The Health Care Policy Blog is a forum for health care policy professionals and Bloomberg BNA editors to share ideas, raise issues, and network with colleagues.
June 19, 2013
by James Swann
The public would have a chance to peek behind the curtain of Medicare claims data, if a recently introduced bill passes Congress. . The Medicare Data Access for Transparency and Accountability...
June 18, 2013
Physicians are concerned that the upcoming transition to ICD-10 is going to be too expensive, according to a June 13 study from the Medical Group Management Association. 95 percent...
June 17, 2013
by Sara Hansard
Jackson Hewitt Tax Service is claiming credit for inducing the HHS June 14 to propose requiring health insurers to allow enrollees in the online marketplaces that open Oct. 1 to be able to pay for...
by Nathaniel Weixel
Consumer and industry opinions differ on what to include in a new FDA guidance on if a change to a device warrants a new marketing application.
by Steve Teske
The double-digit Medicare profit margins of skilled nursing facilities and home health agencies came under fire from three directions June 14, indicating program payments to the sectors could be...
June 14, 2013
An OIG report said Medicare could have saved $910 million in 2011 if clinical lab test payment rates had been reduced to the levels paid by Medicaid and Federal Employees Health Benefits (FEHB)...
June 12, 2013
Comments are coming into the House Energy and Commerce Committee about its plan to revamp Medicare’s physician payment system as the panel continues to refine its proposal in hopes of having...
A proposed regulation implementing a $101 billion health insurance fee imposed by the Affordable Care Act amounts to double taxation, health insurers told the Internal Revenue Service (IRS) in...
June 11, 2013
A bipartisan bill introduced June 10 in the Senate and House would strengthen penalties for medical identity theft and penalize Medicare and Medicaid contractors for excessive error and...
June 3, 2013
Medicare’s Trustees reported May 31 that the program’s Part A Trust Fund would be financially solvent until 2026, two years later than estimated last year, but the Acting Chief Actuary for the...
May 31, 2013
A recent final rule from OIG permitting MFCUs to use federal funds to pay for data mining technology may not end up having a huge impact on fraud prevention, according to an attorney I talked to...
Beneficiaries got a gift from the administration in the form of increased financial incentives for participating in wellness programs offered by their group health plans, part of a final rule from...
With the release May 28 of a third legislative draft that would revamp the Medicare physician payment system and repeal the sustainable growth rate formula, the House Energy and Commerce...
by John T. Aquino
As the Affordable Care Act moves closer to being fully implemented, the concern among biopharmas that ACA will adversely affect the industry continues. At the “Affordable Care Act Is Here to Stay”...
May 24, 2013
House Republicans are moving closer to their goal of having a Medicare physician payment fix on the floor by the August congressional recess. House Energy and Commerce Health Subcommittee Chairman...
May 23, 2013
The Department of Health and Human Services has received more than 830 nonbinding letters of intent from organizations that plan to apply for $54 million in federal grants to be "navigators" helping...
Legislative modifications to the hospital inpatient prospective payment system (IPPS) have undermined its goals, according to GAO.
While reporting requirements under the Sunshine Act have yet to kick in, the payment transparency program is already facing allegations that a specific provision may violate the First Amendment. The...
May 20, 2013
A report that collects 10 articles that I wrote covering the BIO International Convention in Chicago last month is available by clicking on the highlighted...
May 17, 2013
Speakers at a webinar I attended this week said the Sunshine Act might chill legitimate R&D activities carried about by physicians and teaching hospitals. Meenakshi Datta, an attorney with...
May 10, 2013
I spoke with an OIG official this week who told me that updated special advisory bulletin on exclusions was intended to give providers more practical guidance than the original bulletin did when it...
Barring an unforseen twist, the Centers for Medicare & Medicaid Services is about to have its first Senate-confirmed administrator since 2006. The Senate the week of May 13 is expected to vote...
May 3, 2013
The Centers for Medicare & Medicaid Services this week addressed criticism of the lengthy application forms they had proposed for enrolling uninsured people in health coverage. On April 30 the...
May 2, 2013
The effects of sequestration on the Food and Drug Administration were apparent in a particular way at the BIO 2013 International Convention in Chicago that I covered—FDA officials didn’t have the...
Medicare fraud tipsters may soon be rolling in the money, thanks to a recent HHS proposed rule that would increase reward money for a successful tip from a maximum of $1,000 all the way up to $9.9...
May 1, 2013
It may be awhile before policymakers know if Accountable Care Organizations will fulfill their promise of lowering the cost of health care while improving outcomes, but experts have recently...
April 26, 2013
I spent the first part of this week at HCCA's Compliance Institute, and while there, I heard Inspector General Levinson suggest that OIG might be interested in performing compliance reviews on...
April 23, 2013
With the release of the Obama administration's fiscal 2014 budget proposal, it has become clearer how the Department of Health and Human Services has been funding implementation of the Affordable...
April 22, 2013
The Senate Finance Committee April 23 will vote on the nomination of Marilyn Tavenner to be administrator of the Centers for Medicare & Medicaid Services. If the nomination is approved, as...
April 19, 2013
FDA will replace a 2011 draft guidance on investigational devices after industry backlash.
I spoke with OIG's Tony Maida this week about their recently revised self-disclosure protocol , and he told me the idea behind the revision was to increase transparency for providers. He told me...
April 11, 2013
A speaker at a recent gene patent conference I covered suggested that the Supreme Court has of late been retreating back to the ideas of an 1850 case about door knobs.
April 10, 2013
President Obama's FY 2014 budget request takes into account recommendations made by MedPAC.
Under the fiscal 2014 budget proposal released April 10, the Centers for Medicare & Medicaid Services would spend $1.3 billion for grants to states to set up online exchange markets to sell...
President Obama's April 10 budget proposal for fiscal year 2014 includes a 0.3 percent decrease in discretionary spending ($311 million) for the Health Care Fraud and Abuse Control account from...
As expected, President Obama April 10 proposed a fiscal 2014 budget plan that would trim about $400 billion from federal health care spending, the vast majority coming from Medicare. The biggest...
April 8, 2013
The Centers for Medicare & Medicaid Services could soon have its first Senate-approved administrator since 2006. CMS acting administrator Marilyn Tavenner is scheduled to appear before the...
April 5, 2013
It's official: the Healthcare Integrity and Protection Data Bank will soon be no more. HRSA, in an effort to reduce regulatory burden, recently issued a final rule that will result in the transfer...
March 22, 2013
Providers have embraced CMS's Stark law disclosure process, a CMS official said at a conference I attended this week. Troy Barsky, the director of CMS's Division of Technical Payment Policy, said...
March 21, 2013
The first results of the Pioneer accountable care organization initiative will be available this summer, a Centers for Medicare & Medicaid Services official told Congress March 20. Richard...
March 15, 2013
For the first time ever, OIG has updated the guidelines for evaluating state false claims act laws, taking into account amendments made to the federal false claims act in 2009 and 2010. Under the...
March 14, 2013
Medtronic is taking a chance with FDA and CMS's new parallel review pilot.
March 11, 2013
The online health insurance exchange markets that will open for enrollment Oct. 1 under the Affordable Care Act are generating interest among consumers, marketing information company J.D. Power and...
March 8, 2013
It's still early days, and no one really knows what impact the sequester cuts will have on the economy, but I recently talked to a few health care experts who all agreed that the cuts have the...
The Centers for Medicare & Medicaid Services remains committed to ensuring Medicare providers adopt electronic health records, despite an increase in claims upcoding that may be related to the...
February 22, 2013
I recently heard CMS's Peter Budetti speaking at the National HIPAA Conference, and he said CMS is working with other government agencies to create a methodology for calculating the value of cost...
In what's by now a familiar story, a recent report from the OIG discovered that CMS has failed to collect $225 million in state Medicaid overpayments. Between fiscal years 2000 and 2009, the OIG...
In Australia, things are clearer now for owners of gene patents than they were a week ago, while U.S. gene patent owners are still anxiously waiting for the April 15 oral arguments to begin before...
February 21, 2013
Medicare providers already are taking steps in anticipation of sequestration cuts that are likely to occur March 1, including scaling back programs, eliminating positions and postponing...
February 15, 2013
Senate Finance Committee Chairman Max Baucus plans to hold a confirmation hearing on the nomination of Marilyn Tavenner to be administrator of the Centers for Medicare & Medicaid Services. CMS...
February 14, 2013
To no one's surprise, the Medicare program has once again been found to be especially vulnerable to fraud, waste, and abuse. The GAO has designated Medicare as a high-risk program dating back to...
February 8, 2013
Like a broken record, physicians again are facing a Medicare reimbursement cut unless Congress intervenes. The Congressional Budget Office said Feb. 5 that physicians' reimbursement will be reduced...
Lawmakers introduce device tax repeal bills in the House and Senate.
February 5, 2013
The Internal Revenue Service (IRS) disappointed consumer groups and unions when it released a final rule Jan. 30 that could leave some families without affordable health insurance coverage or...
A number of health care attorneys have told me that providers and drug and device manufacturers can expect significantly expanded administrative burdens courtesy of the recently released "Sunshine...
January 31, 2013
What does a Supreme Court case about the sale of soybean seeds have to do with life sciences? A lot, says the U.S. Solicitor General and life sciences attorneys. Bowman v. Monsanto ...
January 25, 2013
Senate Finance Committee ranking minority member Orrin G. Hatch (R-Utah) wants Medicare's eligibility age hiked from 65 to 67, saying it must keep pace with increases in longevity in the...
January 24, 2013
PCORI director Joe Selby talks about how the organization wants to make comparative effectiveness research more patient-centered.
January 23, 2013
Senate Finance Committee Ranking Member Orrin Hatch (R-Utah) and Senate Health, Education, Labor and Pensions Committee Ranking Member Lamar Alexander (R-Tenn.) Jan. 22 introduced legislation...
January 22, 2013
Health care providers are now facing significantly higher penalties for HIPAA violations, courtesy of an HHS final rule released Jan. 17. The HIPAA Enforcement final rule, which was part of an...
The federal government should scrap a proposal to create a national health reinsurance pool and rely instead on state-by-state collections for the program, the organization that represents state...
January 17, 2013
Businesses already are developing strategies to keep their workers productive for longer periods of time, so raising Medicare's eligibility age may only incrementally increase health care costs for...
January 16, 2013
Effective oversight of community mental health centers (CMHCs) is lacking, and Medicare might be wasting taxpayer money as a result, the OIG said in a recent report. A review of nine Medicare...
January 15, 2013
Orphan drugs are called that because the biopharma industry is said to have little interest in developing and marketing drugs that are intended for only a small number of patients suffering from very rare conditions. And yet 40 percent of FDA-approved drugs in 2012 were orphan drugs, and there are plans for consideration of a regulatory orphan drug framework in Canada in 2013.
January 9, 2013
Federation of American Hospitals President Chip Kahn says he is worried that a series of plans that may be considered by Congress and the White House in 2013 to reduce federal spending may be worse...
December 18, 2012
CMS recently released a long-delayed report on the first year results of its predictive modeling program, and while the report includes some positive results, questions remain over the accuracy of...
Eighteen states and the District of Columbia have made the commitment to open state-based exchanges through which individuals and small businesses can purchase health insurance under the Affordable...
December 17, 2012
Europe looks like it will finally have a unitary patent system that will reduce the costs of a patent. But the plan has caused concerns about the sudden speed toward approval and the way in which the patents will be enforced
December 14, 2012
New report finds evidence that Medicare patients are getting sicker, and it's not just because of coding changes.
December 13, 2012
While CMS is actively encouraging the use of EHRs through the meaningful use incentive program, it may be sending a mixed message courtesy of a recent transmittal. Effective Dec. 10, the transmittal...
December 7, 2012
Raising Medicare's eligibility age could become a key component of a deal between the White House and Congress to avert the so-called fiscal cliff, but critics say raising the age would shift costs...
December 4, 2012
It appears the fate of a Medicare pay cut for physicians rests on when and if the White House and congressional negotiators reach agreement on a plan to avert the so-called fiscal cliff, the package...
At a conference I attended recently, a session followed up on an idea of companies looking into the possibility of trade secret protection for their inventions rather than patents.
November 28, 2012
The torrent of regulations to implement the major provisions of the Affordable Care Act began in earnest Nov. 20 when the Department of Health and Human Services issued two proposed rules and...
FDA Tries Updating Device Guidance, Take Two.
HHS Proposed Rule Would Allow `Unbanked' To Enroll in Health Coverage
Medciare Margins Of SNFs, HHAs, Come Under Fire
Is ICD-10 Implementation Too Expensive?
OIG Spotlights Elevated Costs for Medicare Lab Tests