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    <recommendedItem id="20100101_19_423"
                     title="Week 31: Baucus Quotes Gandhi; Obama Wants $80 Billion HHS Boost"
                     score="0.013"
                     href="http://www.medpagetoday.com/Washington-Watch/Reform/tb/18337?impressionId=1265748401713"
                     
      &lt;p&gt;WASHINGTON  --  Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee, likes to start hearings with a quote from a famous leader. This week, he quoted Mahatma Gandhi.&lt;/p&gt;
&lt;p&gt;&quot;Every worthwhile accomplishment . . . has its stages of drudgery and triumph; a beginning, a struggle, and a victory,&quot; said Baucus, who has been an integral part of the negotiations that stalled last month with Congress apparently just weeks away from passing a healthcare reform bill.&lt;/p&gt;
&lt;p&gt;The effort to enact healthcare reform &quot;has certainly seen its struggles,&quot; Baucus said. But he said he agrees with President Barack Obama, who urged Congress during his State of the Union address not to give up on passing comprehensive reform.&lt;/p&gt;
&lt;p&gt;&quot;We have gone well past this effort&apos;s beginning,&quot; Baucus said. &quot;We have endured our share of struggle. Now let us at last bring this bill to victory.&quot;&lt;/p&gt;
&lt;p&gt;Since the election to the U.S. Senate of Massachusetts Republican Scott Brown  --  a vocal opponent of healthcare reform  --  and the president&apos;s State of the Union message, which focused strongly on job creation and improving the economy, healthcare reform has been moved to a back burner.&lt;/p&gt;
&lt;p&gt;But &quot;I&apos;m very confident we&apos;re going to pass healthcare reform this year,&quot; Baucus said during Wednesday&apos;s hearing.&lt;/p&gt;
&lt;p&gt;Obama also urged Congress again not to give up on a bill when he spoke to Democrats at a question-and-answer session on Thursday.&lt;/p&gt;
&lt;p&gt;&quot;All that&apos;s changed in the last two weeks is that our party&apos;s gone from having the largest majority in a generation to having the second-largest majority in a generation,&quot; Obama said. &quot;We&apos;ve got to remember that.&quot;&lt;/p&gt;
&lt;p&gt;Although Baucus used most of his speaking time talking about healthcare reform, the purpose of this week&apos;s hearing was to question Department of Health and Human Services secretary Kathleen Sebelius about the $80 billion increase in funding for HHS requested in the &lt;a href=&quot;http://www.medpagetoday.com/Washington-Watch/Reform/18248&quot; mce_href=&quot;http://www.medpagetoday.com/Washington-Watch/Reform/18248&quot; target=&quot;_blank&quot; title=&quot;Obama&amp;#8200;Requests&amp;#8200;$80&amp;#8200;Billion&amp;#8200;Increase&amp;#8200;in&amp;#8200;Healthcare&amp;#8200;Funding&quot;&gt;president&apos;s 2011 budget&lt;/a&gt;.&lt;/p&gt;
&lt;p&gt;Under Obama&apos;s blueprint, HHS would receive $911 billion in 2011, most of which would be Medicare and Medicaid spending. But the National Institutes of Health (NIH) would also get a $1 billion boost for medical research, and there would be money for improving food, drug, and device safety, and to intensify efforts to help Americans quit smoking and get healthy.&lt;/p&gt;
&lt;p&gt;The President&apos;s budget doesn&apos;t make any provisions for healthcare reform should it be enacted.&lt;/p&gt;
&lt;p&gt;Healthcare spending now accounts for 17.3% of the nation&apos;s total spending, according to &lt;a href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/18302&quot; mce_href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/18302&quot; target=&quot;_blank&quot; title=&quot;In&amp;#8200;Bad&amp;#8200;Economy,&amp;#8200;Record&amp;#8200;Growth&amp;#8200;in&amp;#8200;Health&amp;#8200;Spending&quot;&gt;new data&lt;/a&gt; released by the Centers for Medicare and Medicaid Services.&lt;/p&gt;
&lt;p&gt;The recession of 2009, coupled with growing use of medical services, led to the fastest one-year growth in health spending since the 1960s, according to the CMS report.&lt;/p&gt;
&lt;p&gt;By 2019, national health spending is projected to reach $4.5 trillion and account for about 19% of gross domestic product (GDP), according to the report.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_399"
                     title="In Bad Economy, Record Growth in Health Spending"
                     score="0.012"
                     href="http://www.medpagetoday.com/Washington-Watch/Washington-Watch/tb/18302?impressionId=1265748401713"
                     
      &lt;p&gt;WASHINGTON  --  The recession of 2009, coupled with growing use of medical services, led to the fastest one-year growth in health spending since at least the 1960s, according to a report by the Centers for Medicare &amp;amp; Medicaid Services (CMS).&lt;/p&gt;
&lt;p&gt;In 2009, national health spending grew 5.7% to reach $2.5 trillion, according to preliminary estimates from CMS actuaries and economists published in &lt;em&gt;Health Affairs.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;That $2.5 trillion accounts for 17.3% of total GDP, which declined by 1% in 2009. In 2008, healthcare spending accounted for 16.2% of the GDP.&lt;/p&gt;
&lt;p&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;By 2019, national health spending will reach $4.5 trillion and account for about 19% of the gross domestic product (GDP), according to the report.&lt;/p&gt;
&lt;p&gt;National heath expenditures have grown faster than the GDP for years. But in 2009, the bad economy, job losses, an increasing Medicaid population, and more people seeing a doctor powered the unprecedented growth.&lt;/p&gt;
&lt;p&gt;While the 2009 numbers are preliminary, the authors singled out job losses that resulted in more people qualifying for Medicaid. Spending on Medicaid grew by nearly 10% in 2009, twice as fast as the year before.&lt;/p&gt;
&lt;p&gt;Another spending growth driver: More people utilized healthcare services in 2009, in part because so many sought H1N1 pandemic flu vaccinations.&lt;/p&gt;
&lt;p&gt;Utilization of medical services grew at a rate of 1.5% in 2009, compared with just a 0.9% growth rate in 2009. That translated into growth in spending on physician and clinical services as well: up 6.3% compared with 5% growth in 2008.&lt;/p&gt;
&lt;p&gt;The report also found: &lt;ul&gt; &lt;li&gt;Hospital spending increased 5.9 percent in 2009 compared with 4.5 percent in 2008, and reached $760.6 billion.&lt;/li&gt; &lt;li&gt;Spending on prescription drugs reached $246 billion, up by 5.2% compared with growth of 3.2% the previous year. &lt;/li&gt; &lt;li&gt;Government spending on healthcare in 2009 outpaced private insurance company spending, despite subsidies in the stimulus bill that allowed recently laid-off workers keep their private health insurance plans through COBRA. The number of people with private insurance plans declined by 1% in 2009. &lt;/li&gt; &lt;li&gt;Growth in out-of-pocket spending slowed in 2009, which the study authors attribute to the recession. &lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The good news is the economy is expected to grow in 2010, and analysts predict the growth rates in healthcare to be closer to the growth in GDP. Health spending is expected to decelerate to a growth of less than 4%, while GDP is anticipated to rebound to a 4% growth rate.&lt;/p&gt;
&lt;p&gt;However, that assessment may not be accurate because the estimate is based on a 21% cut in Medicare payments to physicians. Those cuts are slated to go into effect on March 1, but Congress is expected to vote at the last minute to stall the cuts  --  as it does every year.&lt;/p&gt;
&lt;p&gt;If Medicare payments for physicians hold steady  --  &lt;a href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/18094&quot; mce_href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/18094&quot; target=&quot;_blank&quot; title=&quot;AMA&amp;#8200;Pushes&amp;#8200;for&amp;#8200;Permanent&amp;#8200;Doctor&amp;#8200;Pay&amp;#8200;Fix&quot;&gt;either by Congress voting to put the cuts on hold for the next decade, or by voting to overhaul the sustainable growth rate (SGR&lt;/a&gt;)  --  healthcare spending would grow at a rate of about 4.7% in 2010.&lt;/p&gt;
&lt;p&gt;The authors point out the difficulty of forecasting future spending levels in the midst of a recession.&lt;/p&gt;
&lt;p&gt;&quot;How quickly economic growth rebounds, and to what extent, will affect the growth of healthcare spending over the next decade,&quot; the authors said.&lt;/p&gt;
&lt;p&gt;In addition, if a healthcare reform bill ultimately passes, new projections would have to be issued.&lt;/p&gt;
&lt;p&gt;&quot;Should such legislation ultimately be signed into law, there would undoubtedly be many changes in healthcare delivery and financing,&quot; they said.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_369"
                     title="Administration Issues Mental Health Parity Rule"
                     score="0.01"
                     href="http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/tb/18258?impressionId=1265748401713"
                     
      &lt;p&gt;WASHINGTON  --  Under a proposed rule released by the Obama administration, patients in a group insurance plan who are being treated for mental illness or substance abuse may no longer be charged more than if they were receiving medical or surgical care.&lt;/p&gt;
&lt;p&gt;The Department of Health and Human Service (HHS), the Department of Labor, and the Internal Revenue Service issued an interim rule last week containing specific language necessary to enforce the bipartisan &lt;a href=&quot;http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/11169&quot; mce_href=&quot;http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/11169&quot; target=&quot;_blank&quot; title=&quot;Financial&amp;#8200;Bailout&amp;#8200;Carries&amp;#8200;Mental&amp;#8200;Health&amp;#8200;Parity&amp;#8200;Bill&amp;#8200;Through&amp;#8200;Congress&quot;&gt;mental health parity law passed by Congress in 2008&lt;/a&gt;.&lt;/p&gt;
&lt;p&gt;The law  --  called the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act  --  states that if a group health plan covers the treatment of mental illness or drug or alcohol abuse, the limits and financial requirements for these services can be &quot;no more restrictive&quot; than those that apply to medical and surgical benefits.&lt;/p&gt;
&lt;p&gt;That means an insurance plan cannot charge higher copayments, deductibles, and out-of-pocket expenses for mental health services than for treatment of physical illnesses.&lt;/p&gt;
&lt;p&gt;Companies with fewer than 50 employees in their group insurance plans are excluded from the law.&lt;/p&gt;
&lt;p&gt;&quot;The rules we are issuing today will, for the first time, help assure that those diagnosed with these debilitating and sometimes life-threatening disorders will not suffer needless or arbitrary limits on their care,&quot; said Kathleen Sebelius, secretary of HHS.&lt;/p&gt;

&lt;p&gt;The American Psychiatric Association (APA) issued a statement applauding the regulations.&lt;/p&gt;
    &lt;p&gt;&quot;Mental health parity was a major advance for the APA and for our patients living with mental illnesses,&quot; according to the group&apos;s president, Alan F. Schatzberg, MD. &quot;The APA will continue to work hard and submit the important feedback to the administration that is necessary to make sure our patients receive the care they need.&quot;&lt;/p&gt;
    &lt;p&gt;The statement also drew attention to some shortcomings in the regulations, which did not address provider networks and formulary development.&lt;/p&gt;
    &lt;p&gt;The APA intends to submit recommendations for these and other topics during the 90-day comment period.&lt;/p&gt;
    &lt;p&gt;The American Psychological Association also welcomed the regulations.&lt;/p&gt;
    &lt;p&gt;&quot;We are delighted that under these regulations consumers are protected from insurance discrimination to the greatest extent possible,&quot; according to its executive director for professional practice, Katherine Nordal, PhD, in a prepared statement.&lt;/p&gt;
    &lt;p&gt;The rule also requires a single deductible for mental health and medical/surgical coverage. Patients who are being treated for a mental condition at the same time as somatic condition often have to pay separate deductibles which can &quot;prevent access to mental health treatment,&quot; according to the psychologists&apos; group.&lt;/p&gt;
    &lt;p&gt;&quot;It is particularly significant that the regulation will ban health plans from imposing separate deductibles or setting separate out-of-pocket caps for mental health and medical/surgical services,&quot; the statement said. &quot;This is a big win for anyone seeking mental health treatment.&quot;&lt;/p&gt;
    &lt;p&gt;The 2008 law expanded greatly on the Mental Health Parity Act of 1996, which required parity only in lifetime and annual dollar limits. In practice, crtics say, insurers got around that prohibition by charging higher copayments for mental health services and by &quot;cherry-picking&quot; services that would and would not be covered.&lt;/p&gt;
    &lt;p&gt;The 1996 law also specifically excluded coverage parity for substance abuse treatment.&lt;/p&gt;
    &lt;p&gt;The new rule will take effect April 5, 2010.

    </recommendedItem>
    <recommendedItem id="20100101_19_309"
                     title="Increasing Copays: Penny-Wise but Pound-Foolish? (CME/CE)"
                     score="0.005"
                     href="http://www.medpagetoday.com/Geriatrics/GeneralGeriatrics/tb/18173?impressionId=1265748401713"
                     
      &lt;p&gt;Raising seniors&apos; copayments for ambulatory care to offset increasing healthcare costs may backfire on insurers, researchers asserted.&lt;/p&gt;
&lt;p&gt;Seniors enrolled in Medicare plans that increased copayments had significantly fewer outpatient visits but spent more time in the hospital than patients in plans that left copayments untouched, according to Amal Trivedi, MD, MPH, of Brown University in Providence, R.I., and colleagues.&lt;/p&gt;
&lt;p&gt;Assuming an average reimbursement of $60 for an outpatient visit, seven annual visits per enrollee, and an average copay increase of $8.50 per visit, a plan should save $7,150 for every 100 enrollees, they noted in the Jan. 28 &lt;em&gt;New England Journal of Medicine&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;But, assuming an average cost of $11,065 per hospitalization of a person 65 to 84, the researchers estimated that the costs for inpatient care would actually increase by $24,000 for every 100 enrollees in the year after copays are increased.&lt;/p&gt;
&lt;p&gt;Even using more conservative criteria, the increased costs for inpatient care would nearly double any savings from increasing copays, they argued.&lt;/p&gt;
&lt;p&gt;&quot;Cost-sharing has generally been thought to reduce total healthcare spending without harming health for the average person,&quot; the researchers wrote, but these results suggest increasing copays in Medicare beneficiaries &quot;may be a particularly ill-advised cost-containment strategy.&quot;&lt;/p&gt;
&lt;p&gt;Increasing copayments may be particularly harmful to older patients, they said, because they have lower incomes and are more likely to have poor health and greater out-of-pocket healthcare expenses than younger patients.&lt;/p&gt;
&lt;p&gt;To explore the issue in a Medicare population, Trivedi and colleagues compared the use of outpatient and inpatient care between enrollees in 18 plans that increased copays for ambulatory care and 18 that did not. The study included 899,060 patients.&lt;/p&gt;
&lt;p&gt;According to data from the Medicare Healthcare Effectiveness Data and Information Set from the Centers for Medicare and Medicaid Services, mean copays increased during the study period for both primary care ($7.38 to $14.38) and specialty care ($12.66 to $22.05) in the case plans.&lt;/p&gt;
&lt;p&gt;Mean copays remained stable at $8.33 and $11.38 for primary and specialty care, respectively, in the control plans.&lt;/p&gt;
&lt;p&gt;In both groups, there were increases in the number of ambulatory visits over time, but the increase was smaller in the plans that raised copays.&lt;/p&gt;
&lt;p&gt;There was also a rise in the number of hospitalizations, the proportion of patients who were hospitalized, and the length of time spent in the hospital in both groups, but there were larger increases in the plans that increased copays.&lt;/p&gt;
&lt;p&gt;Compared with the control plans, in the year after the increase in copays, case plans had: &lt;ul&gt; &lt;li&gt;19.8 fewer annual outpatient visits per 100 enrollees (95% CI 16.6 to 23.1)&lt;/li&gt; &lt;li&gt;2.2 additional annual hospital admissions per 100 enrollees (95% CI 1.8 to 2.6)&lt;/li&gt; &lt;li&gt;13.4 more annual inpatient days per 100 enrollees (95% CI 10.2 to 16.6)&lt;/li&gt; &lt;li&gt;A 0.7% increase in the proportion of enrollees who were hospitalized (95% CI 0.51% to 0.95%)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The findings were amplified among enrollees living in areas of lower income and education, black patients, and those who had hypertension, diabetes, or a history of myocardial infarction.&lt;/p&gt;
&lt;p&gt;Trivedi and colleagues noted some limitations of the analysis: it was not randomized, and unmeasured differences could have influenced the results.&lt;/p&gt;
&lt;p&gt;Also, the case and control plans could not be matched in a geographic area smaller than census region because of the small number of Medicare plans, and data were lacking on diagnoses, procedures, and costs associated with hospital admissions and outpatient visits.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Trivedi is the recipient of a Pfizer Health Policy Scholars Award and a career development award from the Veterans Affairs Health Services Research and Development Services.&lt;/p&gt;&lt;p&gt;The authors reported no relevant conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_299"
                     title="Teen Pregnancies, Births, and Abortions Increase"
                     score="0.004"
                     href="http://www.medpagetoday.com/OBGYN/Pregnancy/tb/18162?impressionId=1265748401713"
                     
      &lt;p&gt;After a decade of decline, the rate of teenage pregnancies increased by 3% in 2006 as 750,000 women younger than 20 became pregnant, according to a report released by the Guttmacher Institute.&lt;/p&gt;
&lt;p&gt;And as pregnancies increased, so did births  --  41.9 births per 1,000 U.S. teenage girls, which was 4% higher than in 2005  --  and abortions, which increased by 1% from 2005 to 2006.&lt;/p&gt;
&lt;p&gt;In a prepared statement, Planned Parenthood blamed abstinence-only sex education programs for the uptick.&lt;/p&gt;
&lt;p&gt;&quot;It is a tragedy that after a decade of progress in reducing the rate of teenage pregnancy we are witnessing a substantial increase in the number of teens who are getting pregnant,&quot; Planned Parenthood said.&lt;/p&gt;
&lt;p&gt;In a statement released last May in conjunction with the &quot;National Day to Prevent Teen Pregnancy&quot; the American College of Obstetricians and Gynecologists (ACOG), agreed that comprehensive sex education was likely to be more effective than abstinence-only programs.&lt;/p&gt;
&lt;p&gt;&quot;Abstinence works for some teens, but the idea that most teens will wait to have sex indefinitely is rigid and impractical,&quot; said Richard S. Guido, MD, chair of the ACOG&apos;s Committee on Adolescent Health Care.&lt;/p&gt;
&lt;p&gt;But the Guttmacher report suggested that the reasons for increase may be more complex, including &quot;shifts in the racial and ethnic composition of the population, increases in poverty, the growth of abstinence-only sex education programs at the expense of comprehensive programs, and changes in public perception and attitudes toward both teenage and unintended pregnancy.&quot;&lt;/p&gt;
&lt;p&gt;Among black teenagers the pregnancy rate was 126.3 per 1,000 versus 44 per 1,000 non-Hispanic white teenagers.&lt;/p&gt;
&lt;p&gt;A breakdown by state revealed that New Mexico had the highest teenage pregnancy rate, followed by Nevada, Arizona, Texas, and Mississippi.&lt;/p&gt;
&lt;p&gt;Conversely, the lowest teenage pregnancy rate was in New Hampshire  --  33 pregnancies per 1,000  --  followed by Vermont, Maine, Minnesota, and North Dakota.&lt;/p&gt;
&lt;p&gt;Texas had the highest rate of births to teenage mothers  --  62 per 1,000  --  and New York had the highest rate of abortions among teenagers, 41 per 1,000.&lt;/p&gt;
&lt;p&gt;The report was based on data from the National Center for Health Statistics of the U.S. Department of Health and Human Services (number of births), the Guttmacher Institute (total number of abortions), the U.S. Centers for Disease Control and Prevention (age and race/ethnicity distribution of women obtaining abortions), and the Population Estimates Program of the U.S. Bureau of the Census in collaboration with NCHS (population estimates).&lt;/p&gt;
&lt;p&gt;Among other findings in the report: &lt;ul&gt; &lt;li&gt;The pregnancy rate was 71.5 pregnancies per 1,000 girls ages 15-19 and pregnancies occurred among 7% of females in this age group.&lt;/li&gt; &lt;li&gt;Although teenage abortions increased by 1% from 2005 to 2006, the overall teenage abortion rate declined by about a third over the two decades from 1986 to 2006.&lt;/li&gt; &lt;li&gt;The increase in teen pregnancies and births to teenage mothers was observed across all racial and ethnic groups.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The authors said that additional research was needed to determine if the disparities in rates by both race and region carry over to adult women.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The report was prepared by Kathryn Kost, Stanley Henshaw, and Liz Carlin of the Guttmacher Institute.&lt;/p&gt;&lt;p&gt;Lawrence Finer, Rebecca Wind, Susheela Singh, and Laura Lindberg provided comments on early drafts.&lt;/p&gt;&lt;p&gt;The report was funded by grants from the Brush Foundation, The California Wellness Foundation (TCWF) and the Annie E. Casey Foundation. The Guttmacher Institute also gratefully acknowledges the general support it receives from individuals and foundations, including major grants from The William and Flora Hewlett Foundation, The David and Lucile Packard Foundation, and the Ford Foundation, which undergirds all of the Institute&apos;s work.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>