By Mike Lillis - 10/20/10 10:00 AM EDT
• Rules for abortion coverage: After a long and thorny debate, the Democrats decided to allow state-based exchange plans to cover abortion services if the patient pays the full cost of that coverage with a separate check. The restriction did little to appease most Republicans, though, who say the language needs to be more strict to ensure that taxpayer funds don't subsidize abortions.
• The Independent Payment Advisory Board: Also known as "MedPAC on Steroids," the commission is charged with recommending payment reforms to keep Medicare solvent — with Congress forced to act on the suggestions or come up with their own. Critics — mostly Republicans — say it will lead to government rationing, and they want to kill it altogether.
• Comparative Effectiveness Research (CER): The theory behind CER — a system of comparing different treatments for the same ailment to learn which work best — is not controversial. Still, there's plenty of concern that cost considerations — not just clinical analyses — could eventually creep into the equation, leading (again) to a rationing of care. The new healthcare reform law creates a nonprofit institute charged with conducting CER. But the law specifically prohibits members from promoting coverage, practice, payment or policy recommendations based on their research. Still, Republicans are wary.
• The Prevention and Public Health Fund. Republicans say a nondescript fund to promote prevention and wellness is nothing more than a multibillion "slush fund" for local governments to build "jungle gyms." They want it done away with.
Insurance giant tries new cancer coverage strategy
UnitedHealth Group is set to announce a new pilot program designed to eliminate the incentives for doctors to overprescribe cancer drugs, which have skyrocketed in cost in recent years, The Wall Street Journal reports.
Instead, "oncologists will be reimbursed at cost for whatever drugs they prescribe and receive a separate payment covering their services," the Journal writes. http://bit.ly/a1IOgv
Under current protocols, oncologists infuse many cancer drugs in their offices, billing insurers for the drugs' cost along with an additional fee. The more drugs they prescribe, the more fees they get.
"They've become drug dealers," Lee Newcomer, UnitedHealth's vice president of oncology, told the Journal.
Under the pilot, UnitedHealth will require doctors to choose ahead of time how they want to treat several types of cancer, the Journal says.
"The drugs can include anything from standard chemotherapy with generic drugs to costlier branded treatments, such as Herceptin or Avastin," the Journal writes. "The insurer will pay the doctors for each drug they actually end up using, but without the traditional markup, and data on the doctors' choices will be shared among the clinics to identify what works best."
What principled looks like
Plenty has been written about the role of Rick Scott, the GOP candidate for Florida governor, surrounding the $1.7 billion his former company, Columbia/HCA Healthcare Corp, paid to the federal government to settle Medicare fraud allegations.
Scott himself said he knew nothing of the overpayments his company received from the government. Turns out, he's used that argument throughout his healthcare career.
In transcripts released this week from sworn testimony surrounding several old suits against Columbia/HCA, Scott stonewalls the proceedings by refusing to answer questions, claiming ignorance about his own actions or saying he doesn't understand the meaning of words like "predecessor," "chain," "over-capacity" and "public trust." http://bit.ly/aLPGZ5
In 1995, for instance, Scott was deposed by attorney John T. Cusack in an anti-trust case against Columbia/HCA. Some excerpts:
Cusack: Is it fair to say that, under your aegis, Columbia/HCA Healthcare Corporation has grown to be the largest hospital chain in the free world and in the United States?
Scott: What do you mean by chain?
Cusack: A corporation owning a number of hospitals.
Scott: Could you repeat the question again? What do you mean by aegis?
In later questioning:
Cusack: Would you agree that there is some serious over-capacity in the hospital industry?
Scott: What's your definition of "over-capacity?" ... I'm just not sure what serious over-capacity is …
Cusack: You just don't know, is that right?
Scott: I'm not sure I understand the terminology.
Cusack: Didn't you practice corporate hospital law, sir?
Scott: Corporate hospital law. I don't know what your definition of corporate hospital law would be.
Two years later, Scott was deposed by attorney Jack Ayers in another suit against Columbia/HCA. During the testimony, Scott denied knowledge of a 1991 letter on company stationary containing his signature. An excerpt:
Ayers: Do you recall that letter?
Ayers: Do you recall having written it?
Ayers: Is that your signature?
Scott: It looks like it.
Scott: Oh, I don't have any recollection because I don't recall the letter. ... I sign letters all the time that I have not read.
Ayers: Do you believe that a legal education is something you should use, at least in part, for the benefit of the public? Sort of a public trust?
Scott: I'm not sure I understand the question. … What's your definition of public trust?
Ayers: You took the Texas Bar examination, you took an oath. Do you remember in taking an oath to the effect that a license to practice law was a public trust?
The odd exchanges weren't overlooked by Scott's opponent, Democrat Alex Sink, who pieced together two minutes of the video-taped testimony to form a new television spot, which launched this week.
On Monday, Scott told Fox News that the new healthcare reform law should be repealed. Indeed, he said, "if we elected more principled individuals, then that bill wouldn't have passed."
"That's why in the end I decided to run," he added. "Because we've got to elect people that really are principled."