Food Allergen Labeling
All food labels now must clearly state if a product contains any ingredients with protein derived from the eight major allergenic foods. Under the Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA), manufacturers are required to identify in plain English the presence of ingredients that contain protein derived from milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, or soybeans in the list of ingredients or to say “contains” followed by name of the source of the food allergen after or adjacent to the list of ingredients. It is estimated that 2% of adults and about 5% of infants and young children in the United States have food allergies. Approximately 30,000 consumers require emergency department treatment, and 150 Americans die each year because of allergic reactions to food. “The eight major food allergens account for 90% of all documented food allergic reactions, and some reactions may be severe or life threatening,” said Robert E. Brackett, Ph.D., director of the Food and Drug Administration's Center for Food Safety and Applied Nutrition. The statute, however, does not require manufacturers or retailers to relabel or remove products that don't have the labeling because they were labeled before the effective date. For that reason, there will be a period of time where consumers will see packaged food on store shelves and in their homes without the revised allergen labeling, the FDA cautioned.
Rural Access to Part B Drugs
Access problems may prevent rural providers from participating in the new Competitive Acquisition Program (CAP) for Part B drugs and biologicals, Joan Sokolovsky, a senior analyst with the Medicare Payment Advisory Commission (MedPAC), said at a commission meeting last month. Physicians who elect to participate in the program will obtain drugs from a preselected list of vendors, who in turn will take on the responsibility of billing Medicare for the drugs and collecting coinsurance or deductibles from patients. Under CAP rules, drugs must be delivered to the facility where they will be administered. Chemotherapy in rural areas, however, is delivered through satellite facilities, where “sometimes drugs cannot be mixed,” Ms. Sokolovsky said. In a recommendation, MedPAC said that the Health and Human Services department should allow an exception to these delivery rules for rural satellite offices of providers.
Better Coordination for Medicare
Most Medicare beneficiaries see multiple physicians, pointing to a need for better care coordination, MedPAC research director Karen Milgate indicated at a commission meeting last month. Seeing multiple physicians puts beneficiaries at greater risk for duplication of services, increases the potential for adverse events, and may also increase health care costs, she said. In sampling inpatient, outpatient and physician supplier file claims from 2003, with various combinations of diabetes, coronary artery disease, and congestive heart failure, “we found that on average beneficiaries see five physicians. Those in our chronic condition groups on average saw seven physicians. And then, when we looked at those with all three conditions on average they saw 13 physicians” in 1 year, she said. Analysts also looked at the percentage of a patient's care that was billed to one physician. For patients with three conditions, only 25% had half or more of their care billed by one physician, “which of course means that they're seeing multiple physicians,” she said.
P4P: Not Local Yet
Despite the national buzz over pay for performance and the interest in Congress, such initiatives have yet to catch on in many local communities, the Center for Studying Health System Change reported in a study. “While there's been plenty of buzz about pay for performance as a way to improve health care quality, the reality is that these initiatives are off to a slow start in many communities,” said HSC President Paul B. Ginsburg, Ph.D. The study was based on site visits to 12 nationally representative communities: Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y. Of these communities, only two, Orange County and Boston, had significant physician pay-for-performance programs. In the other communities, where to date almost no physicians had received quality-related payments, physician attitudes ranged from skeptical to hostile, according to study results.
Retiree Drug Coverage Continues
In a survey of 300 of the nation's largest private-sector employers, almost four in five (79%) said they would accept government subsidies to continue to provide retiree drug coverage, comparable with Medicare, when the new drug benefit started this month, according to a study by the Kaiser Family Foundation and Hewitt Associates. Another 10% will provide some drug coverage to supplement the new benefit. Only 9% said they planned to stop offering drug coverage to Medicare-eligible retirees. Firms accepting the retiree drug subsidy were less certain about whether they would continue to take this approach in future years, according to survey results. Among those firms that will accept the subsidy in 2006, about four in five (82%) said they were “very” or “somewhat” likely to accept the subsidy again in 2007. Looking ahead to 2010, only half (50%) said they were likely to maintain coverage and accept the subsidy, while 22% said they were unlikely to do so, and 28% said they didn't know.