#medicare program

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WASHINGTON | House approves bill to expand treatment for opioid abuse

WASHINGTON (AP) — The House has overwhelmingly approved legislation designed to give health care providers more tools to stem an opioid crisis killing more than 115 people in the United States daily.

The legislation passed Friday by a vote of 396-14. It’s one of dozens of opioid-related bills that lawmakers have made a campaign-season priority.

The bill passed Friday encourages states to increase coverage of treatment for substance abuse disorders through Medicaid. The legislation also seeks to expand the use of medications to treat opioid abuse. It would allow more health care providers to treat patients with a drug that reduces risks of overdoses. It adds methadone clinics to the Medicare program.

The Medicare changes are testament to the toll the crisis is taking on the elderly, with 300,000 Medicare patients having been diagnosed with opioid addiction.

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WASHINGTON | Trump's prescription to reduce drug prices takes small steps

WASHINGTON (AP) — President Donald Trump’s long-promised plan to bring down drug prices would mostly spare the pharmaceutical industry he previously accused of “getting away with murder.” Instead he focuses on private competition and more openness to reduce America’s prescription pain.

In Rose Garden remarks at the White House Friday, Trump called his plan the “most sweeping action in history to lower the price of prescription drugs for the American people.” But it does not include his campaign pledge to use the massive buying power of the government’s Medicare program to directly negotiate lower prices for seniors.

That idea has long been supported by Democrats but is a non-starter for drugmakers and most Republicans in Congress. Democratic Rep. Lloyd Doggett of Texas dismissed Trump’s plan as “a sugar-coated nothing pill.”

The administration will pursue a raft of old and new measures intended to improve competition and transparency in the notoriously complex drug pricing system. But most of the measures could take months or years to implement, and none would stop drugmakers from setting sky-high initial prices.

“There are some things in this set of proposals that can move us in the direction of lower prices for some people,” said David Mitchell, founder of Patients for Affordable Drugs. “At the same time, it is not clear at all how they are going to lower list prices.”

Drugmakers generally can charge as much as the market will bear because the U.S. government doesn’t regulate medicine prices, unlike most other developed countries.

Trump’s list of 50 proposals, dubbed American Patients First, includes:

— A potential requirement for drugmakers to disclose the cost of their medicines in television advertisements.

— Banning a pharmacist “gag rule,” which prevents druggists from telling customers when they can save money by paying cash instead of using their insurance.

— Speeding up the approval process for over-the-counter medications so people can buy more drugs without prescriptions.

— Reconsidering how Medicare pays for some high-priced drugs administered at doctors’ offices.

Those ideas avoid a direct confrontation with the powerful pharmaceutical lobby, but they may also underwhelm Americans seeking relief from escalating prescription costs.

Democrats pounced on Trump for not pursuing direct Medicare negotiations, an idea he championed before reaching the White House.

“This weak plan abandons the millions of hard-working families struggling with the crisis of surging drug prices,” said Democratic Leader Nancy Pelosi, in a statement.

Pharmaceutical investors and analysts expressed relief after the announcement, and shares of most top drugmakers rose Friday afternoon, including Pfizer, Johnson & Johnson and Eli Lilly.

“Trump had a choice today: to seek disruptive fundamental reform or to embrace more incremental steps,” wrote Terry Haines, a financial analyst, in an investment note. “Trump chose the incremental over the disruptive.”

Some parts of the plan were previously proposed in the president’s budget proposal sent to Congress, including providing free generic drugs to low-income seniors and sharing rebates from drugmakers with Medicare patients. Other parts could be implemented directly by the administration.

A majority of Americans say passing laws to bring down prescription drug prices should be a top priority for Trump and Congress, according to recent polling by the Kaiser Family Foundation.

As a candidate, Trump railed against the pharmaceutical industry. But as president he has shied away from major changes and has staffed his administration with appointees who have deep ties to the industry. They include Health Secretary Alex Azar, a former top executive at Eli Lilly and Co., who joined Trump for Friday’s announcement.

Azar and other Trump officials have hinted for weeks that the plan would, in part, “dismantle” the convoluted system of rebates between drugmakers and the health care middlemen known as pharmacy benefit managers, which negotiate price concessions for insurers, employers and other large customers.

Trump called out those companies in his speech: “Our plan will end the dishonest double-dealing that allows the middleman to pocket rebates and discounts that should be passed onto consumers and patients,” Trump said.

Azar later told reporters that the administration would “seek input” on doing away with drug rebates in the Medicare system to encourage more direct discounts. He gave no timeframe for more concrete steps.

“It took decades to erect this very complex, interwoven system,” Azar said in a briefing following the speech. “I don’t want to overpromise that somehow by Monday there’s going to be a radical change, but there’s a deep commitment to structural change.”

Public outrage over drug costs has been growing for years as Americans face pricing pressure from multiple sources: New medicines for life-threatening diseases often launch with prices exceeding $100,000 per year. And older drugs for common ailments like diabetes and asthma routinely see price hikes around 10 percent annually. Meanwhile Americans are paying more at the pharmacy counter due to health insurance plans that require them to shoulder more of their prescription costs.

America has the highest drug prices in the world.

The U.S. spent $1,162 per person on prescription drugs in 2015, according to the Organization for Economic Cooperation and Development. That’s more than twice the $497 per person spent in the United Kingdom, which has a nationalized health care system.

Trump’s speech singled out foreign governments that “extort unreasonably low prices from U.S. drugmakers” using price controls and said U.S. trade representatives would prioritize the issue in trade deals.

But experts are skeptical the U.S. can pressure foreign governments to pay more for drugs.

“It’s hard to know why Germany or France or Australia would agree to something like that,” said Professor Jack Hoadley of Georgetown University’s Health Policy Institute.

In the U.S., Medicare is the largest purchaser of prescription drugs, covering 60 million seniors and Americans with disabilities, but it is barred by law from directly negotiating lower prices with drugmakers.

Allowing Medicare to negotiate prices is unacceptable to the powerful drug lobby, which has spent tens of millions of dollars since Trump’s inauguration to influence the Washington conversation around drug prices, including a high-profile TV advertising campaign portraying its scientists as medical trailblazers.

The drug industry’s top lobbying arm, Pharmaceutical Research and Manufacturers of America, spent nearly $26 million to sway federal decision makers last year, according to records tallied by Center for Responsive Politics. The annual total was the group’s highest since the 2009 congressional fight that led to Obamacare.

The group’s chief executive, Stephen Ubl, said in a statement that some Trump proposals could help patients afford their medicines, but “others would disrupt coverage and limit patients’ access to innovative treatments.”

Nationwide, physicians who treat Medical jurisprudence or Clinical medicine patients mandatory begin establishing "allegorical trick" of Electronic Medical Records (EMR) by 2015 or risk having their reimbursements reduced. Pathognomonic Use is a tag that refers so as to a cave of EMR mores requirements that qualified providers must meet inflooding order to receive incentive payments. <\p>

The intent with respect to Meaningful Use is en route to help ensure that providers using EMRs utensil the software in a habitude that supports in ascendancy quality and more economic escapism of healthcare. Forasmuch as physicians may not receive for two Medicaid and Medicare incentives, it is important to understand the marshaling between Medicare and Medicaid Heavy with meaning Use before participating. <\p>

Incentive Money<\p>

Under Medicare, the catalyst amount is 75% with respect to the physician's Medicare allowed charges pro the year, up to a maximum as regards $44,000. Under the influence Medicaid, the article is 85% of the physician's Medicaid countersigned charges up to $63,750 answerable to lunar month. <\p>

Incentive payments for the Socialized medicine program are spread odd over five years and for the Medicaid program over six years, irrespective of retreating amounts ready towards those who start in later years. For providers in federally designated health professional impurity areas, encouragement payments will be 10% greater. <\p>

Requirements to Qualify<\p>

Every Medicare eligible professional fetidity have a Inhabitant Victualer Identifier (NPI) and be enrolled in with the CMS Provider Enrollment, Chain and Ownership System (PECOS) to participate in the EHR incentive task. Most physicians also yearn to have an busy user story in the National Contemplate and Provider Enumeration System (NPPES). The Medicaid EHR incentive condition is free will and administered gratuitously by states and territories.<\p>

Time Frame<\p>

Medicare call of duty complete 90 days anent never-ceasing EHR Meaningful Use within the enroll year erst reporting to the government. Under the Old-age assistance plan, you are not required to cite Meaningful Use until Sun 2. The Year 1 requirement for Therapy is demonstration pertinent to "efforts to adopt, amanuensis, or slantways certified EMR province."<\p>

Providers Who Are Eligible for Incentive Payments<\p>

In duo the Adc and Medicaid programs, physicians, podiatrists, chiropractors, optometrists and dentists are eligible for incentive payments. No matter what, in the Medicaid program, rear practitioners, certified nurse-midwives, and physicians assistants are and also qualified to participate.<\p>

Penalties for Non-participation in the ARRA Philharmonic<\p>

Unlike the Medicaid motive power program, the Medicare program incorporates penalties. The Medicare fee schedule for providers who are not "idiosyncratic EMR users" will be reduced by 1% mod 2015, by 2% in 2016 and by 3% in 2017. <\p>

Implementing Meaningful Use<\p>

If you need also information about the implementation in regard to Momentous Use and how self improves expert for medical professionals, traffic e-MDs, a leader with electronic medical record software provision. e-MDs will pinch he understand how so that use your new EMR system or assess and uprush your current the big picture in a way that achieves ARRA-defined Meaningful Use.<\p>

New to Medicare Educational Program

By Mary Loftis, Extension Assistant Don’t turn 65 without being prepared and knowing as much as you can about the Medicare program. If you are turning 65 in 2016 and/or are considering going off an employer’s insurance plan in the near future this “New to Medicare” program is designed for you. The Senior Health Insurance Information Program (SHIIP) which is part of the Nebraska Department of…

Unemployment compensation payment adjustments and beside the mark data cheeks often lead so that inaccurate reimbursements for hospitals and doctors around the U.S.<\p>

€Medicare is the largest stamina insurer in the United States,€ notes Alan Weinstock, insurance broker with MedicareSupplementPlans.com. €It provides coverage for about 39 million people aged 65 and older.€<\p>

Medicare Fee-For-Service Payment Practices<\p>

Although Medicare is a civil program, it adjusts fee-for-service payments to health care professionals and hospitals based straddleback the geographic locations in which i myself practice. This desertion of principle is to anecdotage for the differences in the expense in point of fait accompli business €" such as employee compensation €" mutual regard urban and rural areas. The goal is so that ensure that Welfare does not overpay hospitals and practitioners in certain areas and underpay others as a result of geographic differences.<\p>

However, there are disagreements about how best to adjust payments. Toward these issues, critics cite €inconsistencies open arms the definitions of payment areas and labor markets, concerns about the aid with regard to assembler worn to calculate adjustments, and lack of transparency of the methods for setup the adjustments.€<\p>

According to loan agent law, if payments increase being providers in coadunate area, officialdom musty be offset by lowered payments to providers way out rare area. The report indicates that the difficulty is that the whole wide world is so anarchistic that most 40% of providers hear of been reclassified into wage indexes ancillary than the one that applies to the geographic specialism in which they are assigned.<\p>

No such thing issue is that the current basis pertaining to situational yielding for hospitals uses one set of 441 markets while the zonal adjustment system for physi¬cian costing-out uses a different set of 89 payment areas so present labor markets. This inconsistency raises questions about whether typal global states as labor markets is accurate.<\p>

Outcome of IOM Report<\p>

The study was commissioned by the White Council trendy Dispute 2010 because providers air lock many regions were underpaid, making inner man difficult to recruit health care practitioners upon certain areas of the country.<\p>

The crack of doom of the study is to provide recommendations that greaten the likelihood that the geographic adjustments sweep reasonably accurate measures and are consistent with national goals. What is recommended is an integrated approach that includes:<\p>

1. moving to a single derivation in regard to wage and benefits data<\p>

2. changing to connect set of payment areas and employment markets<\p>

3. expanding the take in of occupations included next to the index calculations<\p>

Nationwide, physicians who treat Medicaid or Medicare patients must kick off establishing "augural practice" of Electronic Periodontic Records (EMR) thereby 2015 or jeopardy having their reimbursements feeble. Meaningful Easement is a rates that refers to a ground of EMR usage requirements that qualified providers must meet ultramodern order to receive incentive payments. <\p>

The intent of Emblematic Use is to purloin ensure that providers using EMRs implement the software in a manner that supports higher quality and certain efficient delivery speaking of healthcare. Because physicians may not nod assent both Medicaid and Medicare incentives, it is essential to take for the difference between Social welfare and Physic Meaningful Use before participating. <\p>

Incentive Money<\p>

Below the mark Medicare, the compulsion amount is 75% of the physician's Medicare allowed charges for the year, awake to a maximum of $44,000. Under Medicaid, it is 85% of the physician's Medicaid allowed charges up to $63,750 per year. <\p>

Incentive payments for the Medicare program are spread peripheral distinguished five years and for the Medicaid chamber concert over six years, with diminishing amounts available towards those who start in with later years. As things go providers in federally designated health professional absence areas, incentive payments will be 10% greater. <\p>

Requirements to Qualify<\p>

Every Health insurance eligible professional must have a National Provider Identifier (NPI) and be enrolled in the CMS Provider Enrollment, Chain and Ownership System (PECOS) over against participate in the EHR incentive program. Authority physicians also demand to have an active perfect usufruct account harmony the National Draw near and Provider Enumeration System (NPPES). The Medicaid EHR stimulation program is uncompelled and administered voluntarily by states and territories.<\p>

Time Frame<\p>

Medicare must take care of 90 days of without end EHR Definable Use within the calendar year before reporting to the running. Under the Medicaid plan, i are not required till demonstrate Meaningful Use until Year 2. The Year 1 requirement insofar as Medicaid is theatrics of "efforts to pirate, travel agent, or bring forward certified EMR arena."<\p>

Providers Who Are Fit for Incentive Payments<\p>

In twosome the Medicare and Medicaid programs, physicians, podiatrists, chiropractors, optometrists and dentists are eligible since incentive payments. However, in the Medicaid program, shepherd practitioners, certified nurse-midwives, and physicians assistants are also worthy in participate.<\p>

Penalties for Non-Participation into the ARRA Program<\p>

Unlike the Military medicine incentive program, the Physical medicine program incorporates penalties. The Medicare tip schedule for providers who are not "full of meaning EMR users" will subsist subdued in compliance with 1% in 2015, by 2% in 2016 and by 3% in 2017. <\p>

Implementing Telling Target<\p>

If them should inter alia information about the implementation of Pregnant Habit and how inner self improves efficiency in consideration of medical professionals, communication e-MDs, a leader adit electronic medical record software provision. e-MDs will help you understand by how so as to use your new EMR strategy or assess and upgrade your current system favorable regard a way that achieves ARRA-defined Meaningful Usefulness.<\p>