SAMHSA’s Weekly Financing News Pulse: National Edition

Table of Contents

National News 

• Senate Votes to Begin Debate on the Patients Protection and Affordable Care Act of 2009
• Update: Senate Confirms Hyde as SAMHSA Administrator
• House Passes Medicare “Doc Fix” Legislation
• Senate Approves $134 Billion Veterans Budget, Increases Health Funding 9 Percent
• Sen. Grassley Introduced Legislation to Allow Longer Medicare Payment Delays in Dubious Cases
• Rep. Adler Sponsors Bill to Increase Oversight at VA Clinics
• OMB Reports $98 Billion in Improper Government Payments; Medicare and Medicaid Account for Over $50 Billion
• GINA to Take Effect, Prevent Employers and Insurers from Genetic Discrimination
• Pharmaceutical Companies Increased Drug Prices 9 Percent Since Last Year; Congressmen Seek Audits
• CCHIT Seeks Comment on Behavioral Health EHR Certification Criteria
• Polls Find Deep Divisions on Health Care Reform
• Army Suicides Rise; Study Finds Mental Health Staff Lacking in Afghanistan, Army to Send More
• Nabi, GlaxoSmithKline Sign Deal Over Nicotine Addiction Vaccine

Studies Released                               

• CMS Report Finds House Health Care Reform Bill Would Increase Health Care Costs
• CMS Pays Out More for Quality Physician Reporting in 2009
• Business Roundtable Report Praises Some Health Care Reforms, Criticizes Others
• Mercer Releases 2009 Employer Health Plan Survey Highlights
• RWJF Report Analyzes Massachusetts’s Health Care Reform, Outlines Lessons for the National Effort
• KFF Releases Health Care Reform Analyses of Racial/Ethnic Disparities and State-Level Variations
• U.S News & World Report Releases Health Plan Rankings
• Study Finds Little Benefit to Hospital EHR Implementation
• Study Find Uninsurance Associated with Higher Mortality After Trauma

Around the Hill: Hearings on Health Financing        

PLEASE NOTE: SAMHSA’s Weekly Financing News Pulse will not be produced over Thanksgiving; the next National Edition will be distributed on Monday, December 7th.

Download SAMHSA's Weekly Financing News Pulse: National Edition here: Weekly Financing News Pulse National Edition final 20091123.pdf (382.48 kb)

This study, supported by the National Institute on Drug Abuse (NIDA) and published in the Archives of General Psychiatry, found that individuals attaining high levels of an anti-cocaine antibody had significantly more cocaine free urine samples than those with lower antibody levels or those taking a placebo.  Unlike the antibodies produced by other vaccines, which destroy or disable the disease-causing agent, the cocaine antibodies prevent the drug from passing through the blood brain barrier to inhibit the drugs euphoric effects.   The study found that the proportion of subjects having a 50 percent reduction in use was significantly greater in those attaining higher antibody levels than those with lower levels.  However, only 38 percent vaccinated subjects attained the high antibody levels and significant effects of the vaccine only lasted 2 months.

Martell, B. A., Orson, F. M., Poling, J. et al. (2009). Cocaine vaccine for the treatment of cocaine dependence in methadone-maintained patients. Archives of General Psychiatry, 66(10), 1116-1123. http://archpsyc.ama-assn.org/cgi/content/abstract/66/10/1116

Authors: Bridget A. Martell, Frank M. Orson, James Poling, Ellen Mitchell, Roger D. Rossen, Tracie Gardner, Thomas R. Kosten.

This Commonwealth Fund report presents the results of the 2009 State Scorecard on Health System Performance , assessing states’ performance in health care access, quality, cost, and outcomes.  The report found that states’ performance continues to vary widely; however, all states face rising health care costs and poor care coordination.  The report notes that Vermont, Hawaii, Iowa, Minnesota, Maine, New Hampshire, Massachusetts, Connecticut, North Dakota, Wisconsin, Rhode Island, South Dakota, and Nebraska were the overall highest performers; however, the scorecard does not yet reflect the effects of the recession because of a reporting lag. 

From the report:

Focused on identifying opportunities to improve, The Commonwealth Fund’s State Scorecard on Health System Performance assesses states’ performance on health care relative to achievable benchmarks for 38 indicators of access, quality, costs, and health outcomes. The 2009 State Scorecard paints a picture of health care systems under stress, with deteriorating health insurance coverage for adults and rising health care costs. On a positive note, there were gains in children’s coverage as a result of national reforms, and improvement in some measures of hospital and nursing home care following federal efforts to publicly report quality data. The scorecard highlights persistent wide variation in performance across states and continued evidence of poor care coordination. Increasing cost pressures and deterioration in access across the U.S., together with geographic disparities in performance, underscore the urgent need for comprehensive national reforms to ensure access, change the trajectory of costs, and enhance value.

Full report: http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2009/Oct/1326_McCarthy_state_scorecard_2009_full_report_FINAL.pdf 

The Commonwealth Fund. (2009). Aiming higher: results from a state scorecard on health System performance, 2009. Douglas McCarthy, Sabrina K. H. How, Cathy Schoen, Joel C. Cantor, and Dina Belloff.

This National Committee for Quality Assurance (NCQA) report on the state of health care quality, released on October 22, found  that overall health care quality in America—including private and public coverage—has been virtually stagnant since 2008.  Previous NCQA reports have found health care quality had improved significantly every year for the past 12 years and NCQA attributes the reversal to the economy and the fee-for-service (FFS) payment model.  In addition to the overall trends, the NCQA report notes that the percentage of patients receiving quality care for many conditions, including for M/SU conditions, remained under 50 percent while some M/SU conditions displayed quality reductions.

From the Executive Summary:

There are probably multiple reasons for the flat results of 2009. First, and perhaps most important, is the lagging U.S. economy. The current downturn began in the fourth quarter of 2008, but employers and health plans had already begun to shift their focus almost entirely to the cost of coverage. When purchasers are buying on the basis of cost alone, plans naturally follow suit and pay more attention to negotiating discounts and less to improving performance. And the most effective tool — tying payments to performance — is not being utilized enough, especially by the giant Medicare program.

Millions of Americans lost their jobs and insurance; many shifted to Medicaid and the Children’s Health Insurance Program (CHIP); others became uninsured. Several states have made enormous strides in focusing their Medicare and CHIP programs on quality but they are not yet the majority. While more than half of Americans with private insurance are in a HEDIS-reporting plan, only 25 percent of Medicaid beneficiaries and 17 percent of Medicare beneficiaries are.

The National Committee for Quality Assurance. (2009).The State of Health Care Quality 2009.

Full report: http://www.ncqa.org/Portals/0/Newsroom/SOHC/SOHC_2009.pdf

This article discusses the implications of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial for private and public payers.  The STAR*D trial found that, for second- and third-line treatment, no second-generation antidepressant was superior to another in terms of effectiveness or of the overall incidence of harmful effects.  The authors conclude that the findings have allowed payers to construct coverage rules with greater confidence.

Little, A., Hansen, R. A., Gartlehner, G. (2009). Impact of the STAR*D trial from the perspective of the payer. Psychiatric Services, 60, 1463-1465. DOI: 10.1176/appi.ps.60.11.1463 http://ps.psychiatryonline.org/cgi/content/abstract/60/11/1463 

Authors: Alison Little, Richard A. Hansen, Gerald Gartlehner, Carrie Gray.