Health Care Reform Memo: November 5, 2012

Deloitte Center for Health Solutions publication

The health care reform memos are issued on a weekly basis, highlighting news from the previous week's activities in the administration and implications for the C-suite and various stakeholder groups.

My take: health reform: upcoming state elections

From Paul Keckley, Executive Director, Deloitte Center for Health Solutions

I had dinner with a European pharmaceutical executive Friday night. The topic: how the U.S. elections might impact the global market for drugs and devices. I was struck by his intense interest in knowing how the potential outcome of Tuesday’s races might impact his company, even though the U.S. is less than 20 percent of his current revenues.

Sometimes it’s good to step back and see our elective process through the eyes of those outside our system. In most democracies, the process appears messy, so ours may not be as unique as we sometimes think. But our elective process matters to the world because our economy may impact the world more than most, so the consequences of our elections are high.

Per the polls, Tuesday’s vote will be about the state of our economy. Health care was the third most important issue in the 2008 election behind the economy and Iraq, and this year it will likely finish second behind the economy.

Opinions about the Affordable Care Act (ACA) will likely influence the outcome of races for the White House, 435 seats in the U.S. House of Representatives, 33 seats in the U.S. Senate and 11 Governor’s races. Polls indicate support for the ACA has eroded somewhat during the campaign season so the majority of Americans are not convinced the ACA is the answer to health reform. Then again, the majority also like key elements in the law but not the law overall, such as having access to insurance regardless of a pre-existing condition, which impacts 50 to 129 million Americans, and the concept of paying providers for outcomes and value instead of volume/fee-for-service (FFS) makes sense to the majority.

Based on what you know or have heard about the health reform law, is it a good start or a step in the wrong direction?

Source: Deloitte 2012 Survey of Health Care Consumers

Looking past Tuesday’s results, there’s the matter of the law: the ACA. Both candidates for the White House believe it can be improved. Both see merits in certain elements, and both see areas where changes are necessary. Though their approaches differ, the reality is regardless of who’s in the White House, health reforms that reduce costs while increasing access and improving safety and quality will happen. It’s simple—we can’t afford the status quo.

In the past decade, while annual median family income has shrunk 0.07 percent (inflation adjusted), insurance premiums have increased 104 percent for employer-sponsored individual coverage and 114 percent for family coverage, and national health expenditures increased by 6.5 percent per year in the same period. Those without health insurance are one in five households and one in three kids.

So the lame duck session’s 21 days of deliberation starts in two weeks, and the new Congress will have no choice: fixing health care is necessary to recover our economy. But it’s more than how we manage Medicare and Medicaid: it’s about how we encourage innovation and enable its delivery to a global market. It’s about how we reduce costs associated with unhealthy lifestyles and unhealthy environments. It’s about changing medical education to equip caregivers with technologies or skills to coach consumers rather than parent them. It’s about implementing incentives that reward right behaviors, while eliminating fraud and waste aggressively. And it’s about constructing a coordinated health system in the world’s strongest economy that leverages modern technologies, embraces transparency and accountability, and rewards operational efficiencies resulting in greatly improved value.

In the 113th Congress, 11 committees may revisit health reform and revise or repeal provisions of the ACA, and the U.S. Department of Health and Human Services (HHS) will continue to tackle urgent issues like how the exchanges are operated and overseen by states, how essential health benefits are defined by states, how employers know whether their shared responsibility meets criteria for affordable coverage, and many others. But in the long term, there looms a larger question: what’s the right path in the U.S. to transform our health system, even though most think that it is fundamentally flawed? The complicating factors are obvious: most do not understand our system and have given little thought to remedies, and long-term systemic solutions often run afoul of short-term political and economic realities. No doubt the ACA will play a role, but health system transformation is much bigger than this law whether one likes it or not.

I am grateful for the national attention health care reform is receiving resulting from the debate about its passage. I wrote the first Monday Memo on February 9, 2009 when negotiations about health reform were heating up, and I suspect regardless of Tuesday’s outcome, the debate will continue because the path to health reform remains bumpy and uneven.

Lest health care reform be issue one in 2016, starting Wednesday regardless of who is in office, policymakers and industry leaders have a unique opportunity to level the path toward a transformed health system. It’s time to pave the path. It can’t wait. And it matters too much.

Paul Keckely

Paul Keckley, Ph.D., Executive Director, Deloitte Center for Health Solutions

PS – Join us this Friday, November 9, for a national Dbrief: After the Presidential Election: The Health Care Industry Response to discuss the election results and what they mean to health care industry stakeholders. To register click here.

Implementation update

Department of Justice will not contest Supreme Court decision to hear Liberty University challenge

The U.S. Department of Justice (DOJ) issued a response to the U.S. Supreme Court’s request for comment on whether the Court should hear Liberty University’s challenge to the ACA. Liberty University asserts the individual and employer mandates violate religious freedom, making the ACA unconstitutional. The DOJ will not contest a decision by the Court to review the case, but believes Liberty’s claim lacks merit.

Background: in November 2010 the Fourth Circuit District Court dismissed Liberty University’s case challenging the constitutionality of the individual mandate that requires individuals to purchase health insurance. In January 2011, the Fourth Circuit Court of Appeals vacated the district court ruling and dismissed the case stating that the individual mandate penalty was effectively a tax, therefore the Anti-Injunction Act (AIA) prohibits lawsuits seeking to block collection of a tax prior to its effective date of January 2014. The Supreme Court later ruled in June 2012 that the AIA does not apply to the mandate.

FTC: success of ACOs, anti-trust oversight focus of agency efforts to cut health costs

Friday, the Federal Trade Commission (FTC) Chairman Jon Leibowitz told media his agency was focused on three areas to achieve lower health costs: (1) increased oversight of anti-competitive hospital mergers, (2) implementation of the pay-for-delay patent settlement agreement between brand and generic drug makers that keep generics off the market, and (3) increased flexibility in oversight of accountable care organizations (ACO). “Health care is 18 percent of [gross domestic product] (GDP) in the United States. That is unsustainable and unacceptable. So whatever we can do to reduce that cost we will,” Leibowitz said. Data from ACOs in coming years should settle whether they are anti-competitive or not. If they lower costs, expect to see them expand. If they end up raising costs that will be more problematic.”

Legislative update

HHS issues rules on Medicare, Medicaid physician pay, outpatient payments

Thursday, HHS released three final rules impacting provider payments in 2013:

  • Medicaid payments for doctors: requires Medicaid to reimburse primary care providers at the same rate as Medicare beginning in calendar year (CY) 2013 through CY2014. The rate adjustment applies to physicians with a specialty designation of family medicine, general internal medicine, or pediatric medicine. The rule also includes a new policy to pay a physician or practitioner to coordinate a patient's care in the 30 days following a hospital or nursing facility stay, and changes to two quality reporting programs—the physician quality reporting system and the electronic prescribing incentive program.
    Note: the rule specifically covers only the difference between the Medicare rate and states' Medicaid rates as of July 1, 2009.
  • Medicare payments to hospital outpatient and ambulatory surgical center services care:  Payments to 4,000 outpatient hospital facilities under the outpatient prospective payment system would increase 1.8 percent—to $48.1 billion—in CY2013 and payments to ambulatory surgical centers will increase by 0.6 percent with projected total payments totaling approximately $4.07 billion.
  • Medicare payments to home health agencies: payments for home health care services will decrease by 0.01 percent—$10 million—in CY2013.

Public health emergency declared in New York

Friday, Secretary of HHS Kathleen Sebelius declared a public health emergency under Section 319 of the Public Health Service Act for the state of New York following Hurricane Sandy. Per Section 1135 of the Social Security Act, HHS can temporarily waive or modify certain procedural requirements under Medicare, Medicaid, and CHIP to ensure that providers are reimbursed for services provided to individuals under extenuating circumstances, such as environmental disasters when health care facilities are compromised.

GAO: Medicare Part D discount program does not increase drug prices

The U.S. Government Accountability Office (GAO) released its report on the Center for Medicare & Medicaid Services’ (CMS) oversight of the Medicare Part D Drug Discount Program and its impact on the pricing of brand name drugs concluding that the program has had no impact on the relationship between brand name drug pricing for beneficiaries in the coverage gap or those below the coverage gap threshold. After the program was implemented in 2011, the median drug price increased by 13 percent for both groups of beneficiaries. Prior to program implementation, the median drug price increased by 36 percent for those in the coverage gap and 35 percent for those below the coverage gap threshold between 2007 and 2010.

Background: per Section 3301, ACA drug manufacturers participating in the Medicare Part D program are required to provide beneficiaries a 50 percent discount on the plan negotiated price for brand-name drugs at the point-of-sale when they reach the coverage gap or “donut hole.” Beginning in 2013, Medicare will pay 2.5 percent of the plan-negotiated price for brand-name drugs. Medicare will increase its subsidy to 25 percent for brand-name drugs by 2020, while manufacturers will continue to pay the 50 percent discount through 2020. GAO conducted this report at the request of Republican leaders of the House Committee on Finance, Committee on Energy and Commerce, and Committee on Ways and Means who raised concerns that drug manufacturers would increase prices for brand-name drugs used by beneficiaries who are in the coverage gap more rapidly than for other drugs to offset the required 50 percent discount.

AHA pursues lawsuit against HHS for denied reimbursements

Thursday, the American Hospital Association (AHA) and four other hospital systems filed suit against HHS for denying payment based on Recovery Audit Contractors’ (RAC) decisions to deny reimbursements on the grounds that the services provided by the hospital, while reasonable and necessary, could have been provided more cost-effectively in other settings (i.e., outpatient). The hospital plaintiffs argue that denying reimbursement based on appropriate setting of care is unreasonable because RACs are not taking into consideration the variables that may require a patient to be treated in a hospital setting vs. an outpatient setting (i.e., high-risk patients).

Background: the RAC program is designed to identify and remediate billing errors. The program was authorized in 2003 as a part of the Medicare Modernization Act of 2003, officially established by the Tax Relief and Health Care Act of 2006, and expanded to Medicaid per Section 6411 of the ACA.

Legislation introduced to allow veterans to access FEHBP for dental and vision

Representative Marcia Fudge (D-OH) introduced legislation to allow veterans who receive health care from the Department of Veterans Affairs (VA) to be eligible for supplemental dental and vision insurance under the Federal Employees Health Benefits Program (FEHBP) that provides dental and vision benefits through the Federal Employees Dental and Vision Insurance Program. Currently, audiology and eye care services including preventive services and routine vision testing is provided to all enrolled veterans and those exempt from enrollment. VA also provides all necessary dental care to those eligible under Class I, IIC, or IV while Classes II, IIA, III, V, VI, and IIB are subject to time and/or service limitations.

Massachusetts lawmaker introduces compounding pharmacies regulation

Friday, Representative Ed Markey (D-MA) introduced the “Verifying Authority and Legality in Drug Compounding Act of 2012” to include compounded pharmaceuticals in the U.S. Food and Drug Administration (FDA) Federal Food, Drug, and Cosmetic Act. According to the bill, states would maintain regulatory authority over compounding pharmacies filling prescriptions for individual patients, but would allow FDA to provide waivers to large scale compounding operations to address a drug shortage or public health crisis. Compounding pharmacies that produce large quantities as manufacturers, distribute across state line, or receive waivers will be subject to FDA regulations and inspection. Absent a waiver from FDA, pharmacies would be prohibited from producing drugs that are already commercially available. The legislation would also require all compounded drug products be labeled as not tested or approved by the FDA, and include information on how consumers can report adverse reactions.

HHS backs flat-rate payment arrangement

The HHS Office of Inspector General (OIG) issued an advisory opinion on a hospital emergency department per diem “flat-rate” physician payment model on Thursday, concluding that it is acceptable as long as there is no intent to induce or reward physician referrals of federal health care program business. According to OIG, on-call coverage compensation creates potential risk that physicians may demand such compensation as a condition of doing business at a hospital, and could be misused to entice physicians to join or remain on the hospital’s staff or to generate additional business for the hospital. OIG provided the analysis at the request of a charitable, non-profit hospital that pays a per diem fee to specialist physicians for unrestricted on-call coverage for the emergency department. The report highlighted several aspects of the hospital’s payment arrangement that prevented anti-kickback violations including:

  • Commercially reasonable payment amounts, within the range of fair market value for actual and necessary services provided without regard to referrals or other business generated between the physician and hospital
  • No intent to compensate the physicians for all care they provide to patients
  • Uniform method of scheduling on-call coverage within each specialty, and equitable policy that is not used to selectively reward the highest referrers
  • Hospital absorbs all costs and none accrue to federal health care programs

Background: per Section 1128 of the Social Security Act (the federal anti-kickback statute) it is a criminal offense to knowingly and willfully offer, pay, solicit, or receive anything of value, directly or indirectly, to induce or reward referrals of items or services reimbursable by a federal health care program (i.e. Medicaid and Medicare). Violation of the statute constitutes a felony punishable by a maximum fine of $25,000, imprisonment up to five years, or both.

State update

State round-up

  • Washington received approval from CMS last week for a dual eligible, fee-for-service medical home pilot program. HealthPathWashington will enroll 115,000 individual dual eligibles in medical homes that pay providers on a fee-for-service basis that include bonuses for quality and cost management goals. The state expects to save approximately $14 million over five years.
    Note: Massachusetts is the only other state to receive CMS pilot approval. It will use a capitated model to manage its dual eligibles program. Of the 26 proposals submitted to CMS, 18 states proposed using the capitated model, five states proposed the fee-for-service model, and three states proposed using a blend of both.
  • Texas officials are awaiting the outcome of several lawsuits to decide whether the Women’s Health Program can continue to receive federal funding if the state excludes Planned Parenthood from the program because of its provision of abortion services. Until a decision is made, Planned Parenthood will remain in the program. Governor Rick Perry (R) has committed to managing the program entirely through the use of state funds if necessary.
  • Despite a CMS decision to delay a bundled payment pilot program because of too few participants, New Jersey hospitals want to continue the project. The program incentivizes hospitals and physicians to lower costs by improving inpatient coordinated care. Support within the state stems from New Jersey hospitals that have had success with an almost identical program. CMS has yet to decide if the state’s hospitals can continue with the pilot.
  • In a letter to HHS, Governor Pat Quinn (D) declared that Illinois will participate in a State Partnership Exchange with the federal government on the implementation and operation of a health insurance exchange (HIX). State officials intend to control the plan management and consumer assistance aspects of the exchange, and administration of a reinsurance program would fall to the federal government. Quinn expressed a commitment to operating an independent state-based exchange in 2015.
    Note: states must declare what type of HIX they will be operating in their state in 2014 by November 16th, 2012.
  • According to the New Mexico HIX Advisory Task Force last week, the state has spent only a fraction of its $34.2 million Level One Establishment Grant awarded to assist in the creation of a HIX. State officials met with HHS to discuss progress to date and remaining deliverables.
    Note: Level One Establishment Grants are awarded for up to one year of funding to states that have made some development under their exchange planning grant.
  • In a progress letter to Nebraska officials, CMS and the Center for Consumer Information and Insurance Oversight (CCIIO) commended the state on its operational progress to date on establishing a HIX. The letter also noted areas in which the state needs improvement, including the state’s delay in choosing a vendor to operate the information technology aspects of its HIX.
  • Cook County Illinois received approval last week of a Medicaid Section 1115 waiver to enroll 114,000 low-income residents of the county in the Medicaid program before the Medicaid expansion in 2014. Although the county will also begin paying its portion of the cost earlier than 2014, the waiver will save the state more than $100 million per year for services that it has traditionally provided through uncompensated charity care.

Industry news

Beaumont-Henry Ford merger

Last week, leaders of the Beaumont Health System in Royal Oak, Michigan and the Henry Ford Health System in Detroit announced plans to pursue a combination pending completion of due diligence in the next 120 day period. The combined entity will have ten hospitals, 38,000 employees and $6.4 billion in revenue including the Henry Ford health plan’s premiums for 648,000 members.

Walmart announces carve out strategy

Walmart will contract for coronary bypass grafts, heart valve replacements, and other complex cardiac surgeries. Procedures will be covered for Walmart employees at the Cleveland Clinic in Cleveland, Ohio; the Geisinger Medical Center in Danville, Pennsylvania; Mayo Clinic sites in Minnesota, Arizona and Florida; Scott & White Memorial Hospital in Temple, Texas; and the Virginia Mason Medical Center in Seattle, Washington. For spine surgeries including lumbar and cervical spinal fusion, it will contract with Scott & White Memorial Hospital and Virginia Mason Medical Center. The program is scheduled to begin in January 2013.

Note: Cleveland Clinic has a similar direct contract with Lowe’s for cardiac surgery.

BMJ: published studies must provide access to scientific documentation

The venerable British Medical Journal (BMJ) announced Wednesday it would require authors to provide patient-level clinical trial data to BMJ as a pre-condition for publication.

FDA examines equivalence of generics

The FDA is looking at its generic oversight policies resulting from examination of the bupropion, a generic version of a branded anti-depressant. It found the time release feature of the drug varied from the branded equivalent, though the active ingredient was the same. Complications from the generic drug prompted the FDA to consider how it should oversee the 120 time-release drugs sold in the U.S. in 2011.

Note: time-release drugs are attractive to consumers because they can take the drugs less frequently. Manufacturers like time-release drugs because they are provided patent protection for the drug itself as well as the formula for time release.

Gene mapping project accelerates personalized medicine opportunities

Wednesday, the $120 million 1000 Genome Project announced it had successfully sequenced the entire DNA of 1000 people in 14 populations spanning Asia, Europe, Africa, and the Americas. The 700 participating scientists identified 38 million variations of the average person’s 23,000 genes. The collaboration across multiple nationalities and the structuring of the data as a toolkit for global researchers is thought to enhance personalized medicine exploration.

Deloitte acquires data analytics firm Recombinant

Last Monday, Deloitte Consulting LLP announced the acquisition of Recombinant Data Corporation, a data warehousing and clinical intelligence solutions firm for health care organizations and academic medical centers. Now known as “Recombinant by Deloitte,” the data analytics firm has seen growth in the health provider, medical research, life sciences and government health markets providing tools in enterprise data integration, population health analytics, clinical genome data assimilation and performance management for accountable care organizations.

Report: significant geographic variation in teaching hospitals

The Dartmouth Institute for Health Policy and Clinical Practice’s analysis of 2010 Medicare data revealed significant regional variation of end-of-life care for chronically ill beneficiaries treated in academic medical centers. The report also found that in areas with more hospital beds and more doctors per capita, patients have longer hospital stays and receive many more physician visits. According to the report, these trends suggest that patients are receiving care, and resident physicians are receiving training based more on local health resource supply and practice style than on evidence-based medicine. Resource utilization for beneficiaries in the last six months of life varied significantly between academic medical centers:

  • Hospital days per beneficiary: 8.9 days to 20.2 days
  • Physician visits per beneficiary: 19.7 visits to 72.6 visits
  • Percent of beneficiaries seeing ten or more physicians: 42.5 percent to 66 percent
  • Percent of beneficiaries enrolled in hospice: 24.5 percent to 59.1 percent

AHIP releases application for health care spending

Last week, America's Health Insurance Plans (AHIP) announced the launch of a new interactive application for iPad that highlights key drivers of health care spending. According to the press release, health stakeholders and policy makers will be able to access interactive charts using 50 years of comprehensive health spending data from the CBO, CMS, and the Office of Management and Budget on the new “U.S. Health Care Spending 101” application.

Ameridose recalls all products 'out of an abundance of caution'

Thursday, the FDA announced that Ameridose LLC, a company sharing common management with the New England Compounding Center (NECC) linked to the recent fungal meningitis outbreak, has voluntarily recalled all of its unexpired products currently on the market. A current FDA inspection of the company’s facility has raised concerns about a lack of sterility assurance for products it produced and distributed. To date, no reports of patients with infections associated with Ameridose’s products have been reported, and FDA is recommending that health care providers do not need to follow-up with patients who received the products.

Related: state health officials also requested that Sophia Pasedis, vice president of regulatory affairs and compliance at Ameridose in Westborough, resign from the Massachusetts Board of Registration in Pharmacy. As former president of the Board, there is concern that she may have had influence regarding disciplinary actions for NECC’s past violations. According to officials, board meeting minutes have provided no definitive proof that she recused herself from cases involving both companies.

GAO: providers self-refer imaging services hurting Medicare

A GAO report based on analysis of Medicare 2010 data revealed that providers who self-referred made 67 percent more referrals (400,000 tests) for magnetic resonance imaging (MRI) / computed tomography (CT) than those that did not self-refer, costing Medicare $109 million. GAO recommended that CMS insert a self-referral flag on its Medicare Part B claims form and require providers to indicate whether the advanced imaging services are self-referred or not, implement a payment reduction for self-referred advanced imaging services when the same provider refers and performs a service, and develop an approach to ensure the appropriateness of advanced imaging services referred by self-referring providers.

Background: self-referral occurs when providers refer their patients to entities—such as themselves or a group practice—with which they or an immediate family member has a financial relationship. In 2010, Medicare FFS beneficiaries received 30 million advanced imaging services. The total expenditures for all advanced imaging services billed under Medicare reached $4.2 billion in 2010.

Reaction: “Qualified physicians regardless of their specialties should be able to provide appropriate imaging services to their patients. Efforts to limit physicians would threaten patient access to health care providers and technologies while obstructing coordinated care models that have been proven to lower costs and improve care. As an alternative to picking winners and losers among providers, policymakers should incentivize the use of physician-developed appropriateness criteria to inform decisions between patients and their doctors.”—The Medical Imaging & Technology Alliance, Executive Director, Gail Rodriguez, October 2012

AHA urges MEDPAC to reconsider “site neutral” physician payments

Last week, the AHA wrote a letter to Medicare Payment Advisory Commission (MedPAC) chairman Glenn Hackbarth expressing concern about its recommendation to expand the use of the “site neutral” payment policy to hospital outpatient departments (HOPD). The expansion of this payment model in conjunction with MedPAC’s recommendation to reduce payment for certain evaluation and management services will result in a $2 billion loss to HOPD’s next year, according to AHA.

Background: Medicare payments are higher for most services if they are provided in a HOPD or provider-based entity than if they are provided in a freestanding physician practice or professional office. At the October 4, 2012 MedPAC meeting, the commission evaluated making Medicare payment rates for evaluation and management office visits equal whether they are provided in HOPDs or freestanding practices.

Groups urge pricing transparency in health care

Catalyst for Payment Reform (CPR) released an issue brief and joint statement along with American Association of Retired Persons, the National Business Coalition on Health, Pacific Business Group on Health, The Leapfrog Group, and the Corporate Health Care Coalition calling for health insurers and health care providers to make price information more transparent for their employees and consumers. According to the statement, efforts by some health plans and independent vendors to provide consumer-friendly health care price tools are limited since hospital, physicians and some health plans restrict access to price data. CPR maintains that purchasers and consumers need price transparency to help purchasers contain health care costs, inform consumers’ health care decisions as they assume greater financial responsibility, and to reduce unknown and unwarranted price variation in the health care system.

Background: CPR is an independent non-profit organization of larger employer health care purchasers, including: 3M, Intel Corporation, Dow Chemical Company, Xerox Corporation, Verizon, Walmart Stores, and General Electric.


“We will implement the law [ACA] and work together to improve where we can. But our country simply can’t afford to fight old political battles, reopen old wounds, and return to the way things were. We are a nation that does what is hard and what is necessary and what is right. And we will be better off 5, 10, 20 years from now because we had the courage and foresight to keep moving forward.” 

President Barack Obama, New England Journal of Medicine, 367:15 October 11, 2012

“I believe the answer lies with patients and families, with reformed insurance markets and fair competition, with strong consumer protections and real entitlement reform. My plan tackles our health care challenges without a federal takeover of the entire system. Instead, it relies on markets over regulations, doctors and patients over bureaucrats and tailored state programs over a 2,700 page solution from Washington.”

Mitt Romney, New England Journal of Medicine, 367:15 October 11, 2012

“Investment in medical start-ups has dwindled of late as companies have struggled to go public and deliver returns to venture capitalists. The Affordable Care Act, the health care reform bill signed into law in 2010, would seem to be the salve these companies need. Starting in 2014, most Americans will have to carry health insurance or pay a penalty. This promises to create millions of new, paying customers for medical companies.” 

Brian Gormley, Emily Maltby “Medical Start-ups Challenged by Health Care Reform, Wall Street Journal, October 31, 2012

Fact file

  • Jobs: startups are 3 percent of U.S. employment but 20 percent of gross job creation. (Source: Michael Porter, “What business should do to restore competitiveness ” Fortune, October 15, 2012
  • Healthy cities: 15 states or localities have adopted restrictions on unhealthy food servings; for every 2 percent increase in calories from trans fat consumed, there’s a 23 percent increase in risk of heart disease. If trans fats are taken out of food supply, 6-19 percent of heart attacks could be prevented, and 200,000 lives saved. (Source: David Agnus, Fortune, “A doctor’s plea to politicians,” October 17, 2012)
  • Fungal meningitis compounding pharmacy update: as of Friday, November 2, 404 cases and 29 deaths. (Source: CDC, “Multistate Fungal Meningitis Outbreak Investigation”, November 2, 2012)
  • Deficit: for FY2012: $1,089 trillion or 7 percent of GDP; total government debt outstanding: $16.07 trillion or 103 percent of GDP (Source: David Wessel, The Wall Street Journal, “Making Sense of Budget Lingo,” November 3, 2012)
  • Registered lobbyists: 11,700 in 2012, which is the lowest number since 2007 when there were 14,800. (Source: Damian Paletta, The Wall Street Journal, “Romney Would Limit Lobbyist Roles,” November 1, 2012)
  • Presidential polling on health care issues: NPR—47 percent trust Romney to handle health care issues; 48 percent trust Obama. PEW research poll—candidate that best represents women’s views on abortion: Obama 48 percent vs. Romney at 39 percent. Respondents place Obama ahead of Romney on Medicare: 48 percent vs. 43 percent. (Source: National Public Radio, “Post-Debate National Survey of Likely Voters,” October 23-25, 2012 and Pew Research Center for People & the Press, “Registered Voters,” October 24-28, 2012)
  • Avoidable deaths: deaths per 100,000 that could have been avoided for U.S. adults under 74: 106.9 for men and 84.5 for women; 20 percent higher than the UK and Germany, and 30 percent higher than France (Source: Ellen Nolte and Martin McKee, “In Amenable Mortality—Deaths Avoidable Through Health Care—Progress In The US Lags That Of Three European Countries.” Health Affairs, September 2012)
  • High risk pool participation (Section 1101 of the ACA): increased from 82,000 in July 2012 to 86,072 in August 2012. (Source: HHS, “State by State Enrollment in the Pre-Existing Condition Insurance Plan, as of August 31, 2012)
  • Private equity investment in health care: from 2010 to 2011, the amount of investment capital in health care doubled from $15 billion to $30 billion (Source: Kara Murphy and Tim van Biesen, “Global Healthcare Private Equity Report, Bain and Company, 2012)
  • Patient expectations of cancer treatment: 69 percent of patients with lung cancer and 81 percent of patients with colorectal cancer did not report understanding that chemotherapy was not at all likely to cure their cancer. The risk of reporting inaccurate beliefs about chemotherapy was higher among patients who rated their communication with their physician very favorably compared with those who rated communication less favorably. (Source: Weeks et al., New England Journal of Medicine, “Patients' Expectations about Effects of Chemotherapy for Advanced Cancer,” October 2012)
  • Employee benefits costs: in 2011, workers’ benefits were 19.7 percent of total compensation vs. 16.6 percent in 2000; benefits increased 10.8 percent from 2007-2011, or $1,302 per worker while wages increased 1.4 percent of $777 in the same period (Source: USA Today analysis using U.S. Department of Commerce, Bureau of Economic Analysis data, 2012)
  • Health care prices: health care prices in August 2012 were 2.4 percent higher than in August 2011, the highest year-over-year reading since September 2010. Prescription drugs had the most rapid year-over-year price growth at 4 percent, and hospital prices accelerated to 3.6 percent since August 2011. (Source: Altarum Institute, “Insights from Monthly Price Indices through August 2012,” October 11, 2012)
National health reform: What now?

National health reform: What now?

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