In 2007, there was a slowdown in the rate of medical spending, according to recent federal data. It’s the first such slowdown in over 45 years. A big part of that rate of decline was in the major decrease in spending for pharmaceuticals and related expenses.  But at over 16% of the GDP, many healthcare economists worry about healthcare spending’s sustainability, and that has the new Congress ready to concerned and ready to act this year. One way that may help would be to reexamine SCHIP, the bill authorizing individual states’ help for families in states in which Medicaid does not cover all basic healthcare expenses to children who need it. Its present incarnation expires in March, and a reorganization is in order; Obama has hinted at this.

• Medicare alters benefit formula for 2020 pharma plans.
• Physicians puzzled as to Apple CEO’s health.
• Did you know there was a plan in place to epidemiologically eradicate the measles virus by next year? Apparently, there are some speed bumps in the road.

The global plan to eradicate measles by 2010 is unlikely to come about say epidemiology experts because of high rates of infection in some parts of Europe where many children go unvaccinated.

• Blue Cross of California plans to reinstate coverage for patients it had dropped in response to investigations by the LA Times.
• An speaking of California, many healthcare workers are not screened adequately for criminal pasts.

The ongoing debate around healthcare reform often centers around what is best for the patient as consumer of healthcare. Sure, doctors are often brought into the mix, but are usually relegated to matters of the periphery — portrayed as forced to capitulate to the strong arm of the insurance companies and government payers. Well, in a way, that is partially true. The level of reimbursement from those physicians who see patients covered by Medicare, for example, can make up a significant amount of a primary care physician’s revenue. And, that is where the debate on healthcare reform should steer next, according to those it directly impacts on the front line — the primary care physicians. Bordering on seeming apocalypse, many primary care providers are presaging the death of the specialty — unless something is done to save it. | LINK

Released today, conservative pundit George Will’s WaPo column focuses on healthcare, specifically its portion of the entire GNP for this country. Read more like a pre-apocalyptic lesson in government involvement in healthcare delivery, his piece attempts to explain how real the pending insolvency for Medicare is within the next ten years and the admonition for President Obama to get up and head this disaster off at the pass. Oh, if only it were that easy.

For starters, because of the state of the economy these days, it is much harder to be a cheerleader for the continued, unabashed free market nature of healthcare coverage, purchasing, and delivery. Naturally, the single payer hypothesis has its detractors, and rightly so. Who is going to bail out the government when it doesn’t get things right the first time?

Unchecked rising healthcare costs; the need to temper government reach in healthcare delivery; the rights of patients — both as consumers and as beneficiaries — all of these issues will surely test the mettle of Obama’s healthcare czar-ocracy and its resolve to “become more connected with the people” in reaching common ground with respect to the current healthcare crisis. It is going to be an interesting and unnerving term for Obama, patients, and just as importantly, physicians and other healthcare providers. It’s finally 2009. Might as well dive into it. | LINK

The Centers for Medicare & Medicaid Services is taking the bull by the horns in its efforts to stem the tide of Medicare fraud, especially with respect to suppliers of durable medical equipment who file bogus claims. CMS is announcing that it has revoked the billing privileges of more than 1,100 medical equipment suppliers in south Florida and southern California (the epicenters for such activities) and suspending payments to home health agencies in the Miami-Dade, Fla. area. In addition to suspending payment, CMS is: implementing extensive pre- and post-payment review of claims submitted by ordering/referring physicians; and validating claims submitted by physicians who order a high number of certain items or services by sending follow-up letters to these physicians. A laudable effort whose magnitude is roughly equivalent to an enormous New Year’s resolution to the trim taxpayer burden of the nation’s public healthcare insurer. | LINK

Happy New Year! from Doctor Pundit. Posting to resume on 1/2/09.

• Minnesota’s most populous county will end fee-for-service Medicare. Sign of the troubled economy? Docs gotta put food on the table, too.
• Medicare Part D open enrollment to end on 12/31.
• Healthcare plan beneficiaries scramble to take advantage of last minute procedures before benefit resets on 1/1. Looks like some docs will put food on the table.

At a time when the weak economy is hurting the industry, medical groups say they are grateful for the bump in business, however temporary. To cope with demand, doctors are adding hours and delaying vacations. High-deductible plans with health savings accounts were introduced in 2004 and now cover about 10 percent of insured Minnesotans. At the same time, deductibles for traditional plans — known as preferred provider organizations — also have jumped, with a $1,000 deductible now the national norm, according to benefits consultant firm Mercer.

Hiring freezes. Acute care and same-day procedure clinic closures. Shrinking inpatient censuses. These are the problems healthcare organizations’ hospitals and clinics are having in these troubled economic times. Brought on by beneficiaries’ lack of coverage via job losses and lingering Medicaid and Medicare cuts in reimbursements, the financial crises shared by these institutions have led to rather disastrous results, bankruptcies chief among them. | LINK | RELATED LINK

Approximately 50 million Americans were covered by Medicaid last year (2007). This year will be another story altogether, as many states are cutting back on funding their share of Medicaid spending. Non-essential preventive care measures, some of the more expensive diagnostic procedures, and payments to nursing homes are all elements to be parsed or significantly slashed. Of course, part of this equation is the primary care provider, whose patient base more than likely consists of a significant number of Medicaid enrollees. Will there be more of a primary care exodus from this patient population as seen with Medicare in the face of federal government healthcare spending deficits? | LINK

Earnest attempt at encouraging healthful behaviors among beneficiaries, or willful mandate by the state to control Medicaid costs? The West Va. Medicaid managed care program, Mountain Health Choices, says it’s trying to study the impact of pledges of preventive health of its participants by requiring a signature acknowledging this initiative; as a result, children of those beneficiaries who don’t sign the health pledge are routed to a provision of the plan that only allows for “basic” benefits. Initial results of a study report “widespread confusion among families and doctors about the changes”. A pulic interest law firm is now suing the state, “alleging it has violated federal law by reducing benefits for children whose parents do not sign a ‘personal responsibility’ statement that allows them to receive enhanced benefits”. | LINK

• FDA requires warnings about suicidality risk with certain popular anticonvulsants.
• Physician in key role in Medicare scam gets 30 years.
• Healthcare providers’ “conscience rule” to take effect, courtesy George W. Bush.
• Editorial: Barack Obama must not “bow to” the demands of abortion rights supporters.
• The state of Utah gets ready to overhaul its healthcare delivery systems.

• NY state recoups over half a billion dollars in amounts lost to Medicaid fraud and waste.
• MN has its first confirmed influenza case of 2008 - 2009 season, and it’s a susceptible strain to this season’s vaccine.
• Pharma company’s use of medical ghostwriting questioned.
• U.S. blacks trounce whites in color cancer death rates.
• Baltimore Sun OpEd:  states must employ total adoption of the electronic health record in overhauling healthcare delivery.

No sooner has Tom Daschle taken the job of HHS secretary than we hear that Barack Obama plans to pump major bucks into the federal healthcare economy.

In a stimulus bill that could exceed $500 billion, Obama has already pledged to increase federal Medicaid spending — perhaps by more than $40 billion over two years — and to make a large investment in health information technology.

Talks are underway about also adding money to retrain medical workers, extending the State Children’s Health Insurance Program, and expanding the law that allows unemployed people to purchase health insurance through a previous employer’s plan, known as COBRA.

At a Chicago news conference yesterday to introduce Thomas A. Daschle as his choice for health and human services secretary, Obama said major reform of the health-care system “has to be intimately woven into our overall economic recovery plan.”

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Medical errors causing harm to patients in many acute care situations have been saturating the media a lot recently.  The result is greater emphasis by hospitals in reducing the incidence of those preventable errors. Even Medicare has gotten into the act, developing compliance programs which utilize indirect methods of negative reinforcement to correct those preventable errors.  Vigilant hospitals can take pride in their efforts to reduce and eliminate those errors by way of their internal quality control mchanisms, but what happens when consistently underperforming institutions do next to nothing to correct preventable deficiencies?  Who polices them?  The government?  Private third parties whose involvent with clients is purely voluntary?  Some food for thought from the NYT.