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Who Deems What Medical Coverage in New Stimulus Bill?


Barb73

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"Tragically, no one from either party is objecting to the health provisions slipped in without discussion. These provisions reflect the handiwork of Tom Daschle, until recently the nominee to head the Health and Human Services Department."

(Bloomberg News, Commentary by Betsy McCaughey, February 9, 2009)

This news item in Bloomberg news was a bit unsettling. It is related to medical coverage, and since there are those of us who are either on disability and/or regular Medicare, it seems appropriate to post it.

Surely, anything to do with medical coverage is vital to all of us, but in particular, to those of us with lung cancer, or those of us caring for our loved ones with this disease where so much involves treatment regimens.

http://www.bloomberg.com/apps/news?pid= ... zfDxfbwhzs

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We do need to keep watching where the $$ goes.

I thought I'd post this too. I got this this morning from the National Cancer Institute

Economic Stimulus Bill

If NCI receives additional funds through an economic stimulus bill, the funding will most likely be highly directed, perhaps to Challenge Grants. Challenge Grants are 2-year grants capped at $500,000 total for both direct and indirect costs where the research can be completed in 2 years. NIH would fund about 1500 Challenge Grants.

Potential funds from a stimulus bill may also be directed to be used for Comparative Effectiveness Research (CER). Since it was first funded in 1937, NCI has been performing CER through its studies into the most effective cancer treatments. NCI developed a list of high-priority CER studies it would like to fund with additional monies and submitted the list to the NIH.

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Hi Katie,

Since I have posted, I saw a posting by gpawleski on another board. Of course, only the first page was available.

It seems to have explained things a bit better than the article which I posted. Whew, glad I saw it.

My extent of watching TV News only includes MSNBC, and rarely, CNN, I hadn't seen anything regarding governmental intervention of treatments for those on Medicare, and/or disability.

I will see if I can locate more info, and if Greg cares to comment it would be most appreciated.

This stuff can make more stress than is necessary. Some of the media does like to bombast with what is most likely to get one's ire up and running.

Barbara

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With all do respect Barbara, we all seemed to be duped by this.

Conservatives have been misinforming the public about the health IT provisions of the stimulus package by falsely claiming that it would lead to the government telling the doctors what they can and cannot treat, and on whom they can and cannot treat. The Hudson Institute fellow, Betsy McCaughey, claimed that the legislation will have the government monitor treatments in order to guide your doctor's decisions.

The new language in the bill tasks the (already existing) National Coordinator of Health Information Technology (NCHIT) with providing appropriate information so that doctors can make better informed decisions. The NCHIT provides counsel to the Secretary of HHS and Departmental leadership for the development and nationwide implementation of health information technology.

Contrary to Ms. McCaughey's statements, the language in the House bill does not establish authority to monitor treatments or restrict what your doctor is doing with regard to patient care. It addresses establishing an electronic records system so that doctors can have complete, accurate information about their patients.

The funding for health information technology in the recovery package is projected to create over 200,000 jobs and a down-payment on broader health care reform. Converting an antiquated paper system to a computer system by making the health care system more efficient.

The Congressional Budget Office has estimated that one-third of $2 trillion spent annually on health care in America may be unnecessary due to inefficiencies in the old system such as exessive paperwork. Investing in infrastructure like health IT would help improve the quality of America's health care.

Currently, fewer than 25% of hospitals and fewer than 20% of doctor's offices employ health information technology systems. Researchers have found that implementing health IT would result in a mean annual savings of $40 billion over a 15-year period by improving health outcomes through care management, increasing efficiency and reducing medical errors.

Investing in health would also help primary care physicians who often bear the brunt of tech implementation without seeing immediate benefits, affording the infrastructure for expanison.

In my annual checkup with my PCP last month, we had spoken about this extensively. He is partly ahead of the IT curve but cannot afford the richness of its expansion. He (and other PCPs) needs this important infrastructure.

I agree, we need to broaden our information horizons.

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Thank you so much, Greg,

I was hoping that you would respond. You have a grasp of this that I lack.

Much as I try to understand the nuances of what is being proposed, my access to the information is limited.

It is through people with more expertise in deciphering this language that we are able to discern more.

Thank you so very much.

You have helped me, and I do appreciate it.

Barbara

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The venue at the lastest Institute of Medicine forum on assessing and improving value in cancer care, was the pharmaceutical and biotechnology industry's efforts to beat back efforts at cost control in cancer care, which is increasingly seen as the next big income generator for Big Pharma. No wonder the "industry" is worried.

They put together a coalition, the so-called Partnership to Improve Patient Care, which includes the lobbying arms of the drug, device and biotechnology industries as well as patient-advocacy groups, most of which accept pharmaceutical industry donations, and medical-professional societies, to lobbying Congress to give the "industry" a major say over how it will be run.

The drug and medical device industries are mobilizing to gut a provision in the stimulus bill that would spend money on research comparing medical treatments. The research funding would be doled out to the National Institutes of Health and other government bodies to focus on producing the best unbiased science possible.

Comparative research has the potential to tell us which drugs and treatments are safe, and which ones work. This is not information that the private sector will generate on its own, or that the "industry" wants to share. Companies want to control the data, how it is reviewed, evaluated, and whether the public and government find out about it and use it. Just about the way they are controlling data now.

Do publicly traded companies have a seat on the governing board of the Securities and Exchange Commission? Should Boeing and Airbus be given the right to determine the scope of the National Transportation Safety Board's inquiry into airplane crashes? It is simply bad governance to give "industry" a seat at the table when officials decide what comparative effectiveness studies will get done.

Barbara. It was appropriate for you to post this information. A good friend said about this issue, "to eliminate laws, policies or conflicts of interest that may be driving up costs unnecessarily would be useful at this point." He remains optimistic. So do I.

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Greg,

Once again, I thank you.

Hopefully, the posting of the article did bring out a clearer understanding of the issue through your explanation.

This evening this very point was addressed on MSNBC, including the history of said author with the pharmaceutical industry.

Had I waited a full day ... but then, there wouldn't have been the chance for this more extended illumination to unfold.

As they say, knowledge is power,

Barbara

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Barbara. Indeed, this point was very much addressed (forcefully) on MSNBC last night. This subject has been a stickler on a couple of the other discussion websites. One of them (will leave them nameless) conveniently deleted the posting after information about the propaganda that was exposed, was posted. It may be that the site was one of those patient-advocacy groups, most of which accept pharmaceutical industry donations. Freedom of information? It's a shame!

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The $1.1 billion earmarked for comparative effectiveness research remained in the bill that President Obama will sign. The House conferees also insisted on keeping the phrase "comparative effectiveness" throughout the authorizing language, removing the Senate's insertion of the word "clinical." The report language did note its removal was "without prejudice."

However, the conferees do not intend for the comparative effectiveness research funding included in the conference agreement to be used to mandate coverage, reimbursement, or other policies for any public or private payer. The funding in the conference agreement shall be used to conduct or support research to evaluate and compare the clinical outcomes, effectiveness, risk, and benefits of two or more medical treatments and services that address a particular medical condition.

We saw a perfect example last week of how comparative cost-effectiveness analysis can be coupled with comparative clinical-effectiveness analysis to provide useful guidance to health practitioners, patients and payers faced with a confusing array of alternatives in one particularly crowded area of health care: colon cancer screening. CMS made a preliminary decision not to pay for virtual colonoscopy.

http://www.nytimes.com/2009/02/13/healt ... opy&st=cse

CMS concluded, based on a comparative cost- and clinical-effectiveness analysis conducted by AHRQ, that taking its costs into account, virtually colonoscopy made no sense either medically or economically. Not all comparisons merit a cost-effectiveness analysis. When one drug, device, surgery or other medical technology is clearly superior to another, then the U.S. health care system, which operates without cost controls, pays for it. This legislation reinforces that approach.

Yet as anyone with even a passing familiarity with the medical science and medical economics literature understands, comparisons are rarely black and white. Most medical technologies only help a fraction of patients. Most medical technologies have some risks associated with their use. Comparative cost-effectiveness analysis is an important tool for accurately evaluating those benefits and risks.

Source: GoozNews

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Greg,

I am following all of this with great interest.

Gradually, even though the material in the bill will take time for me to read and understand completely, you have put a light to a certain key area of concern regarding the medical.

You have helped me to understand the meaning of "comparative effectiveness," and what it does not mean with regard to payments for treatment.

Thank you, Greg,

Barbara

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$21 billion to provide a 60% subsidy of health care insurance premiums for the unemployed under the COBRA program; $87 billion to help states with Medicaid; $19 billion to modernize health information technology systems; $10 billion for health research and construction of National Institutes of Health facilities.

One aspect of the monies was to fund a comparative-effectiveness program to assess whether or not treatments (mostly the newer targeted regimens) are really better than older treatments. Decisions are being made about what cancer treatments patients can actually afford.

Comparative research is not rationing health care. The research funding doled out in the recent Stimulus Package would go to the National Institute of Health, the Agency for Healthcare Quality and Research and the Centers for Medicare and Medicaid Services to focus on producing the best unbiased science possible.

Comparative research has the potential to tell us which drugs and treatments are safe, and which ones work. This is not information that the private sector will generate on its own, or that the "industry" wants to share. Companies want to control the data, how it is reviewed, evaluated, and whether the public and government find out about it and use it. Just about the way they are controlling data now.

Comparative-effectiveness research is not something for patients to be afraid of. It can help doctors and patients, through research, studies and comparisons, undertand which drugs, therapies and treatments work and which don't. Nothing in the legislation will have the government monitoring treatments in order to guide your doctor's decisions. Doctors will still have the ultimate decision, along with the patient.

Yet as anyone with even a passing familiarity with the medical science and medical economics literature understands, comparisons are rarely black and white. Most medical technologies only help a fraction of patients. Most medical technologies have some risks associated with their use. Comparative cost-effectiveness analysis is an important tool for accurately evaluating those benefits and risks.

Another aspect of the monies is the funding for health information technology in the recovery package is projected to create over 200,000 jobs and a down-payment on broader health care reform. Converting an antiquated paper system to a computer system by making the health care system more efficient.

The Congressional Budget Office has estimated that one-third of $2 trillion spent annually on health care in America may be unnecessary due to inefficiencies in the old system such as exessive paperwork. Investing in infrastructure like Health IT would help improve the quality of America's health care.

Currently, fewer than 25% of hospitals and fewer than 20% of doctor's offices employ health information technology systems. Researchers have found that implementing Health IT would result in a mean annual savings of $40 billion over a 15-year period by improving health outcomes through care management, increasing efficiency and reducing medical errors.

Investing in Health IT would also help primary care physicians who often bear the brunt of tech implementation without seeing immediate benefits, affording the infrastructure for expanison. Some PCPs are ahead of the IT curve but cannot afford the richness of its expansion. They need this important infrastructure.

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Thanks Susan. In Jane Gross' screed, the part about "in many nursing homes, women, some near death or too demented to know what's going on, routinely get annual mammograms and Pap smears whether they want them or not," has me feeling good that I supervise my mother's care in her nursing home, although she is pretty cognizant about her life. I've seen a few others that aren't so fortunate.

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No "defensive" Susan. It was quite informative to read the information about nursing home residents. I know that happens and I'm glad I supervise my mother's care.

It's been difficult for the Medicare program to contol the substantial costs of cancer drugs. In a recent issue of the New England Journal of Medicine, an article by Dr. Peter Bach stated that the costs to Medicare of injectable cancer drugs given in doctors' offices increased from $3 billion in 1997 to $11 billion in 2004, an increase of 267% at a time when the costs for the entire Medicare program increased 47%.

It also states that there was a huge reduction in Medicare expenses that occurred when the off-label use of ESAs (drugs for anemia-related issues) was found to actually cause harm to patients. The drugs were proven to be over-used and the net result of expose was that use of these drugs quickly dropped and the costs to Medicare dropped from over $1 billion a year to just $200 million.

In 2003, in the political payback deal of the century, Congress guaranteed premium pricing for pharmaceuticals, by prohibiting Medicare from negotiating drug prices, and it provided hundreds of billions of dollars in U.S. taxpayer subsidies to pay for these premium drug costs. Now the specter of "rationing" is raised.

Dr. Bach stated ways that the Medicare program could control costs. One of those ways was to fund a comparative-effectiveness program to assess whether or not treatments (mostly the newer targeted regimens) are really better than older treatments. Decisions are being made about what cancer treatments patients can actually afford.

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