Tuesday, Dec. 17, 2013

WASHINGTON - Sen. Chuck Grassley of Iowa and Sen. Michael Bennet of Colorado said today they will look for ways to advance their provision to better coordinate care for children with complex medical conditions under Medicaid and the Children's Health Insurance Program (CHIP), leading to better care and health for these children.

"Considering creative models to promote better outcomes for children with medically complex conditions is something we need to explore in the future," Grassley said.  "Working with the Finance Committee on a bipartisan basis and the Congressional Budget Office, I hope we can move these ideas forward."

"Kids in Colorado and around the country deserve doctors and hospitals that have every tool and resource they need to help them get better," Bennet said. "We need to explore ways that we can ensure kids are getting the seamless care they deserve. We'll continue to work closely with the Senate Finance Committee to get this signed into law."

Grassley, Bennet and seven other bipartisan members of the Finance Committee sponsored an amendment to the physician payments bill considered in committee last week that would establish under the Medicaid program and Children's Health Insurance Program an accountable care collaborative providing a network of services to children with medically complex conditions.

The amendment, which was offered and withdrawn, establishes a Medicaid Children's Care Coordination Program for children with complex medical conditions that would provide services through nationally designated children's hospital networks. Medically Complex Children are defined as those who are included in Clinical Risk Groups (CRG) 5b-9.  The CRG methodology is a well-documented and accepted manner of classifying pediatric patients and their diagnoses nationally and can be adopted for these purposes easily.

Patients in these groups have significant lifelong chronic diseases, limiting the probability of churning in and out of the network, Grassley and Bennet said.  Approximately three million children in the country suffer from medically complex conditions, and two million of these children are in Medicaid, accounting for 6 percent of children enrolled in Medicaid and 40 percent of Medicaid spending on children.

Children with medically complex conditions are often need of specialized care that requires services provided by providers found in states outside of the family's state of residence.  Medicaid's state-based structure creates impediments to seamless, integrated models of care that may be more appropriate for these children.

Children's hospitals are seen as the anchors to the nationally designated hospital network.  While anchor hospitals will provide services for network patients including physician, inpatient and outpatient care, the network will necessarily include other hospitals, physicians, and providers to ensure these children receive the needed services in the most appropriate setting possible.  Key to these networks is assurance that there is an adequate network to support the specific pediatric population, Grassley and Bennet said.

Through integrated care and risk-based reimbursement, improved patient outcomes and lower health care costs can be achieved, the senators said.

Grassley and Bennet said they will look for legislative opportunities to advance this proposal in the coming months.

Wednesday December 18th at 7 - 8pm, Healing Lotus Acupuncture will be premiering the first of many online presentations focusing on such topics as: health conditions, Eastern medicine, and nutrition.  These free presentations will be featured on the Healing Lotus website (www.HealingLotus.co), and will occur regularly throughout the month.

Wednesday's presentation will cover the topic of hyperlipidemia (high cholesterol), which continues to be a highly mediatized subject; as seen in November with the updated guidelines for cholesterol management.

In this web presentation Scott Stewart, LAc., Dipl. will be explaining the truth about cholesterol, and the misunderstanding of "good" vs. "bad" cholesterol.  You will learn about the dangers of having a cholesterol count that is too low, which can lead to other diseases; the adverse effects of statin drugs, and how the pharmaceutical industry influences the guidelines for cholesterol; how Eastern medicine views hyperlipidemia; and how you can safely manage hyperlipidemia without taking a drug for the rest of your life.

After the presentation there will be an open forum set up for any questions people have.

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Thursday, Dec. 12, 2013

WASHINGTON - Sen. Chuck Grassley of Iowa today received key committee approval of his measures to increase fair treatment of Iowa doctors in Medicare, improve spending for health care oversight, and increase the transparency of Medicare payments to doctors, among other measures.

"These provisions increase value and transparency in federal health care programs," Grassley said.  "It's important to advance bipartisan measures that make Medicare and Medicaid work better for beneficiaries and taxpayers."

Grassley filed amendments that were accepted during the Finance Committee's consideration of a Medicare physician payment bill.  Grassley amendments passed by the committee include :

--A provision to provide for the improved use of funds received by the Department Health and Human Services for oversight and investigative activities.  The department's Office of the Inspector General protects the integrity of HHS programs and the health and welfare of the people they serve.  The inspector general's office is responsible for providing oversight of nearly $1 trillion in HHS spending oversight, or about $0.24 of every federal dollar. Its responsibilities have grown with expanded programs including the Affordable Care Act.  Grassley's provision allows the inspector general to receive and retain three percent of all collections pursuant to civil debt collection actions related to false claims or frauds involving the Medicare program.

--A provision to help Iowa providers who are geographically disadvantaged by Medicare compared to those in other areas of the country.   Under current law, the Medicare fee schedule is adjusted geographically for three factors to reflect differences in the cost of resources needed to produce physician services: physician work, practice expense, and medical malpractice insurance.   The Grassley amendment makes permanent the existing floor 1.0 on the physician work index under the Medicare physician fee schedule, which helps Iowa providers receive fair reimbursement relative to their peers in other parts of the country, so they are encouraged to continue serving Iowans.

--An extension of provisions to help rural hospitals.  Grassley and Sen. Chuck Schumer included language to continue the Medicare-dependent hospital program and enhanced low-volume Medicare adjustment for prospective payment system hospitals.  These provisions are helpful for rural hospitals in low population areas that are more dependent on Medicare than their urban counterparts and provide valuable health care to their communities.

--Language that would make Medicare claims data available to the public.  Both the House and Senate versions of legislation addressing the Medicare physician payment formula include the key provisions from Grassley and Sen. Ron Wyden's Medicare Data Access for Transparency and Accountability Act (Medicare DATA Act). This would establish a free, searchable Medicare payment database that would be readily available to the public online at no cost.  Today's action is the first time the legislation has passed out of the committee.

"Transparency draws in the public and invites analysis of policy and spending," Grassley said. "More transparency has made a difference in accountability in the tax-exempt sector, and it does the same wherever it's applied in health care."

--A fix to a provision in the underlying bill that created a potential disincentive for providers to participate in Medicaid.   Doctors are increasingly reluctant to participate in Medicaid, yet their participation is critical to the level of service provided by the program.

--A provision directing a study by the Medicaid and CHIP Payment and Access Commission (MACPAC) of individuals whose shifting income and other changing status makes it difficult to track their eligibility for Medicaid or transitional medical assistance.  "Understanding the volatility in income for these individuals will be helpful in informing future policy making," Grassley said.

Grassley also spoke in favor of an amendment from Sen. Debbie Stabenow to establish criteria for Federally Qualified Community Behavioral Health Centers to ensure the centers cover a broad range of mental health services, including 24-hour crisis care, increased integration of physical, mental and substance abuse treatment so they are treated simultaneously rather than separately, and expanded support for families of people living with mental health issues.

On the underlying bill approved by the committee on voice vote today, Grassley said he supported repeal of the sustainable growth rate and the replacement bill but urged caution and careful analysis of the replacement bill's effects, especially on certain kinds of providers.

"If it ends up that the formula in this bill hurts mostly rural providers or mostly providers who treat complex patients or mostly providers who are specialists or mostly providers who are already high quality performers, we can come back and fix it legislatively, even though we all know the winners under the formula will fight against any change," Grassley said.  "The bill does provide the Secretary authority to fix the problem herself if Congress doesn't act.  Therefore, we could be dependent on the Secretary's use of her authority to fix problems as they arise.  However, the bill does not allow for judicial review of the Secretary's use of this broad authority if providers think this authority is being used in an arbitrary manner.  I am supportive of the bill but remain concerned with the uncertainty of how it will ultimately be implemented."

Grassley is former chairman and ranking member of the Finance Committee, with jurisdiction over Medicare and Medicaid.  He is a senior member of the committee.