In this week’s summary, you’ll find details about an event at the Capitol where legislators, advocates, physicians and patients called for prescriber prevails to be restored to the NYS Budget, the growing trend of hospital staff making home visits in efforts to cut down on readmissions, a federal grant for New York to implement it’s Health Care Exchange, and more!
NYS Budget/Presciber Prevails
Senator David Carlucci and Assemblymember Aileen Gunther were joined by a coalition of mental health advocates, physicians and patients this week to call on Governor Cuomo to reinstate “prescriber prevails” for atypical antipsychotics in the 2013-2014 state budget via the 21-day amendments. The group also urged the Governor and Legislature to restore “prescriber prevails” for all drug classes in the Medicaid budget. “Prescriber prevails” means the doctor or physician has authority to decide which medicine is best for their patients. A state Medicaid policy shift in October 2011 gave this authority to managed care health plans as opposed to prescribers. The group argues that for some patients with complex medical conditions, it can take weeks or months – and careful consultation with their physician – to determine the most effective medication regimen.
The Wall Street Journal writes that New York City hospitals are proposing plans to prevent damage to critical infrastructure in order to be more prepared for future hurricanes. The hospitals’ proposals vary in both cost and scope, and implementing the plans will depend on a mix of federal emergency money and insurance payouts (Dawsey, 2/3).
The Wall Street Journal writes about the efforts of some hospitals to cut down on readmissions by using a revamped version of a time-honored practice: the house call. In addition to a growing number of doctors treating frail patients at home, insurers and health systems are sending teams of doctors, nurses, physician assistants and pharmacists into homes to monitor patients, administer treatments, ensure medications are being taken properly and assess risks for everything from falling in the shower to family care-giver burnout (Landro 2/4).
Twice as many elderly people died in hospice care as in a hospital or nursing home compared with a decade ago, but hospice is often treated as a last resort — and used too late to benefit patients and their families, according to a study released this week. The researchers examined Medicare records for 840,000 people 66 or older who died in 2000, 2005 and 2009 (USA Today, Lloyd, 2/5).
Affordable Care Act/Health Exchanges
Governor Cuomo announced that New York State has been awarded a $185.8 million federal grant to implement its State Health Benefit Exchange with the goal of making it easier for New Yorkers to obtain affordable health insurance coverage. New York was one of five states to receive a Level Two Exchange Establishment grant from the U.S. Department of Health and Human Services (HHS) that will facilitate the development of a marketplace where individuals and small businesses can obtain health insurance. It is estimated that at full implementation, one million New Yorkers will enroll in and obtain insurance through the Exchange, including 615,000 individuals and 450,000 small business employees (Gannett, Matthews, 2/4).
Under the Affordable Care Act, community health care clinics are poised to be on the front lines of delivering care to the 30 million Americans that are expected to gain coverage under the law. The Los Angeles Times profiles some of the barriers these clinics face in recruiting and retaining staff. Administrators have trouble finding enough doctors, nurse practitioners and physician assistants to staff their clinics. Staff burnout is also common, and staff members often leave for less-stressful, higher-paying positions elsewhere (Gorman, 2/3).
Late last week, the Department of Health and Human Services proposed a compromise on the Affordable Care Act’s contraception mandate. HHS proposed letting more religiously affiliated employers — but not all employers — opt out of the mandate. The proposal could expand the number of groups that do not need to pay directly for birth control coverage, encompassing not only churches and other religious organizations, but also some religiously affiliated hospitals, universities and social service agencies. Health insurance companies would pay for the coverage. Reuters reports that the U.S. Conference of Catholic Bishops has they could not accept the compromise offer but will continue to work with HHS on a compromise that is acceptable to them (Morgan, 2/7).
The Congressional Budget Office now predicts 27 million people will gain health insurance by 2017, compared with earlier CBO estimates of up to 34 million people. Additionally, up to 8 million people will lose the employer-sponsored health insurance they now have, compared with a previous estimate of 3 million. Fewer people than initially thought will be covered through Medicaid as some governors refuse to expand eligibility under the Affordable Care Act, but some people who lose their insurance will obtain a new policy via public exchanges, the CBO said (Bloomberg, 2/5).
A report from the U.S. House of Representatives Committee on Oversight and Government Reform was released this week and is sharply critical of New York’s Medicaid program. The report identified key areas that it concludes contribute to “billions of wasted tax dollars” in New York. The issues highlighted by the report are believed to be behind the delay in obtaining federal approval for New York’s $10 billion Medicaid waiver request. Among others, the issues are spousal refusal, and a refuted $15 billion in reimbursement for caring for the developmentally disabled that CMS wants New York to repay.
Seniors have saved about $5.7 billion on prescription drugs since January 2011 because of provisions in the 2010 health care law meant to close the Medicare “doughnut hole,” the government announced this week (USA Today, Kennedy, 2/7).
-Jaime Venditti, 2/8/13