Groundbreaking “I-STOP” Legislation Would Crack Down
On Abuses Like ‘Doc-Shopping’ And Rx Forgeries
Amid New York’s growing prescription drug epidemic, U.S. Senator Kirsten Gillibrand endorsed Attorney General Eric T. Schneiderman’s legislation to create an online database to report and track certain controlled substances. Support from Senator Gillibrand follows the recent release of a report from the Attorney General detailing the growing prescription drug abuse crisis in every corner of New York State. Statewide, the number of prescriptions for all narcotic painkillers has increased by six million, from 16.6 million in 2007 to nearly 22.5 million in 2010.

“Abuse of addictive painkillers has increased drastically in the last decade, but our state’s regulation and monitoring of these powerful drugs has not kept up,” said U.S. Senator Kirsten Gillibrand. “I strongly support Attorney General Schneiderman’s I-STOP bill, which would help to rein in doctor shopping, prevent the use of forged prescriptions, and identify patients in need of addiction treatment. It’s the right solution to tackle the growing epidemic of prescription drug abuse.”

“From national leaders like Senator Gillibrand to law enforcement officials and health care advocates, support is growing every day to create the I-STOP database to address the epidemic of prescription drug abuse here in New York,” said Attorney General Schneiderman. “The time is now to streamline communication between health care providers and pharmacists to better serve patients, stop prescription drug trafficking, and provide treatment to those who are addicted.” Prescription drug abuse is the country’s second most prevalent illegal drug problem, and recent reports and studies have documented corresponding data in the state. For example:

• Statewide prescriptions for hydrocodone have increased 16.7 percent, while those for oxycodone have increased an astonishing 82 percent;
• In New York City, the rate of prescription pain medication misuse among those age 12 or older increased by 40 percent from 2002 to 2009, with nearly 900,000 oxycodone prescriptions and more than 825,000 hydrocodone prescriptions filled in 2009;
• In Buffalo, New York’s largest methadone clinic outside of New York City, Catholic Health System, has begun to reorganize its service to accommodate an increase in care needed to treat the number of opiate-addicted expectant mothers and newborns;
• On Long Island, both crisis and non-crisis admissions to drug treatment that involve opiates other than heroin and have increased at alarming rates. Between 2004 and 2009, the number of deaths due to the toxic effects of prescription opioids more than tripled in Nassau County; and
• In the North Country, health care facilities have experienced a staggering increase in the percentage of non-crisis admissions for substance abuse involving prescription narcotics, eclipsing cocaine and heroin in Clinton and Franklin Counties, and surpassing even marijuana in St. Lawrence County.

New York’s current prescription monitoring program requires pharmacists to report controlled substances they dispense at least once every 45 days. There is no tracking of prescriptions written and there is no mechanism whatsoever for pharmacists to ensure that a prescription presented is valid.

Supported by a broad coalition of law enforcement, health care experts and lawmakers, I-STOP will vastly enhance the effectiveness of the present system. Its goal is to enable doctors and pharmacists to provide prescription pain medications, and other controlled substances, to patients who truly need them. At the same time, it will arm them with the necessary data to detect potentially dangerous drug interactions, identify patterns of abuse by patients, doctors and pharmacists, help those who suffer from crippling addictions and prevent potential addiction before it starts.

Attorney General Schneiderman’s I-STOP legislation:

• requires the Department of Health to establish and maintain an online, real-time controlled substance reporting system to track the prescription and dispensing of controlled substances;
• requires practitioners to review a patient’s controlled substance prescription history on the system prior to prescribing;
• requires practitioners or their agents to report a prescription for such controlled substances to the system at the time of issuance;
• requires pharmacists to review the system to confirm the person presenting such a prescription possesses a legitimate prescription prior to dispensing such substance; and
• requires pharmacists or their agents to report dispensation of such prescriptions.

These enhancements of the state’s prescription drug monitoring program are all necessary to assist in patient care by providing a doctor with a patient’s accurate and up-to-date controlled substance prescription history; eliminate the problem of stolen and forged prescriptions being used to obtain controlled substances from pharmacies; crack down on illegal ‘doc-shopping,’ the practice of visiting several different doctors and pharmacies for prescription drugs; facilitate prosecutions of crooked doctors; and achieve significant savings for public and private health insurance programs.

ABH HEALTHCARE NEWS - Week of January 23, 2012

2012 Kicks Off With Massive Show of Support for
Affordable Care Act in the States
A national group of state legislative leaders announced that over 500 state legislators representing all 50 states will file a brief with the U.S. Supreme Court tomorrow supporting the constitutionality of the health law, arguing that “the minimum coverage provision of the Affordable Care Act is a valid exercise of Congress’s Commerce Clause and Necessary and Proper Clause powers.”

In an announcement, the Working Group of State Legislators for Health Reform, a national group of state legislators focused on advancing health reform at the state level that works closely with Progressive States Network, said that over 500 state legislators representing all fifty states have signed on to an Amicus Brief strongly defending the Affordable Care Act in the challenge currently before the Supreme Court. The brief will be filed this Friday and was prepared and filed in conjunction with the Constitutional Accountability Center. "The idea that the federal government does not have the power to address a national problem such as the health care crisis has no basis in the Constitution’s text and history," argue the legislators in the text of the brief.

At a press briefing today, state legislators from around the nation who have signed on to the brief discussed their support for the law and highlighted the positive momentum behind the implementation of the law in their states. “State legislators must continue their work to meet the growing need for high-quality, affordable health care with confidence, knowing that their implementation efforts will not be delayed or derailed by groundless constitutional challenges,” said Sen. Karen Keiser, D-Washington, Chair of the Working Group of State Legislators for Health Reform.

CAC Chief Counsel Elizabeth Wydra said, “Because the Affordable Care Act is supported by the Constitution’s text and history – as well as Supreme Court precedent going back to the Founding era – challenges to health care reform to have a lot more to do with politics than they do the Constitution. After losing in Congress, conservatives are simply looking for courts to give them a judicial do-over. Fortunately, judges across the ideological spectrum – including those appointed by Presidents George W. Bush and Ronald Reagan – have upheld the Act as constitutional, and we are confident the Supreme Court will agree.”

“Almost two years after the enactment of the Affordable Care Act, and as a pivotal year kicks off, this brief is an incredible statement of support for health law from the states,” added Progressive States Network Executive Director Ann Pratt. “It’s also a sign of how responsible state lawmakers all across the nation are coming together in 2012 to turn the tide from political gamesmanship and attacks to working to protect the gains already made for the health security of families under the Affordable Care Act: one million young adults now newly covered, four million seniors who have received help affording prescription drugs, and a patients’ bill of rights that puts an end to many insurance industry abuses.”

This show of support for the Affordable Care Act is part of a larger demonstration of support for the law taking place across the nation this week, as legislators affiliated with the Working Group announced plans for local events in eight states in the coming days that will highlight the benefits the Affordable Care Act has brought their constituents. Progressive States Network (http://www.progressivestates.org) is a non-partisan, non-profit organization dedicated to supporting the work of progressive state legislators around the country and to the passage of state legislation that delivers on issues the issues that matter to working families: strong wage standards and workplace freedom, balancing work and family responsibilities, health care for all, smart growth and clean energy, tax and budget reform, clean and fair elections, and technology investments to bridge the digital divide. Constitutional Accountability Center (http://www.theusconstitution.org) is a think tank, public interest law firm, and action center dedicated to fulfilling the progressive promise of the Constitution's text and history.

ABH HEALTHCARE NEWS - Week of January 16, 2012

The Centers for Medicare and Medicaid Services (CMS) has selected
seventy three individuals for its Innovation Advisors program.
The initiative, launched by the CMS Innovation Center, will help health professionals deepen skills that will drive improvements to patient care and reduce costs. After an initial orientation phase, Innovation Advisors will work with the CMS Innovation Center to test new models of care delivery in their own organizations and communities. They will also create partnerships to find new ideas that work and share them regionally and across the United States.

Funding for this initiative was made possible by the Affordable Care Act. “There has been an incredible groundswell of interest in becoming an Innovation Advisor. It’s clear that doctors, hospitals and health care providers are enthusiastic about implementing the Affordable Care Act and strengthening our health care system,” said CMS Acting Administrator Marilyn Tavenner.

The 73 individuals were selected from 920 applications through a competitive process, and include clinicians, allied health professionals, health administrators and others. By attending in-person meetings as well as remote sessions to expand their skills and applying what they learn, the Advisors will be able to deepen their knowledge in health care economics and finance, population health, systems analysis, and operations research.

“We’re looking to these Innovation Advisors to be our partners—we want them to discover and generate new ideas that will work and help us bring them to every corner of the United States,” said CMS Innovation Center Director Rick Gilfillan, M.D. Among other duties, the Advisors will be expected to support the Innovation Center in testing new models of care delivery, to form partnerships with local organizations to drive delivery system reform, and to improve their own health systems so their communities will have better health and better care at a lower cost.

Each Innovation Advisor’s home organization will receive a stipend of up to $20,000. The stipend will support an individual’s activities while serving as an Innovation Advisor. More information about the Innovation Advisors Program, including a fact sheet and list of participants and their home organization, can be found at: http://innovations.cms.gov/initiatives/innovation-advisors/index.html.

ABH HEALTHCARE NEWS - Week of January 09, 2012

Affordable Care Act Helps Keep Medicare Affordable
The U.S. Department of Health and Human Services (HHS) announced that Medicare Part B premiums in 2012 will be lower than previously projected and the Part B deductible will decrease by $22. While the Medicare Trustees predicted monthly premiums would be $106.60, premiums will instead be $99.90. Earlier this year, HHS announced that average Medicare Advantage premiums would decrease by four percent and premiums paid for Medicare’s prescription drug plans would remain virtually unchanged.

Thanks to the Affordable Care Act, people with Medicare also receive free preventive services and a 50 percent discount on covered prescription drugs when they enter the prescription drug “donut hole.” This year, 1.8 million people with Medicare have received cheaper prescription drugs, while nearly 20.5 million Medicare beneficiaries have received a free Annual Wellness Visit or other free preventive services like cancer screenings.

“The Affordable Care Act is helping to keep Medicare strong and affordable,” said HHS Secretary Kathleen Sebelius. “People with Medicare are seeing higher quality benefits, better health care choices, and lower costs. Health reform is also strengthening the Medicare Hospital Insurance Trust Fund and cracking down on Medicare fraud.”

Medicare Part B covers physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items. In 2012, the “standard” Medicare Part B premium will be $99.90. This is a $15.50 decrease over the standard 2011 premium of $115.40 paid by new enrollees and higher income Medicare beneficiaries and by Medicaid on behalf of low-income enrollees.

The majority of people with Medicare have paid $96.40 per month for Part B since 2008, due to a law that freezes Part B premiums in years where beneficiaries do not receive cost-of-living (COLA) increases in their Social Security checks. In 2012, these people with Medicare will pay the standard Part B premium of $99.90, amounting to a monthly change of $3.50 for most people with Medicare.

This increase will be offset for almost all seniors and people with disabilities by the additional income they will receive thanks to the Social Security cost-of-living adjustment (COLA). For example, the average COLA for retired workers will be about $43 a month, which is substantially greater than the $3.50 premium increase for affected beneficiaries. Additionally, the Medicare Part B deductible will be $140, a decrease of $22 from 2011.

“Thanks in part to the Affordable Care Act, people with Medicare are going to have more money in their pockets next year,” said Centers for Medicare & Medicaid Services (CMS) Administrator Donald Berwick, M.D. “With new tools provided by the Affordable Care Act, we are improving how we pay providers, helping patients get the care they need, and spending our health care dollars more wisely.”

CMS also announced modest increases in Medicare Part A monthly premiums as well as the deductible under Part A. Monthly premiums for Medicare Part A, which pays for inpatient hospitals, skilled nursing facilities, and some home health care, are paid by just the 1 percent of beneficiaries who do not otherwise qualify for Medicare. Medicare Part A monthly premiums will be $451 for 2012, an increase of $1 from 2011. The Part A deductible paid by beneficiaries when admitted as a hospital inpatient will be $1,156 in 2012, an increase of $24 from this year's $1,132 deductible. These changes are well below increases in previous years and general inflation.

For more information on how seniors are getting more value out of Medicare, please visit: http://www.healthcare.gov/news/factsheets/2011/10/medicare10272011a.html
For more information about the Medicare premiums and deductibles for 2012, please visit: https://www.cms.gov/apps/media/fact_sheets.asp

ABH HEALTHCARE NEWS - Week of January 02, 2012

Healthcare Market Resources’ Data Supports Recent Medicare
Home Health Reform for Substantial Savings
Healthcare Market Resources, a leading provider of customized local market research for home health agencies and hospices, has conducted a state by state analysis of the Medicare Home Health Outlier payments. Its research reveals that Washington’s recent health care reform of a 2.5% cap on the outlier payments will in fact produce meaningful health care savings without negatively affecting patient access. “It is as if we are attacking a cancer that is very localized,” Richard Chesney, CEO, Healthcare Market Resources said. “The cap will offer the precision of a scalpel realizing tremendous savings for all yet only impacting a small number of Medicare beneficiaries.”

Remarkably, Healthcare Market Resources’ customized local market research reveals that more than 84% of these outlier reimbursements in 2007 were paid to agencies in just three states- California, Florida and Texas, with Florida receiving the lion’s share. Yet, these states only have 23.4% of Medicare enrollees. Some of those agencies received as much as 80% of their Medicare reimbursement in supplemental outlier payments.

Further analysis of the data found at www.healthmr.com/outliers, demonstrates that 550 agencies were paid slightly over 50% of all outlier reimbursements and almost 88% of these high outlier agencies were in one of the three states mentioned above. A whopping 94% of these agencies were for-profit. “Had the 2.5% cap on outlier payments been in effect in 2007, Medicare home health reimbursements would have been reduced by $845 million or 5.4% of total expenditures,” Chesney stated. “Less than 25% of the agencies would be impacted by the cap.”

A Medicare outlier is a patient who consumes a disproportionate amount of healthcare resources. A home health agency is only reimbursed a fixed amount per episode of care, however, a percentage of patients rack up higher healthcare costs because the intensity of treatment exceeds the fixed amount. The current Medicare system allows home health agencies to recoup some of these expenses through supplemental payments. Under the regulations, this portion of the benefit was originally allocated 5% of the Medicare home health payments.

However, Medicare Home Health outlier provision payments exceeded their projected levels in 2007 representing 6.35% of Medicare payments or $996 million. The recent regulation on outliers has shed light on abuses of the Medicare system and spawned investigations of home health agencies. “The geographic concentration of the outlier spending increases should have been a red flag,” Chesney said.

About Healthcare Market Resources, Inc.
Healthcare Market Resources is a leading provider of custom data for home health agencies and hospices. Its customized local market reports give healthcare leaders a competitive edge for business development and strategic planning initiatives. The insight gained from these marketing tools enables home health agencies and hospices to benchmark their financial, operational, and market performance against their competition. Whether you are interested in market share or market segmentation, Healthcare Market Resources has the tools professionals need to make better decisions for their healthcare organizations. www.healthmr.com. The complete data of the percentage of outlier payments by state can be accessed at www.healthmr.com/outliers. A chart with full details of the data can be found at www.healthmr.com/outliers.