In an effort to buy Congress time to avert a cut in Medicare payments to doctors, the feds said today they’re going to place holds on doctors’ Medicare claims from July 1-15.

That’s actually not such a revolutionary move: By law, under normal circumstances, electronic claims sent in to Medicare aren’t allowed to be paid for 14 days anyway. So for claims sent between July 1 and July 15, Medicare wouldn’t have paid them until at least the second half of the month, with or without the hold. (By law, Medicare can’t pay paper claims until about a month has gone by.)

But what is different is that Medicare also won’t be processing claims in the first half of the month, ahead of sending out the payments. If it were to process them, it would have to factor in the 10.6% pay cut. By giving Congress a bit more breathing room, Medicare avoids changing its systems to reflect the pay cut.

The hold will create a backlog in Medicare’s claims processing. Medicare has a track record of sending its payments to doctors very promptly, as soon as it’s allowed, says Anders Gilberg, vice president for economic affairs for Medical Group Management Association, a trade group for medical practice managers. Medicare spokesman Jeff Nelligan tells the Health Blog that Medicare expects to have the payments out within two to seven business days after July 15.

That doesn’t sound like so long, but it could mean a cash-flow problem for doctors who have lots of Medicare patients, Gilberg says. He also worries that if a bill isn’t passed by Congress and signed by the president by the middle of the month, the pay cuts will go into effect anyway. “At some point they may just have to lift this hold, and now the 10.6% cut goes into effect, and now paying people effectively a couple weeks late,” he says. “It has the potential to be a double whammy if things don’t go right.”

Image: iStockphoto

In an effort to buy Congress time to avert a cut in Medicare payments to doctors, the feds said today they’re going to place holds on doctor’s Medicare claims from July 1-15.

That’s actually not such a revolutionary move: By law, under normal circumstances, electronic claims sent in to Medicare aren’t allowed to be paid for 14 days anyway. So for claims sent between July 1 and July 15, Medicare wouldn’t have paid them until at least the second half of the month, with or without the hold. (By law, Medicare can’t pay paper claims until about a month has gone by.)

But what is different is that Medicare also won’t be processing claims in the first half of the month, ahead of sending out the payments. If it were to process them, it would have to factor in the 10.6% pay cut. By giving Congress a bit more breathing room, Medicare avoids changing its systems to reflect the pay cut.

The hold will create a backlog in Medicare’s claims processing. Medicare has a track record of sending its payments to doctors very promptly, as soon as it’s allowed, says Anders Gilberg, vice president for economic affairs for Medical Group Management Association, a trade group for medical practice managers. Medicare spokesman Jeff Nelligan tells the Health Blog that Medicare expects to have the payments out within two to seven business days after July 15.

That doesn’t sound like so long, but it could mean a cash-flow problem for doctors who have lots of Medicare patients, Gilberg says. He also worries that if a bill isn’t passed by Congress and signed by the president by the middle of the month, the pay cuts will go into effect anyway. “At some point they may just have to lift this hold, and now the 10.6% cut goes into effect, and now paying people effectively a couple weeks late,” he says. “It has the potential to be a double whammy if things don’t go right.”

Image: iStockphoto

AIDS Healthcare Foundation (AHF) is calling upon the Centers for Disease Control (CDC) to immediately release its latest incidence of HIV infections in the United States after an editorial in the respected British medical journal, The Lancet, and recent public remarks by Dr.

Roche announced the introduction of a flexible purchase program that will allow U.S. businesses to maintain access to their own stockpile of Tamiflu® for use in a pandemic situation, with limited upfront investment and more adaptability to deal with unknown factors inherent in pandemic planning.

Though Myriad Genetics was hoping its experimental Alzheimer?s drug Flurizan would surprise naysayers in the scientific and investment communities, the company instead announced that its Phase III clinical trial did indeed fail.

The company said Monday that the 18-month, 1,684-patient study ? the largest Alzheimer?s-treatment study to date ? showed Flurizan failed to improve cognitive functioning or activities of daily living, and added that Myriad is abandoning further efforts to develop the drug. This leaves Elan and Wyeth?s bapineuzumab and Eli Lilly?s gamma secretase inhibitor as the two leading candidates among disease-modifying Alzheimer?s drugs in development.

Flurizan worked by inhibiting enzymes that produce one form of amyloid, the sticky substance in the brain that many scientists believe is responsible for the disease. But there isn?t clear data to show that removing amyloid improves cognitive functioning; the hope was that Flurizan would provide the best human evidence to date. Its failure to deliver prolongs uncertainty about the wisdom of targeting amyloid to treat or even prevent Alzheimer’s. Myriad will still present full data from the study later in July at a major Alzheimer’s conference.

Myriad, primarily a diagnostics company with about $157 million of revenue last year, has spent about $200 million on research and development for Flurizan, Myriad Pharmaceuticals President Adrian Hobden told the Health Blog a few weeks ago. It spent $60 million of that during the current fiscal year.

In midday trading, the stock is down more than 5.5%. However, as the Flurizan R&D costs come off the books, Myriad is likely to achieve profitability next year, said Peter Meldrum, Myriad?s president and CEO. The company hasn’t turned a profit since at least 2003 because of these costs.

Myriad’s Danish partner, Lundbeck, which would have co-marketed the drug in Europe, announced it will write down the $100 million it paid for rights to the drug. Lundbeck’s shares closed down 10% in European trading.

Alzheimer?s brain by Associated Press

This is your brain on Facebook. Researchers at the Stanford University School of Medicine used concepts borrowed from the popular social networking site to analyze the brains of people with Alzheimer's disease. They found that patients' brains were less well-connected than the brains of people without the disorder.

Orexo AB (OMX: ORX), the Swedish pharmaceutical company, announces that the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMEA) has issued a positive opinion recommending approval of Rapinyl, for breakthrough cancer pain.

The brinkmanship over Medicare’s payments to doctors has gone to a new level.

For those of you new to the issue, a quick summary: A few years back, Congress created a Medicare funding formula that suggests payments to physicians should be cut. But each year, just before the pay cut goes into effect, Congress steps in and blocks it with a temporary measure.

The current temporary measure is set to expire tomorrow, when a 10.6% cut is scheduled to take effect. Last week, the Senate narrowly failed to pass a bill that would have blocked the pay cut.

There’s been lots of sniping over the weekend who’s to blame, and the American Medical Association said it was “outraged” and that the country was “at the brink of a Medicare meltdown.”

Enter the Bush administration, which was a target of the AMA’s furor. Senate Republicans and Bush didn’t like the way the bill finds money for doctors by cutting subsidies to Medicare Advantage, the privately administered Medicare plans.

But the administration said today that’s freezing the cuts to buy Congress some more time on the issue. Medicare will hang on to doctors’ claims delivered in the first half of the month. In a statement, the Centers for Medicare & Medicaid services said: “By holding claims for health care services that are delivered on or after July 1, CMS will not be making any payments on the 10.6 percent reduction until July 15, at the earliest. Meanwhile, all claims for services delivered on or before June 30 will be processed and paid in regular order.”

For the moment, at least, doctors have won another reprieve.

Photo by Gary Denness via Flickr

OptiMedica Corp., a global ophthalmic company, has announced the debut of its new PASCAL Slim Line Photocoagulator at the World Ophthalmology Congress, Hong Kong (June 28 - July 2).

Aerocrine AB (STO:AEROB) announced that its handheld airway inflammation monitor, NIOX MINO®, has been registered for marketing and sale in China. Aerocrine's method of measuring airway inflammation, using exhaled nitric oxide (NO) tests, has also been incorporated into China's national guidelines for asthma management. Tests for airway inflammation have received a reimbursement code.