Part B Premiums Up 5.6% for 2007
Medicare's Part B premium for outpatient and physician services will go up by 5.6% to $93.50 in 2007, the smallest increase since 2001, and less than what had been projected by the Centers for Medicare and Medicaid Services earlier in 2006, Dr. Mark B. McClellan, outgoing CMS administrator, announced in a briefing. The Part B deductible will be $131. For the first time in 2007, higher-income beneficiaries—individuals with incomes over $80,000 annually, and couples who make more than $160,000 annually—will pay a larger share of their costs. Spending on Medicare Advantage is flat, but growth continues in the traditional fee-for-service side. The largest contributors to that growth are outpatient hospital services (projected to grow by 12% in 2007), physician-administered drugs, and ambulatory surgery center services. Growth in physician services, such as lab tests and imaging, slowed down significantly from what had been expected, but the volume is still projected to increase 5% in 2007, Dr. McClellan said. Also, if Congress increases physician fees for 2007, the Part B premium will have to be adjusted upward in proceeding years to compensate, he warned.
U.S. System Gets Failing Grade
A comparison of how the U.S. health care system stacks up against systems in other countries on 37 indicators of health outcomes, quality, access, equity, and efficiency shows that America scores an average 66 out of 100, ranking 15th out of 19 countries in preventable deaths. The United States scored particularly low against other nations on efficiency, getting an average score of 51, which the report blames partly on the lack of electronic medical records, used by only 17% of American physicians. Scores for quality and equity of access were highest, at 71. The American Board of Internal Medicine, which participated in a briefing on the report, said in a statement, “We applaud the commission for providing us with a comprehensive, comparative set of measures to use as a basis for improving the performance of our nation's health care system.” The scorecard, which will be updated annually, was developed using a quality framework established by the Institute of Medicine and used indicators from the Department of Health and Human Services, the Agency for Healthcare Research and Quality, the National Committee for Quality Assurances, and others. The full report is available online at
Easing Insurance Hassles
A group of health care organizations has pledged to ease some of the hassles faced by physicians in verifying patient insurance information and to do so by March 31, 2007. More than 20 organizations, including a number of major insurers, will begin to electronically exchange patient eligibility and benefits information using operating rules developed by the Committee on Operating Rules for Information Exchange (CORE), part of the Council for Affordable Quality Healthcare (CAQH), an industry group. The adoption of the CORE rules by insurers and other health care organizations means that physicians will be able to submit an electronic request to a participating health plan and get a response in 20 seconds or less, according to CAQH. Some of the insurers who have committed to adopting the CORE rules include Aetna Inc., Humana Inc., and Wellpoint Inc. Nearly 70 million Americans are covered by the health plans that have committed to using the CORE rules, according to CAQH. The CORE Phase I rules have been endorsed by the American Academy of Family Physicians, the American College of Physicians, and the Medical Group Management Association.
Wal-Mart Offers Drug Discounts
Retail giant Wal-Mart last month began offering generic medications to pharmacy customers in the Tampa Bay, Fla., area at a cost of $4 per 30-day supply. The program will be expanded to all stores in Florida in January and could be expanded across the country in 2007, the company said. “Competition and market forces have been absent from our health care system, and that has hurt working families tremendously,” Wal-Mart CEO H. Lee Scott Jr. said in a statement. “We are excited to take the lead in doing what we do best—driving costs out of the system—and passing those savings to our customers and associates.” The $4 copay will apply to prescriptions that can be filled with 1 of 291 generic medications from a variety of therapeutic categories including antibiotics, cardiac medications, antidepressants, anti-inflammatory drugs, diabetes medications, analgesics, and vitamins. The program will be available to customers with and without insurance. In an effort to remain competitive with Wal-Mart, Target announced that its Tampa Bay area stores would match the lower prices on generic drugs.