Policy and Legislation

On the same day voters in Ohio were summarily rejecting by a margin of nearly 2-to-1 the individual mandate in the Affordable Care Act, justices at the U.S. Court of Appeals for the District of Columbia weighed in with a ruling upholding the mandate as constitutional.

Americans are fed up with big government and want to downsize. That's been the gist of news headlines for some time now. However, a new poll by the Robert Wood Johnson Foundation (RWJF) and the Harvard School of Public Health puts the kibosh on that popular notion.

Representatives of skilled nursing facilities (SNFs) are estimating the SNF sector will potentially lay off 20,000 employees, will forgo the creation of 20,000 new jobs and will alter employee benefits as a result of the Medicare payment cuts that took effect on Oct. 1.

HMS Holdings Corp. announced Monday that it will acquire HealthDataInsights, the Medicare recovery audit contractor for Region D, for approximately $400 million.

So far this year, more than 2.2 million people with Medicare have saved more than $1.2 billion on their prescriptions, for an average of $550 per person, the Centers for Medicare & Medicaid Services announced Friday.

A much-anticipated report from the Institute of Medicine providing guidance to the Department of Health and Human Services on how to define essential health benefits came down squarely on the side of controlling the costs of providing those benefits with an emphasis on benefits that are effective and provide high value.

The Program of All-Inclusive Care for the Elderly (PACE) enables frail Medicare beneficiaries still in their homes to access medical and social services in the community.

It is believed that in its deliberations on how to reduce the federal deficit, the Joint Selection Committee on Deficit Reduction is considering permanently fixing the Medicare sustainable growth rate (SGR) formula. Many within the medical community have vigorously urged the super committee and Congress to repeal the SGR, and the Medicare Payment Advisory Commission (MedPAC) voted to recommend a repeal to Congress.

The growing drug shortage crisis is the number one supply chain concern for providers nationwide says Novation, a group purchasing organization. Yet, even in these dire circumstances, there may be a glimmer of hope.

The Medicare physician payment fee for 2012 is not as bad as predicted, but the lesser cut will be cold comfort to physicians.