 per year, from 3.8% to 5%, and expand on the provisions of the “Inflation Reduction Act” allowing CMS to negotiate the cost of prescription drugs.
In his “Opinion” piece for The New York Times (here, “Joe Biden: My Plan to Extend Medicare for Another Generation), the President wrote that “The budget I am releasing this week will make the Medicare trust fund solvent beyond 2050 without cutting a penny in benefits. In fact, we can get better value, making sure Americans receive better care for the money they pay into Medicare.”
“The two biggest health reform bills since the creation of Medicare, both of which will save Medicare hundreds of billions over the decades to come, were signed by President Barack Obama and me . . . The Inflation Reduction Act ended the absurd ban on Medicare negotiating lower drug prices, required drug companies to pay rebates to Medicare if they increase prices faster than inflation and capped seniors’ total prescription drug costs — saving seniors up to thousands of dollars a year. These negotiations, combined with the law’s rebates for excessive price hikes, will reduce the deficit by $159 billion.”
“We have seen a significant slowdown in the growth of health care spending since the Affordable Care Act was passed. In the decade after the A.C.A., Medicare actually spent about $1 trillion less than the nonpartisan Congressional Budget Office projected before the A.C.A. reforms were in place. In 2009, before the A.C.A., the Medicare trustees projected that Medicare’s trust fund would be exhausted in 2017; their latest projection is 2028. But we should do better than that and extend Medicare’s solvency beyond 2050.”
“My budget will build on drug price reforms by strengthening Medicare’s newly established negotiation power, allowing Medicare to negotiate prices for more drugs and bringing drugs into negotiation sooner after they launch. That’s another $200 billion in deficit reduction. We will then take those savings and put them directly into the Medicare trust fund. Lowering drug prices while extending Medicare’s solvency sure makes a lot more sense than cutting benefits.
Second, let’s ask the wealthiest to pay just a little bit more of their fair share, to strengthen Medicare for everyone over the long term.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
MedPAC Staff and Some MedPAC Commissioners Enthusiastic About Expanding Site-Neutral Payment, BlueCross Cites Potential Gain From Spillover
InsideHealthPolicy reports that staff and some Commissioners at the March 3 MedPAC meeting were supportive of a BlueCross BlueShield Association initiative to extend site-neutral payment beyond evaluation and management office codes, so that actual payment would be made based on diagnosis and procedures, not on where medical care was delivered.
“Medicare has been paying a comparable amount for evaluation and management (E&M) visits provided in freestanding physician offices and in off-campus hospital departments since 2019 -- a move that led to lawsuits that hospitals took all the way to the Supreme Court before it opted not to hear the case. While those regulations were put in place by the Trump administration, the Biden administration stood by them in court and has continued the policies.
“BCBSA has been urging lawmakers to expand Medicare site-neutral payments as a way to save money not just in Medicare, but also in markets due to spillover effects. An Ellis Health policy analysis from BCBSA says adopting site-neutral pay policies for Medicare would save $471 billion over the next 10 years -- $202 billion from 2024-2033 for Medicare, about $67 billion for Medicare beneficiaries on their Part B premiums, as well as an additional $67 billion on cost-sharing, and $107 billion in lower premiums for private health insurance plans.”
DRUGS & DEVICES
Medtronic Accused of “Grooming” Physicians in Wichita, KA, Whistleblower Suit
Medscape reports (here) on a ProPublica investigation and a suit which was “filed in 2017 by a sales representative for a competing medical device firm [which] alleges an illegal kickback scheme between Medtronic and hospital employees. According to the complaint and documents released in the suit, between 2011 and 2018, VA health care workers received steakhouse dinners, Apple electronics and NASCAR tickets, and in turn, Medtronic secured a lucrative contract with the hospital. Meanwhile, the company's representatives allegedly ‘groomed and trained’ physicians at the facility, who then deployed the company’s devices even when it was not medically indicated.”
“Independent from the whistleblower suit, internal investigators at the Wichita facility have also examined the treatment patterns of its vascular patients in recent years and found numerous cases where medical devices were used excessively. While it’s not uncommon to deploy several devices, a medical expert on the investigation team found that the VA doctors sometimes used more than 15 at a time — one used 33 — deviating from the standard of care.”
“The hospital investigation found that amputations increased sixfold in the same time frame as the procedures in question, according to internal emails, but made no conclusion about whether those two things were connected.”
Medscape reported that the VA is “conducting an extensive review of patient care” at the Kansas hospital, “including the number of devices used on patients — to make sure that Veterans were not harmed by any procedures.” An attorney for the medical group denied the allegations in recent legal filings, calling the claims “baseless” and the lawsuit a “witch hunt.”
“The lawsuit comes amid growing concern about one of these procedures — atherectomies — after researchers and doctors have uncovered patterns of excessive and inappropriate use. Recent research (e.g., here) has found that this procedure, a common but costly treatment to shave or laser plaque from blood vessels, is not more effective than cheaper alternatives and may even be associated with a higher risk of complications including amputation. In recent years, several doctors and clinics have been investigated for allegedly taking advantage of Medicare’s reimbursement rates, and one study found that many doctors are resorting to atherectomies in the earliest stages of peripheral artery disease, against best practices that urge noninvasive treatment.”
QALYS Under Attack
Ten Republican Senators have urged HHS and CMS (here) to stop using Quality-Adjusted-Life-Years in the measurement of improved quality of life in research, on grounds that QALYS discriminate against the disabled. Focusing on measures which might be used against drug price hikes, the group expressed concern “particularly as the government bureaucracy plays an increasing role in cost-effectiveness analyses for new medications under the partisan Inflation Reduction Act (IRA).”
They noted that “QALYs place a lower value on treatments which extend the lives of people with chronic illnesses and disabilities” and bemoaned the “history of restricted access occurring in countries utilizing QALY-based cost effectiveness research” which has “raised concerns that its use in the U.S. would result in rationing care to seniors and people with disabilities.”
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Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org
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