Mid-week miscellany

David Ermer–Uncategorized–

While the debt limit negotiations continue, the White House has issued a formal warning that it may veto the Fiscal Year 2012 financial services and general government appropriations that the House passed last month. According to the statement, “The funding level provided by the bill would limit OPM’s ability to implement and administer new statutory responsibilities.” The Senate has not passed its version of this appropriations bill yet.


OPM has created a searchable frequently asked questions page on its open government site.  The insurance related FAQs are here. 

Kaiser Health News published a report with the following lead — “A forthcoming report from the Congressional Budget Office shows that more than two dozen demonstrations projects launched by Medicare and Medicaid over the past decade have failed to stop the upward march of health care costs, CBO director Doug Elmendorf said Tuesday.” Wow, that finding simply confirms what health plans and consumers have witnessed. In that regard, Modern Healthcare reports with respect to a new Medicare demonstration project that “Medicare accountable care organization payments should include potential for bonuses and losses to create “the kind of high-powered incentives to control costs that are urgently needed,” public policy and economics professors contend in a paper published online by the New England Journal of Medicine.” 
The Wall Street Journal reported the pharmaceutical manufacturers are starting to refill their “parched” new drug pipelines. 

Companies have won marketing approval so far this year for 20 innovative medicines that work differently or better than existing drugs, or tackle ailments lacking good treatments, according to the Food and Drug Administration. “New molecular entities,” the FDA calls them. There were just 21 such approvals all last year.

Recently approved are the first therapy shown to extend life for people with advanced melanoma, the deadly skin cancer; the first new treatment for lupus in over 50 years; and two drugs for hepatitis C that are far more effective than current care.

That’s good news that should help the pharmaceutical manufacturers recoup revenue that will be lost when many blockbuster drugs like Lipitor go generic later this year and next year. The country needs productive research efforts like this.

Healthleaders Media reports about a Senate Homeland Security and Governmental Affairs subcommittee hearing on Tuesday at which the Centers for Medicare and Medicaid Services were “battered” about the ineffectiveness of Medicare anti-fraud measures.

A cornerstone of the nearly two-hour hearing included the release of a particularly negative report from the U.S. Government Accountability Office, which said CMS had allowed only 42 of 639 analysts to undergo training to use a database that was tailored to identify fraud and questionable claims worth $21 billion over 10 years. 

Additionally, CMS has not incorporated any data from Medicaid claims, a major potential source of healthcare fraud and abuse, into the system, GAO charges.