HEALTH REFORM CHANGING RAPIDLY

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HEALTH REFORM CHANGING  RAPIDLY

We spend over $2 trillion on health care each year, an average of $7500 a person.   Very soon your health system will change.  A high-level Obama team is already carrying out key elements to overhaul the health care system and put reform priorities quickly in place.  Pilot studies are now being performed by the Innovation Center of Medicare. The plan is to bundle payments and encourage hospital caregivers to coordinate care and fight for who gets the fixed benefit payment.

 HHS, led by Kathleen Sibelius, former insurance commissioner and then governor of Kansas, has already re-organized Medicare and Medicaid services, testing ways to reimburse providers and reduce spending and hopefully improve patient care. She can expand her ideas nationwide without congress’s permission.

INDEPENDENT PAYMENT ADVISORY BOARD

  Mr. Obama will nominate 15 members to this board for six-year terms. The Senate will be required for confirmation. These will be full-time jobs, give great bureaucratic clout, and its duties will be to propose ways to reduce payments to care providers.  The board can put any proposals into effect unless Congress rejected them within 30 days. The president could veto this disapproval and Congress would have to override the veto with a two-thirds vote of both houses of Congress, something very unlikely.

 After 2014, the board can alter payments to doctors and after 2019 it can alter payments to hospitals. It is not authorized to change benefits for Medicare recipients.  It is likely the board will deal also with health insurance in general. This would prevent doctors from shifting their costs to private insurance rather than Medicare.

The board was set up to control Medicare spending, and not take effect until 2014.  Howver, the board was prematurely created  long before its powers to impose changes will take effect.  This has resulted in a great deal of criticism. Its powers are delegated to an unelected board to control government’s health insurance programs.

CURES (CAN)

 A translation research program has been created under the NIH aimed at drug development, called, the CURES acceleration network CAN.   It will give out grants and contracts up to $15 million a year to companies, academic researchers, and patient groups. It will help discover drugs, conduct lab in animal studies, and the developer needs to conduct regulatory approval for clinical trials.

“CAN” will have an advisory board of 24 members, with one third of them from patient advocacy groups (hopefully not from reorganized ACORN people.

Sen. Specter is credited for this organization along with   Amy Comstock RICK, the director of the Parkinson’s action network in Washington DC.  They felt it was time to expand the NIH’s financial pipeline a little bit.

The NIH director will decide who gets the competitive awards, which will go to high-priority therapies that can’t be developed by commercial markets.

Probation in reality reform provides for creating a curious acceleration network, CAN, at the NIH.   Its purpose is to reduce the time taken to move new drugs and therapies to the marketplace. This provision is a brainchild of Sen. Specter and creates new funding where contracts will be awarded to accelerate the development of high need cures defined as, drugs, biological products or devices. Incentives will be given to the commercial market and grants given to develop testing and regulatory processes were promising ideas for new treatments for deadly diseases are now slow and sometimes dropped and not explored.

This agency is given $2 billion to translate research into realities. It is not a part of HHS. Being part of the NIH, $40 billion is now given to NIH. It will have a 24 member board was the chairman and vice chairman will be appointed by the president. Each member will have a four-year term, which is renewable twice. The president will also appoint members to represent the NIH, FDA, DOD, DA, and NSF. They will serve three-year terms.

 The chairman will utilize NIH advisory panels to review applicants for grants. $1 billion of grant money will be given the first year with additional funds in later years. Grants will be up to $15 million per year and given to applicants who do not have private matching funds. Grants can be given to patient advocacy organizations, as well as academic research and pharmaceutical companies.

MINORITY HEALTH AND HEALTH DISPARITIES TO BECOME AN INSTITUTE.

 In 1990 the NIH director established the office on minority health.  In 2000 and the national Center on minority health and health disparities was formed by Congress.   Its mission was to improve and protect the health of racial and ethnic minority populations with health policies that would eliminate disparities. It advises the HHS secretary on public health program activities.

 PHYSICIAN PAYMENT SUNSHINE ACT

This act requires companies to file annual reports to HHS listing all payments or transfers of value to doctors and hospitals of more than $10 per event or $100 total per year.

The information will be posted in a public online database.

 They felt these payments may be influencing prescribing decisions and biasing the results of clinical studies.  Originally the bill was to include all biomedical scientists including those without a medical degree, but was canceled because the director of Pew Prescription Project said the bill could be expanded later.

THE RECOVERY ACT (ARRA) run by CER

 This act contains $1.1 billion for comparative effectiveness research.  Comparative effectiveness research (CER) compares treatments and strategies to improve health. This information is essential for clinicians and patients to decide on the best treatment. It also enables our nation to improve the health of communities and the performance of the health system.

The ARRA act provides over $1.1 billion to support research assessing the comparative effectiveness of health care treatments and strategies.

    * $300 million for the Agency for Health Research and Quality

    * $400 million for the National Institutes of Health

    * $400 million for the Office of the Secretary of Health and Human Services

   1. Conduct, support, or synthesize research that compares the clinical outcomes, effectiveness, and appropriateness of items, services, and procedures that are used to prevent, diagnose, or treat diseases, disorders, and other health conditions.

   2. Encourage the development and use of clinical registries, clinical data networks, and other forms of electronic health data that can be used to generate or obtain outcomes data.

PEW FOUNDATION

The Pew foundation and Pew charitable trusts replaced the Massachusetts office of families USA.  Its main purpose is to improve public policy, inform the public, and stimulate civic life.  It is run by the community catalyst organization, a national advocacy organization 13 years old,

It shapes the health care system by giving money to meet the healthcare needs of vulnerable constituencies. Its staff contains policy analysts, lawyers, organizers, and organizational development specialists---all aimed to achieve reforms, influence and power the processes of health reform.

It seeks to promote policies that eliminate conflict of interests at academic medical centers.  Since $12 billion is spent each year to market drugs to doctors with new medicines and medical devices, the foundation feels this aggressive marketing is creating conflicts of interest that compromise patient care costs.

 It has pushed for more than 70 drugs including Viagra, Lipitor, and Celebrex to be given free to people who can produce a pink slip and proof they been taking a Pfizer drug for three months.   Other drug companies are now offering drugs at a reduced price to those in need to ease the their burden hit by recession.

AHRQ        

 This is one of 12 agencies in the HHS department.   It was formally known as the agency for health care .  Its purpose is to translate research into improved health care practices and policy.  Offering comparative effectiveness research for better decision-making, its goal is to make better-informed decisions on health care services, insurance, cost, access and quality.   It will evaluate changes in the health care system and devise policies designed to improve its performance.   It will sponsor research to obtain high quality healthcare, and develop personal health guidelines.   It is now providing objective evidence-based information to help everyone choose health plans, doctors, or hospitals.

 Its findings are used to improve health care quality accessibility and outcomes of care.  Its goal is to improve the safety, quality, affordability, and accessibility of health care and improve the economic and social well being of people.

 It has a broad range of power that includes the outcomes of care and effectiveness, evidence-based medicine, healthcare quality, medical errors, care for priority populations, the organization and delivery of care, the health care costs and financing, health information technology and knowledge transfer.

 The agency has a $320 million annual budget now and is planning on investing $10 million to develop clinical terminology, messaging standards and develop the use of health information systems.

CER

The reform bill created the federal coordinating Council or comparative effectiveness research.  It has a $400 million budget and will spend $162 million on research and activities in prevention, pharmaceutical outcomes, informatics,

 In its CER program, it is making policy decisions on drug utilization, economic effects of beta blocker therapy in heart failure, type II diabetes in children, and developing an evidence-based practice program on depression, aspirin prevention for heart disease, osteoporosis, colon and breast cancer, It will decide appropriate use of drugs, health care services, and effectiveness of laser treatment. It will make recommendations for the $400 million that it is allocated.

 It acts had two separate levels. One is to compare effectiveness and answer the question which drug works best. The second level is reimbursement.

 Its purpose is to compare different interventions and strategies that prevent diagnose treat and monitor health conditions. Decision-makers will be informed about which interventions are most effective. It will assess health-related outcomes and defining interventions that include medications, procedures, medical devices, technologies, behavioral changes, and delivery system interventions.  It will expand the database sources to assess comparative effectiveness.

 It basically has four major categories of activities.

 1. Research, comparing medicines for a specific condition or discharge process and readmission.

 2.  Train new researchers to conduct and develop its methodology

 3. Distribute a practice-based data network linking databases and patient registries

 4. Translation and adoption of building tools and methods to translate executive of these into practice and measure results.

 It will also research conditions as cancer, to patient population studies on the elderly, minorities, persons with disabilities, and evaluate interventions as devices, behavioral changes, and delivery systems.

PARKINSON’S ACTION NETWORK

 This is a nonprofit organization of 10 staff members trying to find better treatments and a cure for Parkinsonism. It works to get more funding from NIH for research and speaks out on crucial issues of programs at the FDA, Veterans Affairs, department of defense, HHS programs, including Medicare and Social Security, and research freedom for stem cell research.

It tries to bring awareness to lawmakers about the effect of Parkinsonism.   In October 2009 the secretary of Veterans Affairs, Shinseki, made a comment that there could be a service connection to Parkinsonism.  This resulted in speeding up benefits to veterans with Parkinsonism.  This March, the Parkinsonism network convinced the Department of Veterans Affairs to add Parkinsonism as a problem related to Agent Orange and other herbicide exposures during the Vietnam War.

COMMENTARY

In three or four years, Congress and Mr. Obama will be so desperate to find any mechanism or device that can hold down the growth of spending.

 Medicare spending is highly concentrated in a small group of people who have large medical needs.  A study in 2003 showed 6% of the beneficiaries incurred 25,000 or more in program costs and accounted for 55% of Medicare’s expenditures. By eliminating benefits to the 6% a 55% savings could result. This has encouraged various organizations in the HHS to help end of life decision-making.

 Not everyone agrees more information is always better. Since new drugs will be analyzed, drug companies will produce fewer drugs.   You’ll be sold on the fact that older drugs equals or outperform newer ones that are more costly.   You’ll be told that evidence-based medicine will be a simple tool that can manage expensive medical products and cut costs.

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There is a lot buried in the 2400 pages n the health reform bill passed. Key players are in place  and changes will occur very soon.  Be prepared.

Your comments always appreciated.

Visit www.drneedles.com for more discussion of controversial medical issues.

Sources: Science April 2, 2010

http://www.hhs.gov/budget/06budget/agency.html

htttp://www.hshsl.umaryland.edu/consumer/sites/minority.html

http://www.hhs.gov/recovery/programs/cer/draftdefinition.html