The Washington Post reports that both the House and the Senate have enacted the Wellstone – Domenici mental health parity bill. The House did so as a standalone bill (HR 6983) and the Senate included the bill in the bill modifying the alternative minimum tax and extending various otherwise expiring tax provisions. But the House and the Senate still have no resolved their disagreement over how to pay for the bill. According to the Post, “It is unclear whether a joint agreement can be reached in the few days remaining before Congress recesses.” I think that it will. 

• Business Insurance reports that
  

  In 2008, group health care costs increased by an average of 6.0%, to $8,331 per employee, and are projected to rise next year by 6.4%, according to an analysis released Monday by Hewitt Associates Inc. of Lincolnshire, Ill. The analysis is based on information from more than 400 employers. This year’s 6.0% average increase is up from a 5.3% increase in 2007 but is substantially lower than 2006’s average increase of 7.9% and the 9.2% hike in 2005.  * * * As health care plan costs have risen, cost-shifting to employees also has increased. For example, employees’ total health plan costs—which include out-of-pocket expenses, such as deductibles and copayments, as well as premium contributions—averaged $3,513 per employee in 2008, up 9.9% from 2007. Copies of Hewitt’s health care cost analysis are available at www.hewitt.com

• The Chicago Tribune expands on the cost shifting aspect of this Hewitt study.
• On a related note, the Wall Street Journal reports that
  

  As the credit crunch threatens to throw the economy into a deep slump, Americans are already cutting back on health care, a sector once thought to be invulnerable to recession. Spending on everything from doctors’ appointments to preventive tests to prescription drugs is under pressure. * * *
  In a survey by the National Association of Insurance Commissioners last month, 22% of 686 consumers said that economy-related woes were causing them to go to the doctor less often. About 11% said they’ve scaled back on prescription drugs to save money. Some of the areas being hit include hip and knee replacements, mammograms, and visits to the emergency room, according to a survey conducted by D2Hawkeye Inc., a Waltham, Mass., medical data analytics firm, on behalf of The Wall Street Journal.

• Last year, Congress paid for avoiding a statutorily prescribed reduction in Medicare Part B reimbursement to physicians by mandating that insurers and other payers report Medicare related coordination of benefits information to the Centers for Medicare and Medicaid Services (CMS). Payers generally had been providing this information to CMS under Voluntary Data Sharing Agreements with CMS. The new mandate is effective January 1, 2009. CMS has posted a timeline for implementation of this mandate and a paper explaining how payers with VDSAs will be affected by the new mandate. 
• The HHS Office for Civil Rights, which is responsible for enforcing the HIPAA Privacy Rule, has posted guidance for consumers/patients and health care providers on the extent to which the Privacy Rule allows providers to share protected health information with the patient’s family members and friends.

• On Friday, the Centers for Medicare and Medicaid Services announced that the Medicare Part B premium — currently $96.40 will not increase for 2009. This CMS fact sheet explains the rationale for the freeze and it provides the income related premium adjustments for Medicare beneficiaries with taxable income over $85,000. Finally the fact sheet informs us that the 2009 Medicare Part A deductible will be $1,068, a $44 increase over the 2008 Medicare Part A deductible. Medicare Part A pays for inpatient hospital, skilled nursing facility, hospice, and certain home health care services. These changes are significant to the FEHB Program because there is a large contingent of FEHBP annuitant enrollees with primary Medicare coverage.
• The Washington Post reports that in the coming week the Senate will consider the alternative minimum tax / tax extenders bill (H.R. 6049), which now includes the compromise mental health parity bill. According to the Kaiser Daily Health Policy Report, the House leadership, which is not enamored with this expensive bill, plans to take up the mental health parity bill as a stand-alone bill this coming week under suspension of the rules, a procedure that prohibits amendments and requires a two-thirds majority
  for the bill to pass.
• The Wall Street Journal reports that “To pinpoint hereditary sources of longevity, researchers at the Scripps Research Institute in La Jolla, Calif., are recruiting 2,000 healthy people over 80 years old to compare the entire genetic sequences of these “wellderly” to those from people who died of common age-related illnesses before they reached 80.” Keep your fingers crossed. The article cautions that
  

  Many experts in aging are skeptical. “We seem to know a lot about longevity in worms, but we don’t know if any of it is relevant for humans,” says Jan Vijg, who studies the genomics of aging at the Albert Einstein medical college. “The problem is that we don’t really know the basic cause of aging.”

At a February 2007 Senate hearing, GAO banged on HHS for failing, among other things, to create privacy milestones in its efforts to create a nationwide electronic medical records system. This week GAO issued a follow-up report finding that while HHS has made progress, “they have fallen short of fully implementing GAO’s recommendation” — “that HHS include in its overall privacy approach a process for ensuring that key privacy principles and challenges are completely and adequately addressed.”

Senate leaders from both parties agreed yesterday on an alternative minimum tax patch and tax extenders bill (S 6049) that includes as Section 507 the enhanced mental health parity law. According to an AP report, “the tax package is one of the last major issues that Congress must
address in the last weeks before its scheduled adjournment for the year [later this month].” If Congress passes this law before adjournment, the law would be applicable to the FEHB Program in 2010. The major difference between the new law and the FEHBP status quo is that the new law would require parity in network and out of network while the current FEHBP policy is to require parity in-network only.

The Senate Finance Committee held a health care reform-related hearing yesterday titled Aligning Incentives: The Case for Delivery System Reform. The testimony may be found here, and a Kaiser report on the hearing there.

Rep. Pete Stark (D CA), chairman of the Health Subcommittee of the House Ways and Means Committee, has introduced a bill to promote the adoption of health information technology by the medical community (HR 6898). It appears that this issue is being booted into the next Congress.

• The fallout from the Endoscopy Center of Southern Nevada tragedy continues. The Las Vegas Review-Journal reports that

  A 70-year-old woman who has tested positive for hepatitis C filed a lawsuit today against [her HMO] Pacificare of Nevada for referring her to a physician associated with the Endoscopy Center of Southern Nevada for treatment. Alynne Griffiths, who underwent two procedures at the Shadow Lane facility where health officials have linked eight hepatitis C cases due to unsafe injection practices, claims Pacificare won’t pay for her to see a hepatitis specialist outside her network.

  Pacificare is part of United Healthcare.

Congress was gavelled back to order this week for a short three week session before last election season push. I have my eye on the mental health parity bill. The House and Senate have resolved the benefit design issues and now they have to resolve the pay-go or funding issues. I expected that those issues would be resolved by now. But they haven’t. The Kaiser Daily Health Policy Report tells us that the Senate Finance Committee is trying to find funding and that time is running out. CQ reports of talk about a lame duck session that principally is coming from the minority right now.

The Health Now! Coalition lead by former Rep. Nancy Johnson is pushing for health information technology legislation. Be careful what you wish for because, according to the Kaiser Daily Health Policy Report, Rep. Pete Stark (D Ca.) is thinking about financially penalizing health care providers who don’t timely adopt electronic health records.

Newsweek columnist Robert Samuelson wrote an excellent column titled “Getting Real about Health Care.” He makes two key points:

On average [according to data from Brookings economist Gary Burtless], annual health spending per person—from all private and government sources—is equal for the poorest and the richest Americans. In 2003, it was $4,477 for the poorest fifth and $4,451 for the richest.Probably in no other area, notes Burtless, is spending so equal—not in housing, clothes, transportation or anything. Why is this? One reason: government already insures more than a quarter of the population * * * .Medicare is so large and influential that by altering how it operates, government can reshape the entire health-care system. This would require changes in rules and reimbursements to encourage more electronic record-keeping, better case management, fewer dubious tests and procedures, and a fairer sharing of costs between the young and the old. The work would be unglamorous and probably unpopular. But if the next president won’t—or can’t—do it, his presidency will fail in one fateful way.

HHS Secretary Leavitt made essentally the same point about reforming Medicare at a conference that I attended last Spring. In that regard, the Senate Finance Committee held a hearing yesterday on “Improving health care quality: an Integral step toward health reform. Healthcare IT News reports that “Transparency in healthcare, pay-for-performance (P4P) and healthcare IT are among the top ways experts say the country could overhaul its healthcare system to not only improve care, but also reduce costs.”

I noted recently that the EU has begun to approve biosimilar drugs — a topic which our Congress has yet to address. This American Magazine interview with Genentech’s product development president, Susan Desmond – Hellman provides an interesting EU vs. US perspective on specialty drugs:

The biotech industry gets heat from critics who claim that they charge overly high prices for their products. What do you make of this critique?
We challenge ourselves to make important, valuable new medicines. We’re not trying to do something new for small problems. We’re trying to innovate and make a difference for big problems. And the investments necessary and the risk the company takes and the failure rates are such that the business model of biotechnology relies on premium pricing. But we’re sensitive to the most important thing of all for us, which is patient access. My team and the folks at Genentech who work in research and development don’t just want to make drugs that make a difference. We want patients to have access to them. Genentech works very hard to have a strong support mechanism for patients who can’t pay or for patients who can’t afford their copayments, which is more and more common these days. I understand that it has been harder for women in countries outside the United States to get access to Herceptin for breast cancer due to regulatory obstacles. Could you discuss this?
It’s a huge issue for cancer patients. HER2-positive metastatic breast cancer is a very special form of breast cancer. We made a remedy, Herceptin, specifically for the 20 percent of breast cancer patients who have this form of breast cancer that is especially difficult to treat. When a company does trials, it isn’t enough just to do the trial; then one must go to the regulators, not just in the United States but outside the United States, and request approval. An extra layer is that in Europe one has to get approval for the pricing of the product as well. We really find that difficult for patients. The FDA approved Herceptin in less than five months. It was really outstanding. Everyone knew patients were waiting. The sense of urgency that we had, that the FDA had, that physicians in practice had, was huge. That’s what patients deserve. This is the balance that all of us are facing over the next several years as more and more pressure to control healthcare costs comes about. My plea is not to squash innovation. I would submit that in countries like the United Kingdom, where access to Herceptin was delayed because of concerns over the cost of healthcare, there needs to be a healthy public policy debate about patients waiting, their need for new medicines and for innovation, and balancing that with the cost of healthcare.