KHN Morning Briefing

Summaries of health policy coverage from major news organizations

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Medicare Is Considering New Method To Pay For Drugs Administered By Doctors

Federal officials may set up a pilot program that would test how limiting reimbursement affects doctors’ choice of drugs. Also in Medicare news, a federal court revives a hospital industry's lawsuit over the long wait for appeals on payment disputes, and the government details how changes in Medicare prescription drug policy has saved money for seniors.

Bloomberg: Medicare Weighing Changes To Doctor Drug Payments, Memo Shows
The U.S. is mulling changes to how the Medicare program pays physicians for administering expensive cancer drugs and other medications given in doctors’ offices, according to a memo from the Centers for Medicare and Medicaid Services. The memo tells Medicare contractors who process payments to set up a system allowing the government to vary by geographic location how much it reimburses doctors for the drugs they administer. The government could then set up a pilot program to test how limiting reimbursement in Medicare Part B, which pays for seniors’ medical services and supplies, affects doctors’ choice of drugs, according to the memo that was posted on the CMS website. (Tracer and Damouni, 2/9)

Reuters: D.C. Circuit Revives Hospitals' Lawsuit Over Medicare Appeal Delays
A federal appeals court has reopened a lawsuit by the country's leading hospital industry group against the U.S. government over delays in deciding appeals of Medicare reimbursement determinations. Judge David Tatel of the District of Columbia U.S. Circuit Court of Appeals acknowledged Tuesday that the U.S. Department of Health and Human Services was "caught between two Congressionally assigned tasks" - deciding Medicare appeals within set time limits while also carrying out an antifraud program that has caused the number of appeals to skyrocket. (Pierson, 2/9)

Modern Healthcare: Ruling Gives Hospitals Hope On RAC Appeals Backlog
Hospitals persuaded a federal appeals court to give new life to their legal fight to force HHS to work more quickly through a backlog of disputed findings by Medicare's controversial recovery audit contractors. A lower court had dismissed the case in December 2014, saying the delay in processing RAC appeals wasn't unreasonable enough to elicit an order from the court and that HHS and Congress should work together to resolve the issue. But a three-judge panel of the U.S. Court of Appeals for the District of Columbia Circuit reversed that decision Tuesday (PDF) and sent the case back to the lower court for reconsideration. (Schencker, 2/9)

Modern Healthcare: Medicare Beneficiaries Have Saved $20 Billion On Prescription Drugs Since 2010
Nearly 10.7 million Medicare beneficiaries have received discounts totaling over $20.8 billion on prescription drugs, an average of $1,945 per beneficiary, since the enactment of the Affordable Care Act. According to new HHS data released Monday, nearly 5.2 million seniors and people with disabilities received discounts of over $5.4 billion, for an average of $1,054 per beneficiary in 2015 alone. The savings in 2015 is a 12% increase compared to the amount saved in 2014, when 5.1 million Medicare beneficiaries received discounts of $4.8 billion. That equaled an average of $941 per beneficiary in 2014, the report said. (Sandler, 2/8)

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