Checking Up On Health: November 27

Benita Dodd, Vice President, Georgia Public Policy Foundation

Health Policy Briefs

Compiled by Benita M. Dodd 

The Georgia Public Policy Foundation has been out and about for the past two weeks, but we’re back in the office with the latest news on health care regulations, policy, technology and biotech in today’s Checking Up On Health!  

Health care on a budget: How much is too much for a cancer drug treatment? Top health care experts meeting at the Institute of Medicine last month warned the nation’s 15,000 oncologists and their patients: Learn to deliver cancer care at lower costs or watch limits being imposed by the government and insurance companies. Merrill Goozner, senior correspondent for The Fiscal Times in Washington, D.C., reports that a top official from UnitedHealthcare, the nation’s largest insurer, told the forum that reimbursement for cancer care now accounts for 12 percent of all payments for patients not on Medicare and Medicaid. That’s up from 10 percent five years ago. Cancer care has now pulled even with cardiovascular care as the insurer’s biggest expense.  

Bioink in 3D printer may one day grow organs: Three-dimensional printing marks an exciting frontier in health care. Advanced 3D printers can make everything from human ear and foot models for research to prosthetics that can transform a toddler’s life. Next up? 3D bio-printing: producing human tissue and ultimately human organs using inks composed of different human cells. It’s being investigated in advanced academic research labs, and now commercially by San Diego-based Organovo, founded in 2007. Read more here from  

ObamaCare provision in court: The U.S. Supreme Court on Monday ordered a federal appeals court to take another look at whether a key requirement in ObamaCare violates religious freedoms. A pending lawsuit from the private Liberty University had claimed, among other things, that the 2010 federal health law would lead to taxpayer dollars funding abortions and contraception. The high court in June had upheld the overall law championed by President Obama, but left room for continued legal challenges to certain aspects of the law’s application. The Obama administration denies the claim by Liberty, which says it is the world’s largest Christian evangelical university. Source: 

From birds to beasts: The FDA has approved the use of Novartis’ seasonal influenza vaccine for people ages 18 and older. The vaccine, which will be marketed under the brand name Flucelvax, is the first seasonal flu vaccine produced using animal cell cultures instead of the traditional chicken egg method, which allows for a faster production process. Who knew? Traditional flu vaccine production requires a tremendous number of fertilized chicken eggs to grow virus strains and often takes several months before it is ready to be delivered to physicians or pharmacies. Novartis, by the way, provides about 30 million flu doses to the United States every year. Source: Reuters 

Damned if you do, damned if you don’t: State Medicaid costs will jump $76 billion, or nearly 3 percent, over the next decade if all 50 states decide to expand Medicaid eligibility in 2014 under the federal health law. But state spending on the program would still increase to the tune of $68 billion even if not a single one opts for the expansion, according to a study released Monday by the Kaiser Family Foundation. That’s because even states that do not expand eligibility would see a surge of people sign up for the health insurance program for the poor, who were previously eligible but not enrolled. Beginning next October, people will find it easier to sign up for Medicaid because of new online health insurance marketplaces set up under the law, as well as simplified enrollment methods. The insurance exchanges and new enrollment rules start in 2014 regardless of whether states expand Medicaid, with coverage slated to take effect on Jan. 1, 2014. 

The problems continue: John C. Goodman’s Health Policy Blog notes several problems remain with ObamaCare, despite President Obama’s election victory. One is that the law will require all of us to have access to a long list of preventive services without deductible or copayment. Goodman points out that economists at Duke University calculated that if every American actually got all of the recommended screenings and tests, the average primary care physician would have to spend 7½ hours of every working day doing nothing else but providing  preventive care to mainly healthy patients! “What we will be facing is a huge increase in the demand for care, but no change in supply. As the waiting times grow, providers will tend to see those patients first whose insurance pays the highest fees. Those in plans that pay below market will be pushed to the rear of the lines,” he points out.  

Quality over quantity: Becker’s Hospital Review details the top 12 Hospital stories of 2012. Of course, the U.S. Supreme Court ruling in favour of ObamaCare tops the list, but among them was this interesting tidbit: Hospitals are taking on more financial risk. The shift from a fee-for-service payment model to pay-for-performance is leading hospitals to take on increasing amounts of risk. In the future, Becker’s reports, it’s expected that payments will not be tied to volume, but rather to outcomes and value. In an effort to prepare for this, many hospitals are beginning to take on some level of risk and hope to profit financially from doing so. Generally, the higher percentage of payment that hospitals risk on performance scores, the greater the potential reward. 

Quotes of Note

“If you think this is a tough reimbursement environment, just wait a year or two. Leadership is needed to show how to get to better care on a more sustainable fiscal path.” – Mark McClellan, who headed the Centers for Medicare and Medicaid Services during the George W. Bush administration 

“Someone thinks it’s free money [for Medicaid expansion] when it’s not. If we go bankrupt, there’s no way to bail out the United States.” – Ron Bachman, senior fellow, Georgia Public Policy Foundation