Years of economic sanctions, followed by war, have taken a heavy toll on public services in Iraq. Stories of missing drugs, of ill-equipped doctors, and of patients left to suffer the consequences are everywhere in Iraq's public healthcare system, for example.
The Department of Justice and 16 states have joined two whistleblower suits against Wyeth, alleging the drug maker knowingly failed to give the government discounts it provided to private purchasers, a violation of Medicaid law.
As a result of the alleged scheme, Wyeth avoided paying hundreds of millions in rebates to state Medicaid programs for the bundled use of its proton pump inhibitors Protonix Oral and Protonix IV, said the Justice Department in a media release.
Tony West, assistant attorney general for the Civil Division at Justice, says Wyeth "created the Protonix bundle so they could increase their market share at the expense of the Medicaid program--a program to provide the least advantaged Americans with necessary medical care and services."
"By offering massive discounts to hospitals, but then hiding that information from the Medicaid program, we believe Wyeth caused Medicaid programs throughout the country to pay much more for these drugs than they should have," West says.
In response to the suits, Wyeth spokesman Doug Petkus tells HealthLeaders Media, "Wyeth believes its pricing calculations were correct and intends to vigorously defend itself in these actions."
Under the Medicaid Drug Rebate Program, brand name drug makers must offer the government the "best price" offered to private payers for their drugs. They also are required to pay rebates to the state Medicaid programs that are calculated on any discounted prices that are offered.
Federal investigators claim that, between 2000 and 2006, Wyeth offered steep discounts to thousands of hospitals nationwide for Protonix Oral and Protonix IV under a pricing arrangement known as the "Protonix Performance Agreement." The arrangement required that hospitals purchase the drugs together under a bundled arrangement in exchange for a steep discount. Investigators say Wyeth did this to access the lucrative retail outpatient market, intending that patients who used the intravenous version of Protonix in the hospital would later purchase Protonix Oral once they were discharged.
Under the Protonix Performance Agreement, hospitals that placed both products on their formularies and attained certain market share requirements were entitled to up to a 94% discount off the list price of Protonix Oral and up to 80% off the list price of Protonix IV. Although Wyeth was required to pass along the benefit of the lowest prices to the state Medicaid programs, they didn't and therefore avoided paying hundreds of millions of dollars to Medicaid in quarterly rebates, investigators allege.
Two separate civil False Claims Act suits–called qui tam actions–were filed against Wyeth in Massachusetts. California, Delaware, the District of Columbia, Florida, Illinois, Indiana, Louisiana, New York, Michigan, Nevada, New Hampshire, Tennessee, Texas, Virginia, and Wisconsin also have joined the whistleblower suits.
A study released by Deloitte profiling the comparative effectiveness systems of the United Kingdom, Australia, Canada, and Germany concludes that if implemented correctly, comparative effectiveness has the potential to improve care and reduce healthcare costs for Americans.
A survey of more than 70,000 inpatients across England conducted by the Care Quality Commission found significant improvement in infection control when compared to a similar survey done in 2008. Patients said wards and bathrooms were very clean and more noticed doctors and nurses washing their hands between patients, the survey found. One in 10 patients, however, said they were not involved as much as they wanted to be in decisions about their care.
A Gallup Poll has found that up to 29% of Americans would consider traveling abroad for medical procedures such as heart bypass surgery, hip or knee replacement, plastic surgery, cancer diagnosis and treatment, or alternative medical care, even though all are routinely done in the United States. "The data suggest the estimated population of 48 million Americans without health insurance are motivated by costs and would be more likely than those with health insurance coverage to consider seeking medical care from alternative sources," according to the study's findings.
Imposing a "lifestyle tax" on sugary, fattening soft drinks and alcohol are among the revenue-generating ideas under consideration by the Senate Finance Committee as a way to pay for healthcare reform.
"Reforming the system will likely require an upfront investment, but I'm confident it will pay dividends in the future for our health, our economic competitiveness, and our federal budget," says Committee Chairman Max Baucus, D-MT. "The bottom line is that we can't afford not to act. Without healthcare reform, healthcare spending will reach $4.4 trillion by 2018. These policies lay out a wide variety of options for making that investment."
The proposals unveiled Monday are the final set of policy options being considered before the Finance Committee begins to craft a bill in June. Previously, the committee has discussed how to reduce costs in the healthcare delivery system, while improving quality and expanding access.
The latest round of proposals focus on savings achieved from within the healthcare system, reevaluating health tax subsidies, and changing non?health tax provisions.
The Finance Committee will take up the suggestions at a hearing on Wednesday.
The lifestyle tax would slap an excise tax on soft drinks sweetened with sugar, high-fructose corn syrup, or other sweeteners that "contribute to obesity which drives up healthcare costs within the system," the committee proposal states, adding that the tax would "expand on what some states have already done." The tax would not apply to artificially sweetened beverages.
Alcohol excise taxes would increase from $13.50 per proof gallon to $16 per proof gallon. A press release announcing the proposals did not include estimates for how much money the taxes would generate.
The third and final policy options paper regarding financing healthcare reform measures was issued by the Senate Finance Committee on Monday. The full committee will hold a closed-door "walk through" on Wednesday on the option proposals as it moves toward drawing up a health reform bill by June. The committee had earlier released papers on expanding coverage and transforming the healthcare delivery system.
A number of options need to be examined now to slow down rapid increases in healthcare costs "that take up more and more of the budget for American families and businesses," said Committee Chairman Max Baucus (D-Mont.) in a statement accompanying the paper. Without healthcare reform now, healthcare spending could hit $4.4 trillion by 2018.
The policy options focus on three main areas of potential funding sources: savings achieved from within the healthcare system from reductions in current levels of spending; re- evaluating current health tax subsidies; and changing non-health tax provisions.
For health system savings, the committee is re-examining current Medicare and Medicaid payment rates. The options paper notes that their payments are "significantly" different from the actual cost of providing health services. To "correct this inconsistency without hindering the quality of care or patient access," options are suggested, such as by updating payment rates for home health services; re-examining appropriate payments for durable medical equipment, such as oxygen or power wheelchairs; adjusting payments for "high-growth, potentially overvalued services," such as imaging and minor procedures; and reducing the marketbasket updates for those providers with payments that are higher than actual costs.
Noting that Medicare payment rate updates don't account for "new technologies and other productivity increases that reduce costs," the policy options look at ways to adjust annual inflationary increases that account for productivity in Medicare payment rate updates.
Also, citing ongoing research at Dartmouth University and elsewhere that examines variation in healthcare spending by geographic region, the policy options explore ways to reduce this variation by reducing Medicare payments in areas where spending is above the national average. Adjustments would be considered to note any differences in input prices and beneficiary healthcare status.
Several options for modifying current tax treatments of health- related expenses are also examined. This includes re-examining exclusions for employer-provided health insurance. Under current law, employer-provided health insurance is not counted as income for tax purposes. The paper notes that this tax-free status encourages employers to offer "Cadillac plans, or overly generous healthcare plans" that end up promoting the overuse of healthcare services. The paper said that this drives up healthcare costs. Several options are discussed on how to address these exclusions.
The paper also looks at modifying the rules for nonprofit hospitals: the hospitals would be required to maintain a minimal level of charitable activity, limit charges to uninsured, indigent patients, and limit aggressive collection actions. Those hospitals that fail to meet those requirements would be subject to an excise tax, under the current proposal.
Several lifestyle tax proposals—to help promote wellness and healthy choices—are under discussion such as increasing taxes on alcoholic beverages and placing excise taxes on sugar and sweetened beverages.
The tight deadlines the Office of the National Coordinator for Health Information Technology must meet under the Health Information Technology for Economic and Clinical Health (HITECH) provisions of the stimulus law (aka the American Recovery and Reinvestment Act) are spelled out in a new eight-page operating plan released May 18.
Over the next several weeks, the national coordinator, David Blumenthal, MD, will hold hearings and meetings "to develop and vet plans and procedures." The plan notes that the office of the national coordinator will act "swiftly but thoughtfully" to fulfill its legislative obligations.
The plan notes deadlines related to 19 regulations, guidance, reports, and studies, including issuing rules related to HIPAA privacy, security, and enforcement. This includes issuing regulations to modify the HIPAA privacy rule to "generally prohibit exchanging health information for remuneration without individual authorization" and issuing guidance on what constitutes "minimum necessary" under the HIPAA privacy rule.
The definition of what is considered "meaningful use" of an electronic health record system is not included in this plan. "Specific understanding of what constitutes meaningful use will be determined through a process that will include broad stakeholder input and discussion," the document says, with the Department of Health and Human Services (HHS) "developing milestones for major phases of the program’s activities with planned delivery dates."
The Office of the National Coordinator also will be responsible for establishing methods of communicating with the public, such as through a new Web site, according to the plan.
Also, under the operating plan, the office will be responsible for sending to HHS Secretary Kathleen Sebelius an initial set of standards, implementation specifications, and certification criteria in September, and publishing them by Dec. 31.
To pay for an overhaul of the nation's health system, Senate leaders have formally laid out proposals for new taxes on everything from employer-sponsored healthcare benefits and nonprofit hospitals to alcohol and sugary drinks. A bipartisan outline released by the Senate Finance Committee suggests peeling back a number of tax exemptions to pay for expanding health insurance to the nation's 46 million uninsured.
A storefront clinic operated by the University of Chicago Medical Center will close at the end of June, marking another significant step in the facility's groundbreaking, and controversial, plan to pull back on some of the medical services it provides directly to the poor and indigent. Medical center executives say the steep downturn in the economy has forced them to trim $100 million from the hospital's budget to maintain their role of running a world-class hospital, research center, and medical school. The Women's Health Center, which cares for thousands of Medicaid patients, is a money loser, the officials said.
