Comments on: MEDICARE RULE MAY KILL PRIVATE PATIENTS

By: Scott

Scott — Wed, 12 Dec 2007 17:05:11 +0000

NPR just did a story about Medicare pricing with regard to drugs.

http://www.npr.org/templates/story/story.php?storyId=17158948

By: Catron

Catron — Tue, 11 Dec 2007 17:54:52 +0000

His comments confirm my own experiences dealing with CMS apparatchiks. The often screw up their statistcal analyses, and when you call their attention to it, they ignore you.

And it isn’t me that will be going to the grave. It will be those cancer patients.

By: Marc Brown

Marc Brown — Tue, 11 Dec 2007 17:12:04 +0000

So, you’d be prepared to go to the grave on the word of a pharma rep?

By: Catron

Catron — Tue, 11 Dec 2007 16:40:58 +0000

Read the article, Marc. The answer to both questions can be found there.

By: Marc Brown

Marc Brown — Tue, 11 Dec 2007 16:33:55 +0000

Where is your source that they ’screwed up the calculation’? And given that drug companies will still be getting lots for their drugs it is not likely that anyone will go without - and it isn’t “lots of patients” - these drugs are third line treatments.

By: Catron

Catron — Tue, 11 Dec 2007 16:02:21 +0000

No Marc, the “key point” is that CMS (using whatever calculation) has imposed a rule that will cause lots of patients (including many who are not on Medicare) to DIE.

By: Marc Brown

Marc Brown — Tue, 11 Dec 2007 15:47:32 +0000

‘As someone who treats medicare patients with injectable drugs, i can tell you that this is false.’

Well, I’m sure you’re right - the article may have confused average price with wholesale price. But the key point is that it is not based on what hospitals actually paid.

By: Rich

Rich — Tue, 11 Dec 2007 15:16:09 +0000

‘Medicare then reimburses doctors and hospitals at that price, plus a 6 percent fee to cover handling costs.’

As someone who treats medicare patients with injectable drugs, i can tell you that this is false.

What actually happnes (at least in my area) is that medicare reimburses the lowest available wholesale proce, which it determines by polling the suppliers. Now they don’t tae into account volume discounts or minimum purchase requiremens.

So if the lowest available rcioe for drug X is $500 per dose, that is what medicare pays. Now say the supplier with that price has a 20 dose purchase minimum. The supplier with the next best price has a 5 dose minimum and sells the drug for $600. If I cannot afford to float the 20 dose purchase (or cannot dispense 20 doses before they expire), I must displense the drug at a loss of $100/dose, or not dispense it at all.

By: Catron

Catron — Tue, 11 Dec 2007 15:12:55 +0000

The 837 file is a requirement of HIPAA (And you thought that reg was about privacy, didn’t you?). It has nothing to do with what hospitals pay for drugs or anything else. The file contains all manner of data about the patients (much more than anything that could be gleaned pursuant to the Patriot act, BTW). The specific data that CMS is supposed to use for reimbursement purposes has to do with how much hospitals have billed Medicare over some finite period of time. But, as I said, they screwed up the calculation.

The 837 file is what the linked article is referring to when it says “Moules said he believed the data received from hospitals was skewed …”

By: Marc Brown

Marc Brown — Tue, 11 Dec 2007 14:34:43 +0000

And what data is in that file? Here’s some quotes from an NYT piece - note ‘But most other drugs administered via injection in doctors’ offices or hospital outpatient clinics — as Bexxar and Zevalin are — are not reimbursed on the basis of what hospitals say they have paid.’

http://www.nytimes.com/2007/12/07/business/07drug.html?adxnnl=1&ref=business&adxnnlx=1197383026-C0I8+uLoQWQfu0mwRvQ7Kw

‘Hospitals typically do not disclose their reimbursement rates, or whether they make money on any given treatment. The American Hospital Association declined to comment on the matter….

…Herb B. Kuhn, deputy administrator of the Centers for Medicare and Medicaid Services, the agency overseeing Medicare, said that the agency recognized the value of the drugs. But, he said, Medicare does not want to overpay for the medicines and believes that hospital data is the most accurate way to set reimbursement.

But most other drugs administered via injection in doctors’ offices or hospital outpatient clinics — as Bexxar and Zevalin are — are not reimbursed on the basis of what hospitals say they have paid. Instead, companies report the average price of their drugs to Medicare. Medicare then reimburses doctors and hospitals at that price, plus a 6 percent fee to cover handling costs.’