News in brief - May 3, 2004

U.S. House sits on genetics bill - Improper billing collections just a drop in the bucket - Drugmaker Web site links patients to discount programs - Ohio liability insurers questioned about rate setting - Medicare streamlines drug card enrollment - CMS issues call for chronic care management demo

U.S. House sits on genetics bill

Genetic nondiscrimination legislation that passed the Senate last year has been put on hold in the House by Majority Leader Tom DeLay (R, Texas), despite support for the measure from Senate Majority Leader Bill Frist, MD (R, Tenn.).

The bill, which would bar health insurers and employers from making coverage decisions based on the results of genetic tests, has strong bipartisan support. It has met with opposition from the U.S. Chamber of Commerce, which is seeking an exception for cases in which testing reveals that potential hires might be a risk to co-workers.

The business group also wants the bill to have a set expiration date and to preempt state laws. Proponents of genetic testing protections are worried that the clock is running out on the measure.

Improper billing collections just a drop in the bucket

The nearly $1 billion the government collected last year from physicians and companies accused of improperly billing Medicare or Medicaid is likely only a fraction of the money these programs lost, according to Joseph Antos, a resident scholar on health care policy at the American Enterprise Institute.

There has been a renewed interest on Capitol Hill for cutting waste, fraud and abuse from the programs, which now cost a total of $550 billion a year. But lawmakers are also cautious about pursuing aggressive measures that could sweep up physicians and others who have made honest billing mistakes.

Drugmaker Web site links patients to discount programs

The pharmaceutical industry has launched a new Web site (www.helpingpatients.org) that offers access to 40 patient assistance programs offering 400 free or discounted medications. Many of the programs have Web-based forms, and the site has a "Fast Access" option that allows physicians or patients to search across the assistance programs. Drug makers donated about $3.4 billion in prescription drugs last year to more than 6.2 million needy patients, according to the Pharmaceutical Research and Manufacturers of America.

Ohio liability insurers questioned about rate setting

The Ohio Medical Malpractice Commission and leaders of the Senate and House insurance committees last month questioned the state's five largest medical liability insurers about how they set their rates. At the joint committee hearing, lawmakers and commissioners also asked insurance executives about whether they think tort reforms in place will affect rates and whether other reforms could be passed to help the situation.

The state created the commission to study how effective tort reform has been and to evaluate other medical liability issues. Ohio is one of 19 states that the American Medical Association lists as experiencing a full-blown medical liability insurance crisis.

Medicare streamlines drug card enrollment

Medicare is trying to make it as easy as possible for seniors to sign up for the drug discount cards that take effect in June. The Centers for Medicare & Medicaid Services will allow state pharmacy assistance programs in certain situations to enroll low-income beneficiaries automatically. The drug cards include $600 in benefits for low-income beneficiaries and are expected to provide up to 25% savings on drug costs.

CMS also plans to issue a standard enrollment form that will be accepted by all Medicare-approved drug cards. The form will make it easier for community-based organizations, health professionals and consumer groups to help beneficiaries with enrollment.

"Medicare has made it easier for physicians to help our senior patients enroll in the drug card program by streamlining the process through a standard form," said John C. Nelson, MD, president-elect of the American Medical Association. "This important step will reduce the chance for confusion and error as community outreach workers assist seniors with enrollment."

CMS issues call for chronic care management demo

Medicare is looking for organizations to provide chronic care management to beneficiaries with complex diabetes, congestive heart failure and chronic obstructive pulmonary disease. The demonstration project is the result of the Medicare reform bill passed last year. The Centers for Medicare & Medicaid Services is seeking proposals for large-scale chronic care projects from organizations with demonstrated success in care management services.

"Too often, seniors with serious chronic illnesses move from doctor to doctor for their specific health problems without any single doctor getting a full picture of their needs," Health and Human Services Secretary Tommy Thompson said. "This new program will give them the support they need to better manage their conditions and stay healthy."

CMS will choose about 10 projects to serve up to 30,000 beneficiaries in specific regions across the country over a three-year period.