Any momentum gained by President Obama when the issue of exorbitant insurance premium hikes was the healthcare topic du jour last month seems to be all but forgotten as Insurance continues to conduct business as usual. In Mass., the Blues in that state face fighting caps on their rates as its governor, Duval Patrick, reviews requests for increases of anywhere from 8 to 32 percent.

In California, the apparent epicenter of the firestorm over rate hikes, insurance companies seem loathe to change as well, citing the “increasing costs of healthcare” as  a reason for those hikes. All of this movement by Insurance is forcing Obama to take his message to the public to get support for reform. He’ll begin his week by doing so today in Philadelphia.

Wise move? It’s perhaps his only move. With the GOP urging going back to the drawingboard, moderate Dems uneasy over the pricetag of reform ($1T), and House liberal Dems suspicious of Senate motives once the bill is passed; it appears that Obama is turning to the only group left to fully convince the utility of a healthcare overhaul — the American people. | LINK

Physicians — especially those of the primary care type — are spared the potential problems that come with cuts in Medicare payments. At least for another month. President Obama has delayed the anticipated 21% cut in reimbursements while Congress has to take the matter up yet again.

Sen. Jim Bunning (R-KY) created a legislative frenzy last week when he placed a procedural hold on the bill that would have extended health care benefits to the unemployed for an additional length of time. That measure would have also allowed taxpayer subsidies to be used for premiums. Bunning relinquished his standoff yesterday, allowing this extension on cuts in payments to be avoided for another 30 days.

Polling, as a result, shows just how far cuts in Medicare payments to providers and provider organizations will go in threatening care delivery to a huge segment of the chronic care patient population — the same demographic responsible for the heaviest utilization of pharma, primary care, and acute care. Approximately two-thirds of primary care physicians polled by Medscape said they would cease to care for Medicare beneficiaries as a result of the cut.

An extension only holds off the inevitable, and although Senate Democrats are looking for ways to delay cuts further, there has to be a day of reckoning. That could come October 1, if senate legislators work to pass another bill [PDF] and try to reverse the SGR formula [PDF], which is responsible to establishing pay cut schedules in Medicare provider reimbursements.

With reform, the current band-aid strategy the Obama administration is using continues on its sloppy course.

Pfizer’s current research on a potential blockbuster anti-Alzheimer drug is currently back to drawing-board status. According to the pharma company

[T]he drug, called Dimebon, had shown virtually no effect after six months in treating the cognitive decline or behavioral problems associated with Alzheimer’s when compared with a placebo.

Apparently, Wall Street has been watching the results of this Phase I study; the verdict is still out on whether Pfizer will continue to fund the research for this agent — designed to work better and longer at inhibiting some of the most distressing symptoms related to the disease. | LINK

President Obama’s healthcare summit has come and gone. The mere fact that this meeting took place in front of cameras was reason enough to discount any potential for real bipartisanship to occur. The upshot? The Republicans stand firm on their ground to rally against any Obama proposal as the party brands itself on this issue ahead of a potentially gratifying November midterm.

Meanwhile, the White House and the Democrats will say that every effort is being made to “forge ahead” amid the apparent obstructionist natures of the GOP. The problem for both parties is that the American public is becoming tired of what it sees as a spectacle. According to a CNN poll [PDF], 86 percent felt that government is broken, with 14 percent saying it isn’t. Of that 86 percent, 81 percent say the government can be fixed, with 5 percent saying it’s beyond repair.

Whatever the ultimate effect this televised meeting had on patients, lawmakers, physicians, insurance companies, and other interested parties; one thing’s for certain: closed-door meetings are the only way anything can get done. Political theater for the world to see accomplishes nothing but shallow grandiosity on the bumpy road to an ultimate reform bill. | LINK

RELATED: The GOP’s proposals. | LINK

What could possibly be worse for patients as the current state of reform (tune in tomorrow) is more uncertain than ever? According to a JAMA study [PDF], the fact that more physicians are cutting hours — not just primary care docs, but most physician demos across most specialties. Reasons are myriad, but the one essential kernel remains: the increasing layer of oversight (administrative and managed care constraints) has slowly but steadily gained a prominent foothold into how much time a physician can actually devote to seeing patients. According to one family physician

“It added five or six years onto my practice life – and I love what I do,” [Virginia family physician] Dr. Ellington said. “I couldn’t have continued to do what I was doing. I couldn’t do it physically, emotionally and financially. It had become overwhelming.”

And it will only get worse — at the very least for the primary care physician who is already burdened with heavier admin and paperwork hassles, lower pay, increasing patient loads, and lower Medicare reimbursement schedules. | LINK

Pennsylvania and Hawaii are the only two states in the country that do not have a mechanism in place for the regulation of premium rates set forth by insurers as it applies to their small businesses — a demographic courted heavily by both Republicans and Democrats as players in the final direction of pivotal health reform. The Pandora’s Box cast wide open by the recent Anthem BC scandal is adding a new critical layer of scrutiny not only to Barack Obama’s reform trajectory, but also to the ways in which Insurance market fluctuations influence the overall cost of healthcare delivery and access.

Implications for the these two states are obvious, as government regulatory oversight could go a long way in keeping the relationship between small business and the insurance they purchase an open, transparent, and freely accessible system for consumers of healthcare (patients), giving states’ insurance commissioners added muscle. Alternatively, control of regulatory processes by the federal government could add just another layer of bureaucracy (read: increased administrative healthcare costs to the taxpayer and shifting rising costs to other entities — like Pharma) to an already overburdened HHS Dept. Over the next few days, the unfolding issue of federal gov’t Insurance regulation over state’s private insurance markets will become a hot-button one, adding some eleventh-hour drama to the health reform debate. | LINK

Legislative grilling in California begins today for Anthem Blue Cross, the insurer whose efforts to increase some average premiums by almost 40% did not go unnoticed by the White House. Wellpoint, the payer’s parent company, will begin its time being questioned before a special state House committee tomorrow. Although the most likely effect of such questioning will be the negative national PR that has accompanied it, the excessive scrutiny of the company’s books will almost certainly provide the impetus for local reform in this area at the hands of state legislatures as it applies to other insurers — eventually leveling the playing field in the Insurance marketplace.

In other Anthem Blue Cross news, a California man’s breach-of-contract trial with the insurer has just begun.

President Obama’s version of the reform bill (the one he is personally proposing and defending, come later this week) is getting a shot in the arm. Hoping to stoke public animus against the recent massively outrageous insurance premium hikes by Blue Cross in California and in other states, Obama will once again renew the call for a bill mostly on his terms.

Coming nearly a year after he put the push toward reform into overdrive, Obama will include the new provision that will allow the government (HHS) and states the power to bar or limit such increases — even demanding rebates for consumers of healthcare in such an environment. All of this is in anticipation for the bipartisan summit with senate Republican and Democratic leaders at which Obama will add previous provisions which include barring claims denials for pre-existing conditions, and a tax on HDHP (Cadillac plans).

Republicans are standing fast on their admonition to force Obama essentially to start from scratch, with a nod toward a more tepid bill with less obvious government funding. The showdown takes place later this week and will be televised. | LINK

UPDATE: The WH has posted Obama’s proposal summary. | LINK | At initial look, the president’s plan does not appear to repeal the antitrust exemption. | LINK [PDF] | Also, without public option language in the proposed bill (as expected), what’s next for each side? The heavily hyped bipartisan summit awaits this week. But what about afterwards? Assuming the Republicans stick to their guns, obliterating the WH’s strategy of forcing them to defend their antipathy toward the bill on fiscal grounds, will the party extend the drive for nay votes toward mditerms? Since the Dems are down by at least three votes, this could be likely. Perhaps, a protracted fight among both sides will be good for the bill’s ultimate passage on (mostly) Obama’s terms —  then, and only then, will the true transparency of the proposed bill’s language come to light as Americans may use November as a referendum on health reform.

It’s often said that the beleaguered emergency department (ED) is the initial point of care for many patients. In this current broken healthcare delivery system, that means an umbrella which “covers” the uninsured as well as those who are underinsured. The total cost for these points of acute care notwithstanding, how is the best way to explain new numbers out of the CDC this week?

The CDC’s National Center for Health Statistics reported the numbers in its annual summary of U.S. data on disease conditions, health behaviors and use of medical services. The scan figures are based on visits to roughly 500 hospitals and 3,000 doctor’s offices and outpatient clinics.

According to this survey data, the CDC says that the use of imaging modalities in the ED has quadrupled since the mid-1990s. Besides being just another point of confirmation of the origin of skyrocketing healthcare costs in this country, the heavy emphasis placed on tech will not abate anytime soon. Issues pertaining to defensive medicine, integration of such tech into ingrained training of new physicians, and the cost of using such technology within the medical device market are all good reasons to try to begin attacking this startling — yet, unsurprising — statistic. | LINK

• Vanderbilt University (my undergrad alma mater) has announced that it has access to a special blood test that can predict a patient’s risk for heart disease. Using genomic factors, along with the patient’s age, history of stable chest pain, and gender — the assay (dubbed Corus CAD) offers a non-invasive alternative in stratifying coronary disease risk.
  

  The test was developed as a part of a new medical field called genomic medicine, which enables doctors to further personalize patient care based on the unique genomic makeup of individual patients — an important factor for many visiting the doctor. For this reason, the blood test interests many physicians.

  Count me among those interested.

• On a more dour note, there is renewed interest in the recall of rosiglitazone (Avandia), the Glaxo drug with known associations in causing cardiac disease and risk of death; confidential studies via officials in the FDA are recommending the drug’s withdrawal from the market, potentially leaving Pfizer’s pioglitazone (Actos) as the only market alternative in this class to treat diabetes mellitus, type 2.
  

  The company has faced criticism that it has known about the heart-attack risks associated with Avandia for years. Glaxo added a “black-box” warning to Avandia in November 2007 that says the drug can cause or exacerbate congestive heart failure. The company has also faced accusations that it attempted to intimidate scientists and doctors outside the company who raised questions about the safety of Avandia. The company has said that it didn’t try to intimidate anyone.

Last Februrary, Medicare fraud once again took center stage; a Tampa, FL-based managed care outfit was outed by the federal government for intentionally hiding Medicare payments in a specially created private entity called Harmony Behavioral Health. Citing administrative costs as the reason for diversion, WellCare Health kept for itself state funds meant for mental health services and delivery. If there were any reason in the heat of Obama’s reform rhetoric in 2009 to rail against the government’s mishandling of its own Medicare reimbursement policies (as part of shoddily run MA plans) as being part and parcel of the overall increase in the cost of healthcare delivery — it was quite apparent with this case.

Read the rest of this entry »

Hot on the heels of Insurance hiking premiums among policyholders in California comes a warning of sorts from HHS Sec’y Sebelius: California is not immune. In fact, the spectre of recent burgeoning rates seen at the hands of a Blue Cross/Shield plan subsidiary in the Golden Gate State is only the tip of a rapidly moving iceberg in a healthcare marketplace within which Big Insurance says it must remain competitive.

RI, CT, and OR were three other states cited in Sebelius’s remarks. As healthcare reform moves at a more restrained pace in the run-up to an eventual bill, there is no denying the market is seeing the effects of an economy far from recovery. As millions jettison more expensive coverage for the bare minimum, costs for care delivery are beginning to reflect payouts to plans for the sicker and older portion of the risk pools, creating even more urgency for Obama and company for reform as he has seemingly moved on to his other top domestic priority — jobs. | LINK

You know the path toward any sensible healthcare reform is dead when Pharma’s chief lobbyist is prepared to step down. Former Louisiana congressman and PhRMA head, Billy Tauzin — who brokered a deal with the Obama admin to forge forward Pharma’s role in reform efforts — will be calling it quits in June.

You may be wondering why would one of the industry’s most loquacious and opinionated frontmen who could have shepherded his position as long as he wanted has decided to abandon the post. Perceived pressure. Pressure that was sure to mount against him as a complicit player in reform on the Democrats’ terms. But something funny happened on the way to Obama’s Oval Office desk for signature — the reform bill’s chances took a decidedly different turn with the election of Scott Brown to Teddy Kennedy’s long-held Mass. senate seat.

Read the rest of this entry »