House Republicans are moving toward introducing a bill that would lift the debt limit until the first quarter of 2015, while patching the Medicare reimbursement rate for nine months and reversing recent changes to some military retirement benefits, according to multiple sources familiar with internal deliberations.But wait. On the one hand, WH refusal to negotiate on the debt ceiling means all that extra stuff might just be stripped out after House passage. And meanwhile in a parallel universe:
The bill could come up for a vote as soon as next week.
Patching the reimbursement rate for doctors who treat Medicare patients — known as the Sustainable Growth Rate or “doc fix” — and changing cost of living benefits for the military could be costly. Under the emerging plan, House Republicans would seek to pay for those items with an extra year of cuts to mandatory spending and changes to pension contributions.
An agreement has finally been reached in both houses of Congress that replaces the Medicare physician sustainable growth rate formula, or SGR, with plan that provides stable funding updates based pay-for-performance and increases reimbursements by 0.5 percent annually for the next five years. The SGR, part of the 1997 Balanced Budget amendment, essentially ensured that the yearly increase in the expense per Medicare beneficiary does not exceed the growth in GDP.Sarah Kliff:
However, as health care costs began to outpace inflation, the SGR began to fall short of the actual cost of health care services and Congress has repeatedly stepped in to suspend or adjust the payments (“doc fix”). Many physicians groups, including the AMA, have called for a more permanent, less formulaic, solution.
Something weird is happening on Capitol Hill right now. Something just about unprecedented: Republicans and Democrats are agreeing on a multibillion-dollar health policy proposal.So while one GOP proposal treats the "doc fix" as a temporary political sweetener in the debt limit scheme (the one that has to pass with or without extra stuff), another proposal in Congress looks at the long term correction to SGR that's been decades in coming. More on this below the fold.
On Thursday, legislators released a plan to overhaul how Medicare pays doctors, one that would do away with the "doc-fix" ritual and more closely tether the amount that providers make to the quality of care they provide.
Here's a Brookings explainer from December:
Although much media coverage around health care reform recently focused on the Obamacare rollout, another profound but far less publicized change could be coming. Congress is closer than ever to correcting the sustainable growth rate (SGR) formula, an ill-conceived policy that annually threatens physicians with indiscriminate cuts in fees to control Medicare spending.So, here's a twist that gives you an idea where this is going: CVS dumping the sale of cigarettes as of Oct. Why would they give up $2 billion in sales?
In a previous post, we explained the origins of the SGR in the 1997 Balanced Budget Act and reasons it failed to work as planned. Now, there are 2 congressional proposals intended to fix the problem.
If passed, such legislation would make the biggest changes to Medicare physician payments in more than a generation. The proposals would repeal the SGR-mandated cuts and essentially eliminate roughly $140 billion in planned physician fee rollbacks. In return, Medicare would largely change its way of paying physicians. Most importantly, Medicare would move away rapidly from traditional fee-for-service payments and hold physicians more accountable for quality. Such an approach could help physicians change practices to deliver better and less expensive care—reshaping health care delivery across the nation. However, major areas of uncertainty remain.
Well, imagine a world where instead of doctors getting paid for every visit, every test, every service they do ("fee for service"), they now get paid based on measurable outcomes ("pay for performance"). Imagine further that you are a physician group or an insurance entity, and because you want to find out whether patients are taking their medicine to help you achieve your outcomes, you hire someone to check out your patient compliance with medication. Or, maybe you want to see if the doctors in the system are prescribing the cheapest possible medication version.
Enter CVS Caremark:
Our StrengthsNow, if your outcomes are better lung health, and you've hired CVS or are considering them, why would you want them to be selling cigarettes?
We are uniquely positioned to deliver significant benefits to health plan sponsors through effective cost management solutions and innovative programs that engage plan members and promote healthier, cost-effective behaviors. Our integrated pharmacy services model enhances our ability to offer plan members and consumers expanded choice, greater access and more personalized services to help them on their path to better health.
We effectively manage pharmaceutical costs and improve health care outcomes through our pharmacy benefit management (PBM), mail order and specialty pharmacy division, CVS Caremark® Pharmacy Services, our CVS/pharmacy® retail stores, our retail-based medical clinic subsidiary, MinuteClinic® and our online retail pharmacy, CVS.com®.
Pharmacy benefit management is the future, not item sales from brick and mortar stores. And if you followed this far, you now know why CVS dumped ciggies from their store.
We'll walk you through it on the Kagro in the Morning show from Friday.
In other news, Reuters:
The opening of the Winter Olympics was supposed to be a triumph for Vladimir Putin that ended months of criticism of the Russian president over gay rights and talk of corruption surrounding the Games.
But a technical glitch and the choice of an athlete who tweeted what was widely seen as a racist photo of U.S. President Barack Obama to light the Olympic flame meant it ended up stoking controversy.
Efforts by state television to conceal from viewers the moment when one of the five rings that make up the Olympic Games symbol failed to light up, and complaints by a singer that her music was used without permission, made matters even worse.