Here’s a convenient talking point for the Obama campaign as it begins to coalesce its message surrounding healthcare reform spending under the ACA: enrollment in Medicare Advantage is up since the beginning of the current decade, while premiums have been on the decline. HHS Sec’y Sebelius attributes this to the core provisions within the ACA allowing stipulations of bonus payments based upon quality, changes to enrollment periods, new medical loss ratio requirements and penalties, and the power for CMS to reject plan bids.

According to Humana’s last quarterly report, it bought two Medicare Advantage contractors in the third quarter of last year and enrollment increased over the past 12 months. Wellpoint also acquired an Advantage contractor in 2011 and saw increased enrollment.

While it may be a little premature to trumpet reform to this sector of Medicare spending by the government as being a permanent fixture of ACA implementation, it does highlight the need to revisit the drama surrounding payments to providers in FFS plans. Will the doc-fix ever be truly fixed? Bipartisan Senate and House members tasked with establishing a permanent end to reimbursement cuts to physicians will have their work cut out for them starting today — apparently considering everything from repeal of the SGR in its current form for Medicare spending to the use of war funds to finance such a permanent patch. Should be interesting.

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Honestly, these “clock-ticking countdowns” are getting a little irksome. The eleventh hour negotiations surrounding the legislative extensions of the payroll tax cuts for the middle class just hit another roadblock, outlets have reported. Cue the Senate showdown between the GOP and Dems. Closely tied into the GOP plan for the extension of the tax cut is the inclusion of the Keystone XL oil pipeline — a controversial project which President Obama had originally hoped to decide upon by 2013 its potential for environmental sustainability.

The Keystone pipeline pawn would force Obama to make a decision on its contruction by the end of this year.

With respect to healthcare, the inclusion of provisions to forestall cuts to Medicare payments for 2 years, preventing incremental threats to physician reimbursements (no permanent overhaul), would be the political gambit. It’s a political mixed bag for some healthcare entities. Hospitals would be better served by more long-term solutions to the so-called doc-fix problem. Providers would be spared more frequently intermittent threats to reimbursement. If passed, this payroll tax cut extension would eliminate the possibility of approximately 27 percent in cuts to Medicare payments.  | LINK

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He’s leaving his much embattled post, and he is not mincing words. Don Berwick will be stepping down as CMS head in lieu of what was sure to be a highly contentious Senate confirmation procedure next year. Calling much of what Medicare “does” as wasteful, the departing CMS chief sounded more like he was delivering a eulogy than offering up hopeful solutions to be implemented in his absence.

Dr. Donald M. Berwick, listed five reasons for what he described as the “extremely high level of waste.” They are overtreatment of patients, the failure to coordinate care, the administrative complexity of the health care system, burdensome rules and fraud. “Much is done that does not help patients at all,” Berwick said, “and many physicians know it.”

Berwick’s ascension came at a time in which President Obama was looking for a CMS chief who shared the same sense of analytical urgency in efforts to fix the nation’s ailing healthcare delivery system. Berwick sounded the clarion call for reform, but received very little cooperation from the GOP side of the ideological aisle, with those members of congress (and some Dems) essentially putting up a wall between him and any actionable improvements. Perhaps his own words project why he was essentially doomed from the start.

Berwick said he had not sought the job. Indeed, he said, “I did not even know if I was fit for it.” He took the post, he said, because he sensed that immense “tectonic shifts” were occurring in the health care delivery system.“I came with an agenda,” Berwick said. “I wanted to try to change the agency to be a force for improvement, covering one out of three Americans.”

Restating the obvious really does physicians he laments no good unless positive change, outside of obvious hyperbole, does occur. According to many pundits — including this one — his replacement offers more of the same, with true change occuring only if legislative control swings back to the Dems in 2012. | LINK

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For Don Berwick, MD, the path to greatness as head of the Centers for Medicaid and Medicare Svcs was essentially doomed from the start. President Obama’s choice to head the federal agency was one made via his executive powers, bypassing congressional confirmation and giving Berwick a scarlet letter on the forehead ever since. Sure, there were the efforts at priming the PR pump in the first year since the reform bill was signed into law — his efforts to eliminate the quality chasm in hospitals and other care settings, bringing new light and interest into so-called comparative effectiveness research to improve healthcare, and most recently, his support of a citizen-led innovation care advisory panel, of sorts, to create models of reform in cutting Medicare spending on the run-up to reform. But it was all for naught. Senate Republicans, miffed at the recess appointment at the outset, never were willing to give the new CMS head a chance. Rather than face an uphill battle with pending confirmation hearings amid a hellish re-election campaign, Obama decided to drop him in favor of a less controversial pick:

President Obama said on Wednesday he plans to nominate Marilyn Tavenner as administrator of the Centers for Medicare & Medicaid Services to replace Dr. Donald Berwick, who has never won the support of Congress. [...] Tavenner, Berwick’s principal deputy, was the Virginia secretary of health and human resources. She has served as a board member of the American Hospital Association and as president of the Virginia Hospital Association.  Ms. Tavenner holds a B.S. in nursing and an M.A. in health administration, both from the Virginia Commonwealth University.

You can bet that this nominee will be a safer one — an administrator who can hold steady on policies of Medicare spending without being seen as a “rationer” of healthcare delivery whose ideas on cutting federal costs of healthcare will not be perceived as coming from a wealth redistribution model.

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With the SCOTUS set to take up the ACA and its constitutionality this term, more fuel to the fire has just been added to an otherwise white hot election ’12.

Although recent polls seem to dignify the usually staid Newt Gingrich with the flavor-of-the-campaign tiara at the moment, the sure bet is on the “electable” former governor of Massachusetts and originator of all things Universal Healthcare, Mitt Romney. For President Obama, it presents an interesting “problem” which will require appropriate strategies for the White House in keeping the president on message, as they say, over the next twelve months.

No matter how the SCOTUS rules on the matter before it, Obama has got the winds of the ACA behind him. The wheels have been in motion for the past year-and-a-half to the get the first provisions of the reform law into place. Issues such as coverage extensions  for adult children of policy beneficiaries and increased employer-based protections for workers practically guarantees and confirms widening of likes versus dislikes ratio with respect to the law. All of this cannot be ignored by the court as it hears arguments early next year.

Conversely, Mitt Romney could benefit from a negative ruling by the court. After signing into law an individual mandate provision in Mass’s. law as governor, Romney initially praised the action, calling it the “ultimate conservative idea”. Known as much for his flip-flops on this issue (because he is running for president, after all) as he is for his corporatist, milquetoast demeanor — a negative decision of the courts would give him immediate justification for blasting it.

Perhaps that’s why he is mum on the issue now. Further, Romney can make the repeal of the law a central campaign mantra, if the SCOTUS upholds it — “realizing” that individual states can have mandates if they so desire, but not at the direct imposition of the feds.

Regardless, the rhetoric on the constitutionality of the ACA will ramp into high gear next summer; and the ride will be a tumultuous one for both candidates. | LINK

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Is it too early for this sort of news, or is a political agenda afoot? According to a new Gallup survey, the nascent reform law is still leaving a significant amount of uninsured without adequate coverage from employers. Ditto for the elderly and the government.

Some of the main components of the Affordable Care Act, such as tax credits for small businesses that provide health insurance to their employees, and the establishment of a pre-existing condition insurance plan, have done little to boost Americans’ health coverage, the survey found.

This report comes on the heels of a recent appeals court decision reaffirming the constitutionality of the law and its coverage mandates. It’s no secret, however, that the ACA is still struggling to get in the good graces of the majority of stalwart congressional Republicans and some Dems. Still a little early to say if the report will gain traction ahead of the first GOP primaries in less than two months; but, it represents another PR hurdle the law’s proponents must overcome on the road to reclaiming the White House in ’12. | LINK

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Okay, here’s what we do know about the current state of solvency of Medicaid post-stimulus funding: states are grappling with a larger share of Medicaid liabilities than before, and they are immediately reacting with a combination of cuts to providers/hospitals and pulling in the reins on certain services.

Although states are bearing a bigger share of the Medicaid burden this year than they have in the recent past, overall Medicaid spending (state and federal dollars) is projected to grow by only 2.2 percent, the lowest amount since 2006, [a] Kaiser report [shows]. That is because the stimulus funding ended, and program costs are stabilizing as the national economy shows tentative signs of recovery and enrollment growth slows.

The article is a lengthy one, but worth a read. The Kaiser-funded survey trial of states with respect to this question suggests many states are implementing myriad Medicaid spending stopgaps in the short term. All this is on the table as the bipartisan so-called congressional supercommittee gets ready to release its report on trimming the current budgetary deficit.

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The president will issue an executive order today requiring the FDA to act on potential drug shortages in the phrama marketplace. Previously, drug companies were only required to notify the agency if a preparation was to be discontinued. Any other notification would be completely voluntary on the part of the manufacturer. The executive branch action is only the latest maneuver^[1] by this administration to “get tough” in the way of roadblocks initiated by the GOP in the legislature to nix his jobs bill en toto.

Most preparations affected are used in the aucte setting: electrolyte mixtures, chemotherapeutics, and anesthetics. The FDA reported over 170 instances of shortages in 2010, with an increase projected for this year. President Obama also expressed his support for legislation that would require streamlining the notification process; pharma companies would have to notify the FDA of shortages six months in advance. All of this is good news for patients, who stand to benefit the most from timely intervention in acute medical treatments. | LINK

1. In the past week, Obama has issued orders creating relief for “underwater” homeowners and current college students with high tuition debt.

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The news Wednesday morning of a 3.6 percent increase in Social Security COLA payments for 2012 is somewhat of a mixed blessing for Medicare beneficiaries, many of whom have had to shoulder stagnant SS income over the last couple of years due to negligible inflation. The increase — set to take place in January — could be offset by higher Medicare B premiums, which are deducted from SS payments.

Typically, and unsurprisingly, Medicare B premiums increase at rates higher than inflation — but those increases cannot exceed COLA, by law. Dually eligible recipients over the last couple of years, as well as higher income senior beneficiaries, were not protected from rate increases over 2010 because of Medicaid payments incurred by the former and Part B surcharges paid by the latter group.

The majority of Medicare beneficiaries, however, paint a variable picture with respect to SS income and Part B liability; and the degree of variability has to due with the amount of the monthly SS benefit paid to seniors. All of this is a stark reminder of the degree of the increasing costs of healthcare delivery on Medicare and how it compares and impacts SS entitlements year-in and year-out.

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The reining in of costs associated with spiraling Medicare coverage amidst the proposed so-called “doc-fixes” addressing incessant threats of congressionally mandated cuts has many on the Hill wondering what will the Super Committee do to remedy the situation? FYI, the Super Committee is the bipartisan congressional panel made up of 6 Dems and 6 GOPers tasked with putting the brakes on deficit spending to the tune of $1.5T over the next ten years. Issues of Medicaid and Medicare spending are high on the panel’s agenda.

Specifically, futher tightening of Medicare eligibility rules and block-grant funding of Medicaid are mong the most rancorous of discussions — so much so, that at least one Republican moderate senator has chosen to distance herself from the Super Committee recommendations forthcoming. Sen Olympia Snowe (R-ME) also cites her support of branded pharma rebates (something her GOP colleagues really aren’t enthusiastic about) as another mechanism to trim costs.

The ramped-up schedule endorsed by the panel has states, insurance companies, and policywatchers of reform on the edge of their collective seats as issues of funding of the Medicare hospice benefit funding and possible elimination of the SGR formula for determining Medicare reimbursements to phsyicians and hospitals are discussed along with Medicaid funding. | LINK

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