What Are the Top 20 Priciest Medicare Prescription Drugs?

 

High Drug Costs

A look at Medicare‘s top 20 priciest prescription drugs in 2015, ranked by their cost above the program’s “catastrophic” coverage threshold. Medicare’s catastrophic protection kicks in after a beneficiary has spent a given amount of their own money, $4,850 this year. The beneficiary pays only 5 percent, while their insurer pays 15 percent, and taxpayers cover 80 percent. Catastrophic spending is a large and growing share of total costs, threatening to make Medicare’s popular prescription plan financially unsustainable.

Five Health Issues Presidential Candidates Aren’t Talking About — But Should Be

http://khn.org/news/five-health-issues-presidential-candidates-arent-talking-about-but-should-be/

5 things_770

References to the Affordable Care Act — sometimes called Obamacare — have been a regular feature of the current presidential campaign season.

For months, Republican candidates have pledged to repeal it, while Democrat Hillary Clinton wants to build on it and Democrat Bernie Sanders wants to replace it with a government-funded “Medicare for All” program.

But much of the policy discussion stops there. Yet the nation in the next few years faces many important decisions about health care — most of which have little to do with the controversial federal health law. Here are five issues candidates should be discussing, but largely are not:

3 charged in $1 billion scheme to defraud Medicare in Florida, DOJ dubs biggest ever

http://www.healthcarefinancenews.com/news/3-charged-1-billion-scheme-defraud-medicare-florida-doj-dubs-biggest-ever

The owner of more than 30 Miami-area skilled nursing and assisted living facilities, a hospital administrator and a physician’s assistant were charged with conspiracy, obstruction, money laundering and healthcare fraud in connection with a $1 billion scheme involving numerous Miami-based providers, the United States Department of Justice announced.

Assistant Attorney General Leslie Caldwell of the Justice Department’s Criminal Division said in a statement that the charges represent the largest single criminal healthcare fraud case ever brought against individuals by the DOJ.

Philip Esformes, 47, Odette Barcha, 49, and Arnaldo Carmouze, 56, all of Miami-Dade County, Florida, were charged in an indictment claiming that Esformes operated a network of more than 30 skilled nursing homes and assisted living facilities known as The Esformes Network, which gave him access to thousands of Medicare and Medicaid beneficiaries.

The Facts on Medicare Spending and Financing

http://kff.org/medicare/issue-brief/the-facts-on-medicare-spending-and-financing/

Figure 1: Medicare as a Share of the Federal Budget, 2015

Overview of Medicare Spending

Medicare, the federal health insurance program for 57 million people ages 65 and over and people with permanent disabilities, helps to pay for hospital and physician visits, prescription drugs, and other acute and post-acute care services. In 2015, spending on Medicare accounted for 15% of the federal budget (Figure 1). Medicare plays a major role in the health care system, accounting for 20% of total national health spending in 2014, 29% of spending on retail sales of prescription drugs, 26% of spending on hospital care, and 23% of spending on physician services.1 This issue brief includes the most recent historical and projected Medicare spending data from the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary (OACT), the 2016 annual report of the Boards of Medicare Trustees2 and the 2016 Medicare baseline and projections from the Congressional Budget Office (CBO).3

Houston physician gets 3-year prison term for fraud

http://www.beckershospitalreview.com/legal-regulatory-issues/houston-physician-gets-3-year-prison-term-for-fraud.html

Fraud

Healthcare CEO faces life in prison for fraud that led to 2 patient deaths

http://www.beckershospitalreview.com/legal-regulatory-issues/healthcare-ceo-faces-life-in-prison-for-fraud-that-led-to-2-patient-deaths.html

Fraud

The CEO and co-owner of a Maryland diagnostics company is facing life in prison after a federal jury convicted him of two counts of healthcare fraud that resulted in death, according to the Department of Justice.

On Wednesday, a federal jury found 67-year-old Rafael Chikvashvili, PhD, guilty of healthcare fraud. Dr. Chikvashvili was the co-owner and CEO of Owings Mills, Md.-based Alpha Diagnostics, which was a portable diagnostic services provider, principally of X-rays.

According to evidence presented at trial, Dr. Chikvashvili was involved in a scheme to defraud Medicare and Medicaid. He and others allegedly conspired to create false radiology, ultrasound and cardiologic interpretation reports. He also allegedly submitted insurance claims for medical examination interpretations that were never completed by licensed physicians, according to the DOJ.

Dr. Chikvashvili allegedly instructed his nonphysician employees to interpret X-rays, ultrasounds and cardiologic examinations, which, according to testimony provided at trial, resulted in two patient deaths.

Where’s the value in accountable care?

Where’s the value in accountable care?

From left: Stephanie Baum of MedCity News, Christina Miles of Aon Hewitt, David Van Houtte of Aetna, Dr. Katherine Schneider of Delaware Valley ACO and Dr. Greg Carroll of GOHealth Urgent Care

Accountable care is supposed to be about paying for value. But six years after passage of the Affordable Care Act heralded the shift away from fee-for-service, Dr. Greg Carroll, corporate clinical leader of GOHealth Urgent Care, has an important question: “Where’s the value?”

Healthcare spending will make up 20% of U.S. economy within a decade

http://www.fiercehealthcare.com/finance/healthcare-spending-will-make-up-20-u-s-economy-within-a-decade?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiTXpVMk1HRm1NRE5pWW1JMSIsInQiOiIrM3BwTVBRRXorTzl3NjQxOWNPOUh1UUxUT0ZcL2xNTGdleWQzKzRFRzIwZzhHYTg2T0c3TWlZV1BjUEsxd0JBRmNJaGk0WU9NMTRvWmFyZndPVit2SzZmUDFxM1dWSm1OV2l4Rnd1YlBMWTQ9In0%3D

Bar graph with arrow showing upward growth

Healthcare spending will comprise 20 percent of the U.S. economy by the middle of next decade, according to new data from the Office of the Actuary of the Centers for Medicare & Medicaid Services and published in Health Affairs.

Expenditures on healthcare services will grow at an average rate of 5.8 percent per year between 2015 and 2025, about 1.3 percent higher than projected annual growth in the U.S. gross domestic product, CMS concluded. By 2025, healthcare spending will comprise 20.1 percent of the U.S. economy, up from 17.5 percent in 2014. Expenditures totaled $3.2 trillion last year.

Despite the seemingly robust spending growth, it remains lower than the 8 percent annual growth clip that occurred in the two decades before the Great Recession of 2008, which helped to slow expenditures significantly. In 2015, spending grew at a 5.5 percent rate. This year, it is projected to be 4.8 percent, attributable in part to the slower expansion of newly insured under the Affordable Care Act.

“The Affordable Care Act continues to help keep overall health spending growth at a modest level and at a lower growth rate than the previous two decades. This progress is occurring while also helping more Americans get coverage, often for the first time,” said CMS Acting Administrator Andy Slavitt in a statement.

Is the CQO Position Needed?

http://www.healthleadersmedia.com/quality/cqo-position-needed?spMailingID=9208161&spUserID=MTMyMzQyMDQxMTkyS0&spJobID=961199903&spReportId=OTYxMTk5OTAzS0

“In a healthcare system’s most mature state, everyone owns quality,” says Baylor Scott & White Health’s chief quality officer. So if everyone owns quality, why have a CQO?

http://www.beckershospitalreview.com/quality/what-makes-an-ideal-chief-quality-officer.html

 

Few Young Doctors Are Training To Care For U.S. Elderly

http://www.healthleadersmedia.com/physician-leaders/few-young-doctors-are-training-care-us-elderly?spMailingID=9208161&spUserID=MTMyMzQyMDQxMTkyS0&spJobID=961199903&spReportId=OTYxMTk5OTAzS0#

“With the growing elderly population across America and West Virginia, obviously we need healthcare providers,” Goldberg said. That includes geriatricians — physicians who specialize in the treatment of adults age 65 and older — as well as nurses, physical therapists and psychologists who know how to care for this population.

“The current workforce is inadequately trained and inadequately prepared to deal with what’s been called the silver tsunami — a tidal wave of elderly people — increasing in the population in West Virginia, across America and across the world really,” Goldberg said.

The deficit of properly trained physicians is expected to get worse. By 2030, one in five Americans will be eligible for Medicare, the government health insurance for those 65 and older.