HEALTHCARE REFORM: QUESTIONS

Last week, the Washington Post printed an article that highlighted a possible decrease in Medicare benefits if the Health-Care bill passed the Senate. Now I don't know if the $500 Billion that was eluded to had closure of obsolete and duplication of service dictates attached to it, but I would like to know more about what the negatives are without having to stoop to the depths of Fox Noise to find out.

The Centers for Medicare and Medicaid Services put out the initial report that the paper built the story on. They claim that Medicare cuts contained in the health package are likely to prove so costly to hospitals and nursing homes that they could stop taking Medicare altogether. A little far reaching, but still a worthy question. Mind you this is based on whatever information they were looking for when compiling their facts. (It is the Washington Post)

If there is such a large amount of funding missing from Medicare and the startling revelations from this report are true, then there's a problem. If the Senate was to alter, seek other sources or increase the final tally...there will be some explaining to do.

Adding 30 - 50 million more people to the already stressed public health program known as Medicare is expected to cost more and we are well aware of the Trillion dollar price tag that our Congress has saddled on the American taxpayer. At the the same time; this is understood as a bitter, but necessary pill to take in order to close the holes in our embarrassment of a national health system.

To remain solvent, Medicare spending per beneficiary would have to grow at roughly half the rate it has over the past two decades to meet the measure's savings targets. Considering the population age bubble and the mere fact that this increase in availability of that same care will extend the very lives of those in the system...it sounds wholly unrealistic. Don't you think?

On the flip side; we've been told that Out-of-pocket spending would decline more than $200 billion by 2019, with the government picking up much of that. The President has also been on the record that there will be no decrease in Medicare spending as a result of this reform. I want to believe him. This country needs to free itself from the grip of the private insurance companies. Like I said before; it all depends on what you're looking for in your research.

The individual stories of pain and suffering because of the cold and heartless bureaucrats in some Insurance HQ in Connecticut cutting needed services to their own clients has pounded this need for reform home in a very real way.

What I want to know is the very real way we are going to pay for this reform and will the Public Option actually provide the desired pin we need to pop the ballooning expenses we've been subjected to for so long?

MARRIAGE EQUALITY? NEW YORK?

NEWBURGH BUDGET MAKES KINGSTON LOOK GOOD

The City of Newburgh Common Council voted to pass a budget for 2010 with a tax increase of 26% while laying off about 30 employees. The only dissenting votes came as a protest against their City Manager salary who makes $164K annually.

Like the City of Kingston, Newburgh has a deadline to vote on a budget. Theirs however is at the end of November. Kingston has until the end of the year. The months that their Council negotiated with the Unions (looking for help through concessions) fell apart and thus, more people will be out of work in all departments.

The Council was faced with a 35% tax increase before this past Saturday's special meeting. Part of their solution was a $5 million bond. The City of Kingston has already floated a Revenue Anticipation Note just to pay the bills leading into February. Unless that anticipated revenue comes from the State like promised, we may have to follow the same path.

There is still time to discuss the options with OUR unions before the Council meets for the last time in the second week of December.

Happy Thanksgiving everyone!

CLICK IT OR TICKET: NY BUCKLE BLITZ

The warnings are out there. You don’t want to get caught driving without your seatbelt on over the Thanksgiving holiday weekend. The State Police are expected to really crack down with their Buckle Up New York campaign and it wont be relegated to some random locations. They plan to be everywhere!

The goal is to get more drivers and passengers to buckle up every time they get behind the wheel and ride as a passenger. We all know it saves lives, but this is one of the holidays with the highest fatalities and seat belts are the best defence against crash-related injuries. Law enforcement will be out in force to protect the safety of our roads and highways.

Last year, there were about 400 deaths in the US on Thanksgiving Day. Half of those that died were not wearing seatbelts. Considering this weekend marks the beginning of the heavy holiday travel season, you will have that many more close encounters with on-coming traffic. People die needlessly in traffic crashes every year, the least you can do is be prepared and buckle up!

PUBLIC & PRIVATE: OSHA EXISTS FOR A REASON

Safety rules for the workplace are implemented for a good reason. They provide the optimal working conditions for private and municipal employees when followed correctly. Have there been incidents in the area you'd like to highlight?

CONTINUED 2010 BUDGET TALKS

No-one needs to be told that the Common Council is faced with severe staffing cuts, diminished funds and a population saddled in the middle, with our Mayor, the Unions and the Department Heads bickering in the press and the Blogs.
What hasn't been discussed is whether certain offices and programs can function with fewer personnel and funding. I think we need to look at the impact to our "quality of life" issues as this budget matures.

Our Recreation Department has been decimated by these cuts and the Clerks office will be in deep crap if we don't restore a few needed dollars. And frankly; what we see in the level of Police protection and the expected cuts in that department, scares the bejesus outta me.
The fighting between the Mayor and the Fire Department, I'd rather let them fight that out amongst themselves. There are issues there that need to be settled in court and I'd rather all of us Aldermen stay out of that one.

However; there is promising news from the CSEA situation (City Hall & DPW Employees). Continuing negotiations between the Administration and the Union, may yield some movement that might actually help employees and taxpayers. We'll watch and see.
As for the tax rate...remember the 10% rate increase is not what you pay. It's based on your assessment and the expected 8% decrease in residential property set for 2010. The diminished value of your home is what caused the high number in the first place; even with a 0% budget increase. The average property would see a 3.5% increase out-of-pocket at the current rate.

What concerns me is the expectation of additional sales tax revenue slated for 2010, which comes from the projections coming out of the county budget. I think the County estimates of a $26Million increase in sales tax revenue is artificially inflated, so we are likely to have funding issues by this time next year.
(We get a percentage)

Get ready to float another Revenue Anticipation Note this time next year.

AFFORDABLE HEALTHCARE: HR 3962

Below, is a report issued on the proposed Health Care Bill that the House passed last week. Without pictures and sarcastic commentary, I thought to just post it for discussion:

AMCP Releases Summary Of Key Provisions In H.R. 3962, 'Affordable Health Care Act For Americas'

The Academy has released a summary of key provisions of interest to managed care pharmacists in H.R. 3962, the "Affordable Health Care Act for America." These include provisions on Medicare Part D drug price negotiations, the Medicare Part D coverage gap, PBM disclosure, follow-on biologics and comparative effectiveness research. On Oct. 29, House Speaker Nancy Pelosi (D-CA) released H.R. 3962, which is the consolidation of the H.R. 3200 bills reported by three House committees: Energy & Commerce Committee; Ways & Means Committee; and Education & Labor Committee.

The following is an AMCP staff summary of some of the key provisions of interest to the Academy.

Medicare Part D - Drug Price Negotiation

The bill repeals current law and directs the Secretary of Health and Human Services (HHS) to negotiate drug prices with drug manufacturers in Medicare's Part D program. The bill retains the current law's prohibition on establishment of a national formulary.

Medicare Part D - Coverage Gap

Beginning with a $500 reduction in 2010, the bill eliminates the "doughnut hole" with a complete phase-out by 2019. The bill pays for the elimination of the gap with funds raised by requiring drug manufacturers to provide Medicaid rebates for drugs used by full dual eligibles. It also incorporates a voluntary agreement with the drug manufacturers to provide discounts of 50% for brand-name drugs used by Part D enrollees in the Part D "doughnut hole," beginning in 2010.

Public Health Insurance Plan

The bill establishes a new government-run health insurance plan within the exchange that would compete with private health plans. Under the government plan, among other requirements, the Secretary would be required to negotiate drug prices and establish a drug formulary. The public plan is provided startup administrative funding, it is required to amortize these costs into future premiums to ensure it operates on a level playing field with private insurers.

Health Insurance Purchasing Pool/Exchange

The bill creates a new marketplace called the national "Health Insurance Exchange," with an option for states that agree to meet federal standards to run their own exchange. People are eligible to enter the Exchange and purchase health insurance as long as they are not enrolled in employer sponsored insurance, Medicare or Medicaid. The Exchange is also open to businesses, starting with small firms (25 or fewer employees).

PBM Disclosure

The bill requires that PBMs that enter into contracts with plans that participate in the health exchange disclose certain financial information, including rebate information.

Repeal of the Antitrust Exemption for Insurers

The bill removes the antitrust exemption for health insurers and medical malpractice insurers with regard to price fixing, monopolization, and dividing territories. It retains the exemption with regard to exchange of certain information.

Follow-on Biologics

The bill authorizes FDA to approve follow-on biologic drugs. It would grant biologics manufacturers 12 years of exclusive use of their data before a follow-on biologic manufacturer could begin developing alternatives. [Note: The amendment is identical to a follow-on biologics amendment adopted by the Senate Health, Education, Labor and Pensions Committee.]

Comparative Effectiveness Research

The bill creates a new Center at the HHS Agency for Healthcare Research and Quality (AHRQ) to conduct, support and synthesize comparative effectiveness research (CER). It prevents the Center from mandating payment, coverage or reimbursement policies. Further, it ensures that research findings are not construed to mandate coverage, reimbursement, or other policies to any public or private payer.

Generic Exclusion Agreements

The bill prohibits brand name drug companies from settling patent litigation with generic competitors by paying them to delay marketing their products.

Medication Therapy Management Grants

The bill provides for two types of federal grants that would promote medication therapy management (MTM) services. The bill provides for: (1) grants to eligible entities to establish community-based, multidisciplinary teams to support primary care practices with the provision of "pharmacist-delivered medication therapy management services (including 'medication reconciliation"), as a component and (2) grants to eligible entities for the specific purpose of implementing pharmacist-delivered MTM services in the treatment of chronic diseases. [The provisions are similar to the provisions included in the Senate HELP Committee's health care reform bill.]

Sunshine Provisions

The bill includes requirements that manufacturers and distributors of covered drugs, devices, biological, or medical supplies under Medicare, Medicaid, or CHIP report to the HHS Inspector General information on their financial relationships with:

- Physicians, physician groups, and other prescribers
- Pharmacies and pharmacists
- Health plans, pharmacy benefit managers, and their employees
- Hospitals and medical schools
- Organizations that sponsor continuing medical education
- Patient organizations
- Professional organizations [The Senate Finance Committee bill only applies to physicians.]

Other Medicare Part D Changes

The bill makes various changes, technical and otherwise, to Medicare Part D, including elimination of vaccine coverage in Part D and provides for vaccine coverage under Part B, effective 2011.

Medicare Advantage Reforms

The bill reduces MA benchmarks to fee-for-service levels over three years, reaching equality of payment rates in 2013.

Center for Medicare and Medicaid Payment Innovation

The bill gives the Department of Health and Human Services broad authority to conduct demonstration projects of new payment models through a newly created Center.

Fraud, Waste and Abuse

The bill makes numerous changes to fraud and abuse laws, as well as enhances the authority of the HHS Inspector General. The bill includes new exclusion authority for obstructing an investigation or audit, new civil monetary penalties and exclusion from Medicaid or CHIP, if an entity owns, controls or manages an entity that is suspended, excluded or terminated from Medicaid or is affiliated with an individual or entity that has been suspended, excluded or terminated from Medicaid.

Conclusion

The Academy is closely monitoring health care reform developments and will do all it can to advocate for its positions as legislation moves forward on Capitol Hill. Please check http://www.amcp.org or your Daily Dose for updates.

Source
AMCP

MY DAY ON PACKER SIX

So, this past Tuesday, at the request of one of the city employees, I went to the DPW barn at the beginning of their morning shift. I was there when they were assigning trucks for the crew and accepted the invitation to ride with one of the teams.

With Paul driving packer 6, and accompanied by Andre and Charlie, we set out to collect trash in the uptown district. First, I will remind you that Tuesday was a nice crisp day and is also the lighter of the four collection days for the garbage crew.

After a few stops, I put on a reflective vest and joined the guys throwing trash. Walking fast along the packer, grabbing the bags and cans along the curb didn't require allot of experience to do well, but it does require common sense to keep from hurting yourself. I must say, the temptation to pull from both sides of the street is strong. The streets are narrow enough that the collection from both sides seems the natural method. But that's against the contract.

With the new rules in place as of Nov 1st, the trucks no-longer leave the barn at 5:30 or whenever they left, now they're lucky if they get out around 7:15 after the mandatory safety checks. Which aren't initiated until 7am. Go figure.

Now we approach the uptown district and there are already cars parked for the business district and people walking all over the place. So much for getting through this area without delays. Oh, did I mention we only pull from one side?

Every street we passed through had to be revisited to collect from the opposite side. So, not only did we walk the route twice, but we also spent that much more diesel and offer that much more risk of accident in a more crowded neighborhood. And get this...the mandatory break, we had to trek back to the barn on O'Reilly St to take that break.

So, drive back out to the Stockade, we resume where we left off. You know...walking the route twice in heavy traffic. We got quite a bit done before lunch break. We went to UCRRA before taking lunch; knowing we would be closer to the barn when we were done. 4.5 tons on the truck. Not a bad scoop for the morning.

After lunch we treked back to uptown to finish the route. (you know, walking the streets twice in heavy traffic using double the fuel) Now we really hustled through the residential portion of the Tuesday run, collecting enough to warrant another journey to UCRRA before the 2:30 cut-off time. Another 4.5 tons.

Getting off the scales before the end of the shift, Andre went off with another crew while Charlie and I tackled the leaf bag collection in Ward Seven. Zipping up and down the Stephan/Derrenbacher neighborhood streets was interesting. Even while pulling from just one side of the street circling around twice. Did I say circling the streets twice again? I'm sorry.

Anyway, we set out to dump the leaves at our designated site for the end of the day; couldn't leave em in the packer because the morning crew needs it for the Wednesday run on Thursday. (holiday)

Earlier that morning, while we were circling the Pearl/Washington Ave area, I noticed the 12 man crew scooping leaf piles on upper Pearl. Using large excavation equipment, a whole lot of fuel and man hours to collect the loose piles. Doesn't seem right to me.

Considering the amount that Charlie and I collected ourselves in bag form, I'd say we have issues in regards to leaf collection. I recommend the council address this once again in the 2010 session as I did in 2008. The loose leaf piles on the street should be a distant memory.

Those same 12 employees could be throwing bags at a faster pace and the neighbors wouldn't have to put up with the unwanted debris and unwarranted street closure during the process. Imagine having the loose leaf crew collect cardboard, trash and recyclables. I know; over the top wishful thinking.

Anyway, with the good exercise on the back of a packer being similar to a day at the construction site, I was of course willing to do more, but I had to go clean up and prepare for the Council meeting scheduled that evening.

The issue of "Stint" should be a topic of discussion for us Councilmen as we head into 2010. The practice was successful for 30+ years and implemented for good reason. I'd like the opportunity to address it before leaving the Council.

The only other Alderman who has experienced the job of refuse collection was Al Teetsel, and for me, it had been 7 years since my first time. As I was leaving the DPW barn, the repeated question from the employees was whether we could see Bob Senor and Me on the back of a packer for a day, and see if Bob could keep up with me. I think I impressed the guys with my stamina. Even if it was the lightest run on the lightest day of the week.