alzheimer's
Lilly gets a pair of lucky breaks for a single proposal
Medicare officials are proposing a policy that would likely increase payment to doctors for administering drugs paired with diagnostic scans that are used for, among other things, assessing patients’ eligibility for a new class of Alzheimer’s drugs, my colleague John Wilkerson reports.
The proposal, included in an annual pay rule for hospital outpatient services, would pay for the drugs used with the scans separately, instead of bundling them with other services. Typically, when drugs are unbundled, doctors make more money from administering them, according to the nonpartisan investigative arm of Congress. The policy would benefit the makers of the radiopharmaceuticals, including Eli Lilly, and the makers of the Alzheimer’s treatments, like, well, also Lilly. Eisai and Biogen were the first to secure approval of a monoclonal antibody, Leqembi, that is approved to clear amyloid in the brain.
Last month, a bipartisan group of senators asked Medicare for the policy that Medicare is now proposing. The policy would build on the administration’s expanded coverage policy for brain scans that detect a brain plaque associated with Alzheimer’s.
insurance
Sharp criticism emerges at MA conference
Critics and gadflies took the stage at the fifth National Medicare Advantage Summit Wednesday, to talk about MA’s longstanding coding problems, my colleague Bob Herman writes. “We’ve allowed the business side to lead rather than the clinical side. And I think risk adjustment is one area where that’s clearly the case,” said Rick Gilfillan, a former top Medicare official who is now an independent consultant.
“There is a whole cottage industry that has sprung up because of [Medicare] Advantage, where in order to stay even relevant in the business at all, you have to do multiple activities that really bring no patient value,” Rebecca Welling, the vice president of risk adjustment at Intermountain Health, said on the same panel. She then explained how in-home health exams and several types of technology function only as coding vehicles for insurance companies.
The industry has criticized the Biden administration’s recent and relatively modest changes to MA’s risk adjustment system, which pays insurers and other groups for enrolling and caring for sicker people. But for Zeke Emanuel, a health policy expert at the University of Pennsylvania who spoke during the summit Wednesday, changes have been long overdue. “It’s inaccurate,” he said of risk adjustment. “It’s just not terribly predictive.”
regulations
Medicare doesn’t budge on hospital price transparency
Despite years of pressure from consumer advocacy groups including Cynthia Fisher’s Patients Rights Advocate, Medicare is refusing to modify its requirements for how hospitals have to report price data, my colleague Bob Herman reports.
Patient Rights Advocate has accused hospitals of not complying with government requirements, and of posting estimates instead of actual prices.
science
The burning questions from Fauci’s memoir
Former NIAID Director Anthony Fauci sat down with STAT’s Rick Berke and Helen Branswell for our First Opinion podcast. Their wide-ranging conversation touches on Fauci’s favorite dinner parties, how he’s learned to deal with critics, and his decision to turn down a multimillion-dollar job.
Fauci called the recent presidential debate “disturbing,” and said the President Biden we all saw during the debate wasn’t the Biden he had come to know. He called Biden’s doctor, Kevin O’Connor, a “good guy” and a “good doc.”
