If Indiana hospitals want an expansion of insurance coverage for low-income Hoosiers, Gov. Mike Pence thinks they should contribute toward the hundreds of millions of dollars it would cost. The Pence administration has started discussions with hospital leaders to use an existing program known as the Hospital Assessment Fee to generate money to help the state cover costs it would incur under an expansion of health coverage to as many as 400,000 Hoosiers. That expansion, called for by President Obama’s Affordable Care Act, did not happen in Indiana this year, as it did in 26 other states, in large part due to Pence’s concerns about the fiscal impact on the state. The health insurance expansion would be paid for entirely by the federal government in 2015 and 2016, but then require state contributions that could rise to $393 million per year by 2020, according to estimates by the actuarial firm Milliman Inc. Other elements of Obamacare are estimated to cost state government $123 million per year by 2020. The Hospital Assessment Fee effectively taxes hospitals to provide the state government with the funds needed to raise its reimbursement rates for Medicaid patients. When the state does that, the federal government increases its 2-for-1 matching funds to support the Indiana Medicaid program. Hospitals end up getting twice as much in new revenue as they pay out in assessments. Doug Leonard, president of the Indiana Hospital Association, said hospitals are open to Pence’s approach, but are waiting until the idea is fleshed out and numbers are attached.
Indiana University Health was chosen by a Wisconsin hospital system to provide heart and aorta surgeries there after surgeons the hospital system had been using were employed by a competing provider. Wisconsin-based ProHealth Care will pay the salaries of the three IU Health surgeons who will work in ProHealth’s Waukesha Memorial Hospital, which is midway between Milwaukee and Madison. ProHealth performs more than 400 cardiothoracic surgeries each year. IU Health performs more than 1,900 cardiothoracic surgeries at its 19 hospitals in Indiana. “The goal for the two health systems is to collaborate to establish and oversee a premier surgery program in Waukesha that will incorporate the clinical protocols, care pathways and quality metrics that have been the foundation of IU Health’s nationally ranked cardiovascular program,” IU Health spokesman Gene Ford said in an email. IU Health said it would evaluate similar opportunities, but stopped short of saying it is making out-of-state partnerships a business strategy.
Eli Lilly and Co. is in a three-way race to introduce a new kind of breast cancer drug, which at least one analyst thinks could become a $6 billion-a-year blockbuster. According to Bloomberg News, Indianapolis-based Lilly, New York-based Pfizer Inc. and Switzerland-based Novartis AG all presented data on Sunday about experimental drugs that stopped growth of breast cancer tumors. Pfizer’s drug, palbociclib, stopped tumor growth for 20.2 months in advanced forms of hormone-related breast cancer, twice the time seen with an older therapy by itself. Lilly’s bemaciclib stopped tumor growth for an average of 9.1 months. Doctors told Bloomberg that the new class of drugs, called CDK inhibitors, offers the first major new therapy in a decade for patients whose breast cancer fails to respond to other treatments. Mark Schoenebaum, an ISI Group analyst in New York, predicted Pfizer’s drug could generate peak sales of $6 billion a year.
Indiana Attorney General Greg Zoeller filed Medicaid fraud charges April 2 against Sally Metzner, 57, owner of Anderson Dental Center, and eight of her employees. According to the Associated Press, the charges allege Metzner and her employees started a scheme in 2006 to submit false and inflated claims for payment of dental services to the Indiana Medicaid program, sometimes using forged documents, to receive more than $300,000 in ineligible Medicaid payments. The allegedly fraudulent billing continued even after state, federal and local authorities executed the first of three search warrants at the clinic, the attorney general's office said. For example, instead of billing Medicaid $30 for the routine use of the anesthesia nitrous oxide, the practice allegedly billed it as a $125 intravenous procedure known as "deep sedation.”