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CMS nomination of Dr. Berwick official

President Obama on April 19 officially nominated Donald M. Berwick, MD, to be the next administrator of the Centers for Medicare & Medicaid Services.

Dr. Berwick, a pediatrician, is president and CEO of the Institute for Healthcare Improvement, a Cambridge, Mass., nonprofit organization that promotes concepts to improve the quality of patient care. He is also a clinical professor of pediatrics and health care policy at Harvard Medical School in Boston.

CMS has been without a permanent administrator since Mark B. McClellan, MD, PhD, stepped down in October 2006. A White House official on March 29 had confirmed that Dr. Berwick would be tapped for the nomination, which requires Senate approval.

Physician organizations, including the American Medical Association, applauded the nomination, citing Dr. Berwick's widely respected leadership on quality and patient safety issues.

In a statement, Obama said Dr. Berwick "has dedicated his career to improving outcomes for patients and providing better care at lower cost. That's one of the core missions facing our next CMS administrator, and I'm confident that Don will be an outstanding leader for the agency and the millions of Americans it serves."

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Massachusetts health reform chief moves on

Jon Kingsdale, PhD, the first director of the agency responsible for implementing Massachusetts' landmark 2006 health reform law, is resigning effective June 4. Kingsdale wrote in his April 15 resignation letter that he wants to seek new challenges and that he hopes to "play some role in national health care reform."

Kingsdale "has been a tremendous asset in our efforts to expand health care coverage to all Massachusetts residents," said Massachusetts Gov. Deval Patrick. Kingsdale was appointed director of the Commonwealth Health Insurance Connector Authority in May 2006. Before that, he served as a senior executive at Tufts Health Plans for almost 20 years.

The Massachusetts health reforms were a model for the national law enacted in March. The state law includes a requirement either to have health coverage or pay a tax penalty, and it created a health insurance exchange to offer coverage options. About 97% of residents have insurance, up from about 94% in 2006. But Massachusetts leaders at times have struggled to pay for and control coverage cost increases in the exchange.

Kingsdale will be succeeded by Glen Shor, assistant secretary for health care policy in the governor's office. Patrick said Shor has been his point person for implementing health reform.

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N.Y. steps up Medicaid anti-fraud efforts

Medicaid fraud convictions in New York state hit a record high in 2009, according to an April report from the state attorney general's office.

The report comes as states, along with the federal government, ramp up efforts to combat fraud, waste and abuse in public health care programs. New York's Medicaid Fraud Control Unit obtained 148 criminal convictions and collected $283 million in stolen funds in 2009, surpassing recoveries obtained in the three prior years.

Settlements and judgments came largely from cases involving phony home health care services, illegal off-label marketing and kickbacks paid by pharmaceutical companies, as well as prescription drug fraud by physicians and pharmacists.

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Health IT money would go to mental health under bill

Reps. Patrick Kennedy (D, R.I.) and Tim Murphy (R, Pa.) have introduced legislation that would extend incentives for "meaningful use" of electronic medical records to mental health professionals, psychiatric hospitals, and other outpatient mental and behavioral health services.

The Medicare and Medicaid bonuses for meaningful use are available largely for physicians and hospitals. But the lawmakers said an important sector of the health care community is excluded, including clinical psychologists, clinical social workers, psychiatric hospitals, substance abuse treatment facilities and mental health treatment facilities. They said the Health Information Technology Extension for Behavioral Health Services Act, introduced on April 15, will help ensure that physicians and mental health professionals are working together through the use of interoperable EMRs.

In late December 2009, the Centers for Medicare & Medicaid Services outlined the first of three stages of meaningful use objectives physicians and hospitals would need to meet to secure EMR bonuses.

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Prosthetics, orthotics coverage parity proposed

Sens. Tom Harkin (D, Iowa) and Olympia Snowe (R, Maine) have introduced legislation that would require group health plans that cover prosthetics or orthotics to provide that coverage on the same terms as medical and surgical benefits.

According to the lawmakers, while most insurers cover prosthetics and orthotics, there are instances in which the benefits are arbitrarily capped or exclusions are imposed. The Prosthetics and Custom Orthotics Parity Act, introduced April 16, would require health plans to provide the same benefits parameters for prosthetic devices as they do for other treatments.

"Hundreds of thousands of Americans living with limb loss are currently required by their insurance companies to pay out of pocket for prosthetic devices that are integral to their daily lives," Harkin said.

This content was published online only.

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