Health Roundup: Medicare 'doc fix' lobbying heats up

Medicare 'doc fix' lobbying heats up: Blaming congressional inaction, the nation's largest doctors lobby is urging lawmakers this month to block a steep cut scheduled to hit Medicare doctors at the start of December.

The American Medical Association (AMA) is warning that a failure to prevent the cut would be "a catastrophe for seniors" because many doctors would stop seeing Medicare patients altogether. Physicians are facing a 23 percent cut on Dec. 1, and an additional 1.9 percent cut is scheduled for Jan. 1.

"This is not about doctors," AMA President Cecil Wilson told reporters on a press call Monday. "It's about access to care for senior citizens."

AMA is endorsing a temporary pay patch, delaying the cuts for 13 months and providing a 1 percent pay increase for doctors instead. The time cushion will allow Congress next year to consider ways to scrap the 13-year-old formula — the Sustainable Growth Rate (SGR) — that dictates Medicare physician payments, replacing it with a system that better reflects the true cost of delivering care, AMA says.

Obama administration weighs in: Health and Human Services (HHS) Secretary Kathleen Sebelius, speaking before the Association of American Medical Colleges, said Monday that the "single biggest step" Congress can take to strengthen Medicare is to prevent the cuts.

"We know that healthcare providers also face significant barriers as you strive to deliver the best care possible. And we’re committed to working with you to reduce them," she said. "That starts with preventing the 23 percent cut in Medicare payments to doctors that’s scheduled to take effect at the end of the month. These drastic cuts could force doctors out of the Medicare program and jeopardize the care of our seniors. On Thursday, I attended a Cabinet meeting where the president stressed that preventing these potentially disastrous cuts must be one of our top priorities. The American Medical Association has proposed a 13-month extension. And I hope that Congress will act quickly to pass it, so that our doctors and seniors can have some peace of mind while we work on a long-term fix."

HHS offers guidance on medical loss ratio for mini-med plans: HHS has issued a memo providing additional guidance on how mini-med plans can apply for a waiver from annual limit requirements and advising that the plans will receive special treatment for medical loss ratio (MLR) requirements next year. The issue came to a head in late September when McDonald's announced it would drop coverage for 30,000 employees if it had to spend 85 percent of premiums on care, as called for in the healthcare reform law; HHS at the time said McDonald's and 29 other companies were getting waivers from the annual limit provision prohibiting insurers from offering less than $750,000 of coverage in 2011, but the MLR issue was left unresolved.

"HHS intends to promulgate, in the near future, regulations implementing the MLR provisions of Section 2718, including a special methodology that takes into account the special circumstances of mini-med plans in determining how administrative costs are calculated for MLR purposes (and thus how MLR ratios are calculated for such plans)," reads the guidance, dated Friday. "The special methodology for mini-med plans would apply at least for the first year for which the MLR provisions are effective. Because little data are available to adequately assess and validate the assertions of the industry presented in support of special treatment for these plans under Section 2718, HHS intends to collect data on an accelerated basis to inform its determination whether mini-med plans should be accorded similar treatment for the second and third years preceding 2014."

Hospital group weighs in on health exchange: The Federation of American Hospitals (FAH) wants the state heath insurance exchanges that start operating in 2014 to offer at least three health plans, each offering a maximum of four policy options.

"This approach would ensure patient choice and competition among plans without creating too many offerings that will undoubtedly confuse consumers," the FAH writes in comments regarding the National Association of Insurance Commissioners' draft legislation.

"We recognize that there is a delicate balance at play here," reads the letter. "In response, the FAH urges the NAIC to structure the Model Act in a way that promotes national standards for qualified health plans ('QHPs') while also allowing for the flexibility associated with local governance of state Exchanges. We believe this approach will best serve patients and providers while also achieving the goals of the Patient Protection and Affordable Care Act ('PPACA')."

FDA slammed for tainted generic drug decision: The Food and Drug Administration risked its integrity by awarding first rights to sell a lucrative generic drug to a company that did free consulting work for the agency, according to a Government Accountability Office report due out Tuesday.

As a result, "agency officials ran the risk of undermining public confidence in the integrity of FDA's operations," including heparin-related drug approvals, the report says, according to a copy reviewed by The Wall Street Journal.