The big legislative health care news this week was President Trump’s call for bi-partisan legislation to lower prescription drug prices in his State of the Union address on Tuesday evening. In his address he commended Sen. Charles Grassley (IA) for his efforts in that area. “I am calling for bipartisan legislation that achieves the goal of dramatically lowering prescription drug prices. Get a bill to my desk, and I will sign it into law without delay," Trump said.
We have reported on the Grassley-Wyden bill (S.2543) in the Senate during the last few weeks. It was during our visits to a number of Senate offices recently that we learned that some Republicans in the Senate are divided over the bill resulting in its current stall.
The bill that the House of Representatives has sent to the Senate (H.R. 3) is not really a bi-partisan bill and, therefore, will not make it through the Senate. But it could be used as a starting point for negotiations to see if a bill that could make through both the House and the Senate could be developed.
Continuing on the prescription drug update, a report has just come out that insulin, which has become the prime example of the huge increase in the cost of medicines, could have saved Medicare $4.4 billion in 2017 if Medicare had negotiated the same prices as the Department of Veterans Affairs, which already bargains for discounts. For more than two dozen different insulin products covered by Medicare Part D that year, spending was $7.8 billion, based on estimated rebates of 41% received from drug makers. However, if the federal health care program had negotiated, as the VA does, and used the list of covered medicines spending would have dropped to nearly $3.4 billion.
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As of Jan. 1, home health agencies across the country are grappling with a significant change in how Medicare pays for services. Agencies are responding aggressively by cutting physical, occupational and speech therapy for patients. They are firing therapists. And they are suggesting that Medicare no longer covers certain services and terminating services altogether for some longtime, severely ill patients.
Altogether, about 12,000 home care agencies (most of them for-profit) provided care to 3.4 million Medicare beneficiaries in 2017, the most recent year for which data is available.
To qualify for services a person must be homebound and in need of intermittent skilled care (less than eight hours a day) from nurses or therapists.
Previously, Medicare’s home health rates reflected the amount of therapy delivered: more visits meant higher payments. Now, therapy isn’t explicitly factored into Medicare’s reimbursement system. Instead, payments are based on a patient’s underlying diagnosis, the presence of other complicating medical conditions, the extent to which the patient is impaired, whether he or she is referred for services after a hospitalization or a stay in a rehabilitation center (payments are higher for people discharged from health care institutions) and the timing of services (payments are higher for the first 30 days and lower thereafter).
Agencies now have a stronger financial incentive to serve patients who need short-term therapy after a stay in the hospital or a rehabilitation facility. Also attractive to care providers will be patients who need nursing care for complex conditions such as post-surgical wounds.
At the same time, there are fewer incentives to serve patients who need extensive physical, occupational and speech therapy.
The link below will take you to the official Medicare page that tells you exactly what is covered regarding home health care.
If your home health care agency says you no longer need services you can call the Medicare Rights Center (national help line: 800-333-4114). They can help you understand what’s going on and potentially intervene on your behalf.
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While not legislative in nature, we want to touch on the Coronavirus in our update this week because it is getting so much attention in the news.
Experts say that influenza still poses a much greater risk than the coronavirus. Influenza kills more Americans each year than any other virus. So far this winter, the flu has sickened 19 million people, has hospitalized 180,000 and killed 10,000, including 68 children, according to the Centers for Disease Control and Prevention. Yet only 45% of adults are vaccinated against the flu. More than 12,000 people ages 65 and older died from the disease during the 2017 flu season. It is not too late for seniors to get a flu shot.
Neglected diseases like diarrheal illnesses, tuberculosis, malaria, and pneumonia kill thousands of people every day. But because they have been doing so for decades, they simply don’t catalyze the same urgency we see in the face of a novel, fast-moving outbreak.
Please understand that we are not trying to downplay the seriousness of the coronavirus. Part of the concern of government health authorities is that it is so easily spread and it is new and they don’t fully understand all its effects.
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