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  • SGR Action Starts Up Again



    WASHINGTON -- This week in Washington marked the resumption of a bipartisan congressional committee tasked with fixing the problem with the sustainable growth rate (SGR) formula for Medicare physician reimbursement.


    The 20 Democratic and Republican lawmakers agreed on one thing: The SGR formula should be repealed.


    Whether the House-Senate committee -- which held its second formal meeting Wednesday morning -- will actually have the will to completely scrap the Medicare payment formula is another issue.


    Although every member seemed to agree that a long-term fix needed to happen, it's unclear if this committee will approve anything beyond a shorter-term extension so doctors won't face the 27% reduction in Medicare payments set to kick in at the end of this month. The shorter-term fix could be one or two years.


    CBO Says Healthcare Spending Will Double in Next 10 Years


    Federal healthcare spending will more than double over the next decade, according to a projection released Tuesday by the Congressional Budget Office (CBO).


    The cost of federal healthcare programs is expected to increase by 8% each year from 2012 to 2022 to reach $1.8 trillion by 2022, which would be about 7.3% of the gross domestic product in that year, CBO found.


    Currently, healthcare spending accounts for about 5% of GDP. Spending on Medicare, Medicaid, and other healthcare programs cost about $856 billion in 2011, and is projected to cost slightly less -- $847 billion -- in 2012, reflecting a decline in Medicaid spending. After that, the cost each year will rise quickly, CBO said.


    FDA Whistleblowers Sue Agency over Email Monitoring


    Six former FDA scientists are suing the agency, saying it unlawfully monitored personal email accounts from their work computers after the scientists complained to Congress about allegedly unsafe medical devices that had been approved or were close to approval.


    The scientists worked for the FDA's Center for Devices and Radiological Health (CDRH) and first made internal complaints in 2007. They took their case to Congress in 2008 and wrote to the White House the following year.


    After the FDA learned of the letters the group was writing, it started to secretly monitor their computers, according to the lawsuit, which was filed in U.S. District Court for the District of Columbia last week, charging the agency with violating their First, Fourth and Fifth Amendment rights.


    Sen. Charles Grassley (R-Iowa) wrote to the FDA earlier this week asking about the case and requesting a response by Feb. 17.


    Enrollment Up in Medicare Advantage Plans


    Enrollment in Medicare Advantage plans has risen by 10% in the past year and premiums have dropped by 7%, despite billions of dollars in reimbursement cuts to the program, Department of Health and Human Services (HHS) officials announced Wednesday.


    Enrollment in the plans -- which are run by private insurers -- has grown from 11.7 million Medicare beneficiaries in 2011 to 12.8 million in 2012, a 17% increase. The average premium has dropped by more than $2 per month since last year and now averages $31.54 per month, according to HHS.


    AMA Seeks ICD-10 Delay


    The American Medical Association wrote to HHS urging it to "immediately halt" plans to require doctors to use the new ICD-10 coding system by Oct. 1, 2013, calling the requirements overly burdensome on doctors who are already scrambling to adhere to electronic health record requirements.


    Starting in 2013, doctors and hospitals are slated to use the new ICD-10 model for assigning payment values to procedures. There are 68,000 diagnosis codes under the ICD-10 model, which is a fivefold increase from the current amount of about 13,000.


    Getting technology up to speed for the new codes is a major undertaking, AMA CEO James Madara said in a letter to HHS Secretary Kathleen Sebelius. The timing "could not be worse" for the transition to ICD-10, Madara said, because many physicians are already spending lots of time and money implementing another federal mandate -- electronic health records -- into their practices.


    Next Week


    On Tuesday, the Health Subcommittee of the House Ways and Means Committee will hold a hearing exploring whether the current Medicare fee-for-service model should be ditched for a model that rewards doctors for high-quality, efficient care.


    On Wednesday, the Oncologic Drugs Advisory Committee will discuss a supplemental biologics license application for denosumab injection (Xgeva) for the treatment of men with castrate-resistant prostate cancer at high risk of developing bone metastases, or spread of cancer to the bones.


    The following day, the same panel will discuss another supplemental new drug application for decitabine (Dacogen) to treat acute myelogenous leukemia in adults 65 years of age or older who are not considered candidates for induction chemotherapy.


    Also on Thursday, the Anesthetic and Analgesic Drug Product Advisory Committee will discuss a supplemental new drug application for a capsaicin 8% Patch (Qutenza) to treat HIV-associated peripheral neuropathy.
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