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EYE ON WASHINGTON

doi: 10.1097/01.COT.0000303886.30744.9e
DEPARTMENT: EYE ON WASHINGTON
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• Two Health Care Quality Organizations Join Forces

The Ambulatory Care Quality Alliance (AQA) and the Hospital Quality Alliance (HQA) have announced that they are collaborating to form the new Quality Alliance Steering Committee, a national organization to coordinate promotion of quality measurement, openness, and improvement in care.

AQA is an alliance of 135 physician organizations, consumers, employers, and health plan representatives that makes available quality information about physician care. HQA is a coalition of hospitals, nurses, physician organizations, accrediting agencies, government, consumers, and businesses to shares quality information about key aspects of hospital care.

The new steering committee will work closely with the Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ). As a first step, the committee will coordinate and expand several ongoing pilot projects that are designed to combine public and private information to measure and report on performance.

AQA has six pilot projects, and the joint steering committee will explore options for expanding these pilots to include hospital and cost-of-care measures, as well as increase the number of pilots.

HQA has been providing useful information on the quality of heart attack, heart failure, and pneumonia care to patients in more than 4,000 hospitals. A year after this effort began, HQA expanded its Web site to include information on prevention of surgical wound infections, and there are plans to add additional aspects of care over the next few years.

“This collaborative effort is an important step toward the critical goals of enabling consumers to make more informed health care decisions and supporting improvements in the quality and cost of health care in the United States,” said then-CMS Administrator Mark McClellan, MD.

And AHRQ Director Carolyn Clancy, PhD, commented in a statement that the new steering committee will help coordinate efforts across a broad spectrum of cross-cutting issues as the two organizations continue working toward a more uniform approach to measuring and reporting hospital and physician performance nationwide.

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• House Bill Aims to Amend Social Security Act to Improve Payment for Cancer Drugs

Representative Ralph M. Hall (D-TX) has introduced HR 5179, a bill to amend Title XVIII of the Social Security Act to ensure adequate payment for drugs and biologicals under Medicare Part B.

The purpose of the bill is to revise the average sales price (ASP) method to pay for drugs. The bill would direct the Secretary of Health and Human Services to increase the payment amount for a drug or biological to the extent necessary that it is never less than the widely available market price.

HR 5179 had no cosponsors, but Rep. Hall has sent a letter to his Congressional colleagues asking for their support. It reads, in part: “The Medicare Improvement and Modernization Act significantly changed the way Medicare pays for chemotherapy drugs administered in doctors' offices, and there are still some drugs that physicians are having trouble purchasing at the Medicare payment rate. This bill will grant CMS the authority, which it does not now have, to alter payment rates for those drugs in order to ensure that patients receive the care they need.”

Mr. Hall further elucidated the problem: Since the ASP includes sales to all buyers, including very large ones, and lags behind actual prices by several months, it does not reflect what private physicians must pay. They generally cannot purchase drugs for the amount that Medicare reimburses.

The proposed bill would ensure that all physicians can purchase drugs for a price that Medicare will pay— that is, the “widely available market price.” The legislation also would eliminate “prompt pay discounts” to wholesalers but would allow them to private physician practices.

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• ASTRO Testifies about Medical Imaging for Medicare Beneficiaries

ASTRO submitted testimony to a House Energy and Commerce Committee on Health hearing about the use of imaging services and appropriate care for Medicare beneficiaries.

“Cancer is a primary health concern for many older Americans,” the Society noted in the statement. “In recent years, Congress has recognized this and has expanded Medicare coverage for a number of cancer screening services. ASTRO is concerned that if Deficit Reduction Act caps are applied to radiation therapy, access to critical tools used in cancer treatment will be reduced, resulting in increased waiting times for services and a negative effect on cancer survival.”

“Patient safety and quality of care would be severely compromised without use of imaging technology in the delivery of radiation therapy.”

“To ensure excellence in patient treatment and improved outcomes, it is imperative to invest in the latest technology available. Radiation therapy is less invasive, less expensive, and has a higher cure rate than most other cancer treatments. Use of imaging in radiation oncology benefits millions of cancer patients and not only improves precision and tumor control, it saves money by reducing or eliminating nonessential or inappropriate treatment. It is vital that limitations to these important imaging services are not imposed on planning and treatment of cancer with radiation therapy.”

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• House Democrats Urge Speaker to Allow Vote to Lower Rx Drug Costs

House Democratic Leader Nancy Pelosi (D-CA) and senior House Democrats—John D. Dingell (D-MI), Charles B. Rangel (D-NY), and Henry Waxman (D-CA)—sent a letter to Speaker Dennis Hastert (R-IL) urging him to bring legislation to the House floor that allows Medicare to negotiate for lower prescription drug prices, saving consumers and taxpayers billions of dollars.

Representative Pelosi mentioned the failures of the Part D prescription drug law that result from the prohibition against price negotiation, noting that drug companies will reap approximately $2 billion in windfall profits this year because Medicare is specifically prohibited from using its purchasing power—a power that should be used to negotiate lower drug prices for seniors and people with disabilities.

This is especially true for the 6.4 million low-income seniors and disabled people who previously had prescription drug coverage through Medicaid and joined the rest of the Medicare population in Part D on January 1. States and the federal government had received large rebates or discounts from manufacturers of prescription drugs.

This discount is now lost because Part D prescription plans have not been able to negotiate similar low drug prices for their enrollees. Further, prices for drugs used by this population are higher under Part D than they were under Medicaid.

The billions in drug company profits, along with the extra payments given to Medicare managed care plans and savings from requiring price negotiation, should be devoted to closing the gap in coverage, she said, noting that this would make it possible to provide substantially better coverage for millions of Medicare beneficiaries at no extra cost to the government.

© 2006 Lippincott Williams & Wilkins, Inc.
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