News Briefs: Week of Nov. 29 - Dec. 3

This roundup includes the following news briefs:

National Influenza Vaccination Week is scheduled for Dec. 5-11, and the CDC is providing downloadable materials -- including posters, flyers and brochures -- that physicians can distribute to their patients.

National Influenza Vaccination Week aims to highlight the importance of flu vaccinations -- especially for those in high-risk groups, such as the elderly and people with chronic health conditions -- and to foster increased use of the vaccine after the holidays.

The CDC's Web page dedicated to the event includes a schedule of regional, state and national events.

The CDC's Advisory Committee on Immunization Practices, or ACIP, expanded its recommendations for annual influenza vaccination this year to include all people ages 6 months and older in whom the vaccine is not contraindicated. The AAFP has adopted the ACIP's flu vaccine recommendations as policy.

HHS has issued new regulations that -- as of 2011 -- will require insurance plans to spend 80 percent to 85 percent of their premium dollars on medical care and health care quality improvement rather than on administrative costs.

The regulations, known as the "medical loss ratio" provision of the Patient Protection and Affordable Care Act, are intended to make the insurance marketplace more transparent and to make it easier for consumers to purchase plans that provide better value for their money, according to a press release from HHS.

Insurance companies that fail to spend 80 percent to 85 percent of premium dollars on medical care and health care quality improvement will be required to provide a rebate to customers as of 2012. The new rules will apply to 74.8 million people in health plans, and as many as 9 million Americans could be eligible for rebates totaling as much as $1.4 billion starting in 2012, according to HHS. Average rebates per person could total $164 in the individual market.

The Medicare Payment Advisory Commission, or MedPAC, has urged Medicare to adopt a two-sided risk model in addition to the bonus-only model proposed for accountable care organizations, or ACOs.

In a letter (9-page PDF; About PDFs) to CMS Administrator Don Berwick, M.D., MedPAC says that a two-sided risk model would allow ACOs to share in some portion of savings from the program. At the same time, however, they would share the risk for the same portion if spending is over target rates. "Because the ACO would know that its actions to reduce spending would count toward its bonus payment (or toward reducing any loss) it would have a stronger incentive to control spending, even when doing so would decrease its own fee-for-service revenues," said MedPAC.

According to MedPAC, the two-sided risk model, "is necessary for the shared savings program to meet its potential. Such a model would increase the strength of the incentives to control spending and volume, remove thresholds for savings, and encourage entities that want to share in first-dollar savings to become ACOs." Over time, the two-sided risk model should become the dominant or only ACO model available, said MedPAC.