First Edition: April 9, 2014

Apr 9 2014

Today's headlines include coverage of the release of Medicare billing and utilization data, as well as early insights into who enrolled in health coverage as a result of the health law.   

Kaiser Health News: Early Drug Claims Suggest Exchange Plan Enrollees Are Sicker Than Average
Kaiser Health News staff writer Julie Appleby, working in partnership with The Daily Beast, reports: "Offering a first glimpse of the health care needs of Americans who bought coverage through federal and state marketplaces, an analysis of the first two months of claims data shows the new enrollees are more likely to use expensive specialty drugs to treat conditions like HIV/AIDS and hepatitis C than those with job-based insurance" (Appleby, 4/9). Read the story.

Kaiser Health News: Oregon Medicaid Plan Sees High Demand
Oregon Public Broadcasting's Kristian Fodn-Vencil, working in collaboration with Kaiser Health News and NPR, reports: "Millions of Americans who didn't have health insurance last year now do, as a result of the Affordable Care Act. In Lane County, Oregon, Trillium Community Health Plan is struggling to deal with a huge influx of new patients. CEO Terry Coplin says they expected 26,000 people to sign up in the first few years. Instead, about that many signed up in the first few months" (Foden-Vencil, 4/8). Read the story.

Kaiser Health News: Capsules: Primary Care Shortage? Not For The Insured, Study Shows
WHYY's Elana Gordon, working in partnership with Kaiser Health News, reports: "Researchers posing as nonelderly adult patients made nearly 13,000 calls to primary care practices across Pennsylvania, New Jersey and eight other states between fall 2012 and spring of last year. What they found may provide some comfort amid growing concerns of doctor shortages, especially as more people gain coverage through the Affordable Care Act, potentially straining the health system" (Gordon, 4/8). Check out what else is on the blog.

The New York Times: Sliver Of Medicare Doctors Get Big Share Of Payouts
A tiny fraction of the 880,000 doctors and other health care providers who take Medicare accounted for nearly a quarter of the roughly $77 billion paid out to them under the federal program, receiving millions of dollars each in some cases in a single year, according to the most detailed data ever released in Medicare's nearly 50-year history (Abelson and Cohen, 4/9).

The Washington Post: Data Uncover Nation's Top Medicare Billers
The Medicare program is the source of a small fortune for many U.S. doctors, according to a trove of government records that reveal unprecedented details about physician billing practices nationwide. The government insurance program for older people paid nearly 4,000 physicians in excess of $1 million each in 2012, according to the new data. Those figures do not include what the doctors billed private insurance firms (Whoriskey, Keating and Somashekhar, 4/9).

The Wall Street Journal: Small Slice Of Doctors Account For Big Chunk Of Medicare Costs
The long-awaited data reveal for the first time how individual medical providers treat America's seniors-;and, in some cases, may enrich themselves in the process. Still, there are gaps in the records released by the U.S. about physicians' practice patterns, and doctors' groups said the release of such data leaves innocent physicians open to unfair criticism (Weaver, McGinty and Radnofsky, 4/9).

Los Angeles Times: Release Of Medicare Doctor Payments Shows Some Huge Payouts
Ending decades of secrecy, Medicare is showing what the giant healthcare program for seniors pays individual doctors, and the figures reveal that more than a dozen physicians received in excess of $10 million each in 2012. The Obama administration is releasing a detailed account Wednesday of $77 billion in government payouts to more than 880,000 healthcare providers nationwide that year. The release of payment records involving doctors has been legally blocked since 1979, but recent court rulings removed those obstacles. No personal information on patients is disclosed (Terhune, Levey and Smith, 4/8).

The Associated Press: Medicare Database Reveals Top-Paid Doctors
Topping Medicare's list was Florida ophthalmologist Salomon Melgen, whose relationship with Sen. Robert Menendez, D-N.J., made headlines last year after news broke that the lawmaker used the doctor's personal jet for trips to the Dominican Republic. Medicare paid Melgen $20.8 million. AP's analysis found that a small sliver of the more than 825,000 individual physicians in Medicare's claims data base -; just 344 physicians -; took in top dollar, at least $3 million apiece for a total of nearly $1.5 billion (4/9).

USA Today: First Look At Medicare Data In 35 Years
Reimbursements to doctors who provide Medicare services in 2012 ranged from nearly $21 million to a single Florida ophthalmologist to the $27,000 for the average anesthesiologist, according to the first look at government payment data in 35 years. The data were released this week by the Center for Medicare Services after a court order lifted an injunction sought by the American Medical Association had been in place since 1979 (Hoyer and Kennedy, 4/9).

Politico: Medicare Pay Data Laid Bare
Yet the massive release brings what federal health officials tout as a measure of transparency to a notoriously inscrutable system. Academic researchers and the media are expected to immediately begin dissecting the information to identify potential cases of fraud or abuse as well as differences in how Medicare services are used in various parts of the country (Norman, 4/9).

The New York Times: Doctor With Big Medicare Billings Is No Stranger To Scrutiny
The doctor who bills the most for Medicare in the country is a South Florida ophthalmologist whose offices were twice raided last year by the FBI and whose generous political contributions and cozy relationship with New Jersey Senator Robert Menendez are under investigation by federal public corruption prosecutors, a New York Times analysis of Medicare data shows (Robles, 4/9).

Here's the Centers for Medicare & Medicaid Services provider data site. 

The New York Times: Study Looks At Earliest Health Law Enrollees
The health of those who enrolled in new coverage is being closely watched because many observers have questioned whether the new marketplaces would attract a large share of sick people, which could lead to higher premiums and ultimately doom the new law (Thomas, 4/9).

Los Angeles Times: Employer Insurance Increasing As Obamacare Rolls Out, Study Finds
In addition to gains in insurance coverage as a direct result of the Affordable Care Act, the number of Americans covered by employer-provided insurance also has increased in the last year, according to newly released data from the Rand Corp. As previously reported by my colleague Noam N. Levey, Rand estimated that the number of Americans with health insurance rose by about 9.3 million as of mid-March. The group's researchers note that the number probably has increased as their survey missed much of the final surge of enrollments in the online marketplaces created by the healthcare law, also known as Obamacare (Lauter, 4/8).

The Associated Press: Many 'Obamacare' Critics Accepted Its Subsidies
Several big corporations have reaped millions of dollars from "Obamacare" even as they support GOP candidates who vow to repeal the law. This condemn-while-benefiting strategy angers Democrats, who see some of their top congressional candidates struggling against waves of anti-Obamacare ads partly funded by these companies (4/8).

The Wall Street Journal: Health-Care Law, Economy Boost Ranks Of The Insured
Research released Tuesday shows 9.3 million Americans gained insurance coverage since the Affordable Care Act took full effect, though most who bought policies through newly established exchanges weren't uninsured and employers accounted for much of the rise in the newly covered. The figures from the nonpartisan research firm Rand Corp. are the latest findings to paint an emerging picture of the law's impact. This and other studies released recently suggest the 2010 law is meeting its goal of lowering the number of Americans without insurance (Corbett Dooren, 4/8).

NPR: Lessons Learned For 2015 From This Year's Obamacare Sign-Ups
President Obama was thrilled last week when he was able to announce that more than 7 million people have signed up for insurance under the Affordable Care Act. "This law is doing what it's supposed to do," the president said in the Rose Garden. "It's working." But that's not to say it couldn't work better. Among those suggesting ways to help is the consumer group Families USA. The group's got a list of 10 specific changes it says could improve outreach and make the overall process easier for people to navigate (Rovner, 4/9).

The Associated Press:Va. Senate Passes Budget With Expanded Medicaid
The Virginia Senate approved its version of a roughly $96 billion two-year budget Tuesday as Republicans and Democrats pointed fingers over who is responsible for a potential state government shutdown. Two weeks after the start of a special session devoted to passing a state budget, the Democratically controlled Senate approved a spending plan that includes accepting federal Medicaid funds to provide new health insurance to as many as 400,000 low-income residents (4/8).

The Washington Post: Gansler Asks O'Malley For Independent Probe Of Maryland Health Exchange, Gets Rebuffed
Maryland gubernatorial hopeful Douglas F. Gansler on Tuesday called on Gov. Martin O'Malley (D) to appoint a special counsel to investigate the state's online health insurance exchange, in his latest attempt to call attention to its shortcomings (Wagner, 4/8).

The Washington Post: Democrats, GOP Clash As Debate Opens On Ryan Budget Plan
Ryan aims to reduce the top individual income-tax bracket to 25 percent and keep military spending on its current trajectory. About $3 trillion of his savings would come from revamping health care, first by repealing the ACA -; but leaving intact taxes and savings from the law -; and by altering Medicare into a program in which the elderly would receive premium supports from the federal government but buy insurance on their own (Kane and Yoder, 4/8).

The Associated Press: GOP Lawmakers Balk When Spending Cuts Turn Real
When House Republicans pass Rep. Paul Ryan's budget for a fourth year in a row this week, they'll go on record again in favor of big spending cuts across a wide swath of programs, including Medicaid, food and farm aid and eliminating subsidies for Amtrak and airline flights to small cities. But a budget is only a non-binding framework. It can promise the sky, but to actually fulfill its pledges requires follow-up legislation (4/8).

The Wall Street Journal's Washington Wire: Top Ten Campaign Ads: The More Things Change….
In fact, three of the top five ads focus on health care and date from the 2008 presidential campaign, providing a bracing reminder of how little the last six years of debate about health care have done to resolve differences between the parties. The No.1 ad -; an attack on GOP presidential nominee John McCain's health-care proposals by then-Sen. Barack Obama – features arguments that sound very much like today's slings and arrows (Hook, 4/9).

The Wall Street Journal's Washington Wire: Koch Brothers Launch Health Law Ads Against Democrats Udall, Braley
The campaign arm of the Koch-backed nonprofit Freedom Partners launched on Tuesday a nearly $1.1 million ad campaign against two Democratic Senate candidates: Rep. Bruce Braley of Iowa and Sen. Mark Udall of Colorado. The campaign, which will be broadcast in both states for the next three weeks, targets the candidates' support of the Affordable Care Act (Ballhaus, 4/8).

Los Angeles Times: CVS Caremark To Pay $20 Million To Settle SEC Charges
CVS Caremark Corp., the country's second-largest pharmacy chain, has agreed to pay $20 million to settle charges that it misled investors and used improper accounting techniques to artificially boost its financial earnings, the U.S. Securities and Exchange Commission announced Tuesday. … According to the SEC, CVS had conducted a $1.5-billion bond offering in 2009 but did not tell investors that it had recently lost "significant" Medicare Part D and contract revenues in its pharmacy benefits business segment (Lopez, 4/8).

The Wall Street Journal: CVS To Pay $20 Million To Settle SEC Allegations
CVS allegedly further misled investors on an earnings call that same day by maintaining there was a slight improvement in its "retention rate," the SEC claimed, saying the drugstore chain omitted changes to how it calculated the rate. The SEC also claimed the company made improper accounting adjustments that overstated the financial results for its retail pharmacy business. Those adjustments were tied to CVS's treatment for its acquisition of another drug-store chain, Longs Drugs Stores (Kell, 4/8).

Los Angeles Times: Takeda And Eli Lilly Ordered To Pay $9 Billion Over Actos Drug
A federal jury awarded a combined $9 billion in punitive damages against Takeda Pharmaceuticals U.S.A. Inc. and Eli Lilly & Co. after it found that the drug makers did not disclose cancer risks for their diabetes medicine, Actos (Li, 4/8).

The Wall Street Journal: Intuitive Surgical Earnings Fall As Robot Demand Softens
Intuitive Surgical, which is expected to report earnings April 22, has struggled over the past year as doctors took a more conservative approach toward performing some minimally invasive procedures. Concerns about the safety and cost-effectiveness of the company's robots have also hurt sales, analysts said (Walker and Stynes, 4/8).

NPR: Calif. Medical Center Offers Cure To Indigenous Language Barrier
Immigrants from Mexico don't always speak Spanish. Instead they speak indigenous languages. That's created huge communications problems but a hospital in Salinas has found a solution (Almanzan, 4/9).