Sen. Tom Coburn: Health Care Reform that Will Kill the U.S. Economy

 

Sen. Tom Coburn, Regina E. Herzlinger

Posted April 27, 2009 | 10:36 AM (EST)

With little fanfare, Congressional leaders may be near to agreeing on the most sweeping expansion of government in a generation - the de-facto takeover of the health insurance market by the government. Congressional Democrats are already icing the champagne. When the President's "Medicare for all" plan is coupled with the budget, which contains a "down payment" of $634 billion over the next decade for health care, government-run health care may be inevitable.

All sides in this debate acknowledge that the U.S. has long needed easier access to health insurance. This need has gained urgency for the many Americans who are fearful of losing their employer-sponsored insurance in the midst of a recession. Unfortunately, the President's plan will not only endanger the U.S. economy, but millions of patients as well.

Sen. Tom Coburn: Health Care Reform that Will Kill the U.S. Economy

Ohio.com - Prices bleed uninsured

Medical society seeks lower costs for patients stuck with high lab bills

By Cheryl Powell
Beacon Journal staff writer

POSTED: 06:00 p.m. EDT, Apr 26, 2009

 

If you don't have health insurance, getting a blood test can be a real pain in your pocketbook.

 

The Summit County Medical Society recently launched an effort to persuade Akron's three hospital systems and labs in the area to discount bills for uninsured patients.

 

By law, medical institutions must charge everyone the same rate for services.

 

But most bills then are steeply discounted for patients covered by government and private health-insurance plans.

Medicare, for example, ends up paying $18.57 in Ohio for a cholesterol test that area labs charge $96 to $147.75 to provide.....

Ohio.com - Prices bleed uninsured

Shortage of Doctors an Obstacle to Obama Goals - NYTimes.com

By ROBERT PEAR

Published: April 26, 2009

WASHINGTON — Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the supply of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.

Graphic

Primary Care Providers in Short Supply

The officials said they were particularly concerned about shortages of primary care providers who are the main source of health care for most Americans.

One proposal — to increase Medicare payments to general practitioners, at the expense of high-paid specialists — has touched off a lobbying fight.....

Shortage of Doctors an Obstacle to Obama Goals - NYTimes.com

CAN PUBLIC HEALTH INSURANCE FIX HEALTH CARE? | ajc.com

No: Government intervention stifles competition, innovation

By WAYNE OLIVER

All Americans want health care coverage. All Americans like choice. Americans who like their current health insurance coverage should be able to keep it.

 

Those without coverage should have the freedom to choose the most appropriate plan that fits their specific needs and that of their family. But, everyone should have access to affordable health coverage.

 

President Obama wants to create a public plan option for health consumers under the age of 65. The public plan option will establish a government-run health insurance company —- a move that is poised to undermine health care providers, employers and the very sustainability of the entire health care system, not to mention the health and well-being of patients.

 

Big government should not stick its nose into private markets —- much less compete in them.....

CAN PUBLIC HEALTH INSURANCE FIX HEALTH CARE? | ajc.com

New Medicare policy may pose risks to black kidney patients

A change in Medicare reimbursement policy could make it more difficult for black Americans with kidney disease to access dialysis services, suggests a study in an upcoming issue of the Journal of the American Society of Nephrology. "The change in payment policy may disadvantage a substantial group of dialysis patients," said Areef Ishani, MD, University of Minnesota.

Under the new policy, the Centers for Medicare & Medicaid Services will make a single payment to dialysis units to cover both dialysis and injectable medications, which were previously reimbursed separately. African American dialysis patients have more problems with anemia (low hemoglobin) than white patients and thus may require more treatment with costly erythropoiesis stimulating agents to raise hemoglobin levels.

On analysis of 12,000 patients starting dialysis during 2006, the researchers confirmed that African Americans had lower initial hemoglobin levels when starting hemodialysis compared to white patients. Also, the average required dose of ESAs over the first two months on dialysis was 11% higher in black American patients.

Since dialysis centers will no longer be reimbursed for the higher ESA doses, the researchers are concerned that the new policy could create a "financial disincentive" to accept black Americans.

"The CMS has suggested that the new reimbursement scheme will adjust for a variety of factors," said Ishani. "If race is not included as a payment adjuster, African American patients could be disadvantaged by this policy change."

The study is limited in that it included only patients who were over age 67 at the start of dialysis and had Medicare as their primary insurance source. Also, it only looked at ESA use during the first two months on dialysis.
Dr. Ishani consults for the Chronic Disease Research Group. Haifeng Guo; Thomas Arneson, MD; Lih-Wen Mau, PhD; Suying Li, PhD; and Stephan Dunning are employed by the Chronic Disease Research Group. David Gilbertson, PhD and Allan Collins, MD have received consulting fees from Amgen.

The study will appear online at http://jasn.asnjournals.org.

Welcome to NephrOnline :: Property of Grand View Media Group

New Medicare and Medicaid Resource Available: Features MA, SNP, PDP and Medicaid Enrollment Data, Market Share Trends, Contract Statistics, and Plan Design Information

 

The 2009 Managed Medicare and Medicaid Factbook is packed with rates, benefit designs, directories, trends and strategies on the Medicare Advantage (MA) program and managed Medicaid. It features coverage of the overhauled Medicare program, including new payment rates, and practical information on the Part D drug benefit, Special Needs Plans and MA private fee-for-service.

 

Washington, DC (PRWEB) April 22, 2009 -- Atlantic Information Services, Inc. (AIS) -- AIS, publisher of industry-leading newsletters Health Plan Week, Medicare Advantage News and Drug Benefit News, is pleased to announce publication of "Managed Medicare and Medicaid Factbook: 2009." With 2010 Medicare Advantage Rates recently being announced and submission deadlines looming, it's critical that health plans have solid data to remain competitive in the shifting Medicare Advantage, Part D and Medicaid markets. For detailed information on this publication, go to http://www.aishealth.com/Products/gfb.html....

New Medicare and Medicaid Resource Available: Features MA, SNP, PDP and Medicaid Enrollment Data, Market Share Trends, Contract Statistics, and Plan Design Information

New Bill Offers Medicare Reimbursement Fix for Intravenous Immune Globulin

 

18 patient advocacy and health care professional groups join with Congressional sponsors Reps. Israel, Brady and Schwartz to announce new legislation; call for patient access to IVIG

 

WASHINGTON, April 22 /PRNewswire-USNewswire/ -- Members of Congress and patient advocacy groups announced today the introduction of new legislation - H.R. 2002, Medicare Patient IVIG Access Act of 2009 - meant to remedy inadequate Medicare reimbursements that currently restrict patient access to Intravenous Immune Globulin (IVIG), a life-saving and life-enhancing therapy for many primary immunodeficiency diseases; chronic lymphocytic leukemia; Kawasaki disease; autoimmune and neurological conditions such as chronic inflammatory demyelinating polyneuropathy, Guillain-Barre syndrome, idiopathic thrombocytopenic purpura, myasthenia gravis, myositis, multiple sclerosis, just to name a few.....

New Bill Offers Medicare Reimbursement Fix for Intravenous Immune Globulin

Health System Overhaul sees Medicare at the Centre | TopNews United States

Submitted by Jason Ramsey on Wed, 04/22/2009 - 18:12

As a part of the reforms of the U. S. healthcare systems the elderly could see changes in Medicare said lawmakers and experts. The $2.5 trillion health care system overhaul is a top priority for President Barack Obama who links it to long-term U. S. economic recovery.

During a committee discussion with industry groups on ways to change the payment system, Senate Finance Committee Chairman Max Baucus said, "Medicare is going to be the driver to achieve quality reforms, in large part because the other players tend to follow Medicare."

Health System Overhaul sees Medicare at the Centre | TopNews United States

Opinion | Opinion Pieces Discuss Medicare Reform Strategies - Kaisernetwork.org

Opinion | Opinion Pieces Discuss Medicare Reform Strategies

      The Washington Times on Sunday published two opinion pieces about Medicare reform. Summaries appear below.

• Len Nichols, Washington Times: Because Medicare makes up 20% of total government spending, the U.S. "should start thinking of health, Medicare and fiscal reforms as inexorably linked," Nichols, director of the New America Foundation's Health Policy Program, writes. According to Nichols, "Today's Medicare payment structure rewards providers for delivering volume, not value, and for doing more care, not better care. These incentives are perverse." He adds, "In short, Medicare must buy smarter." Nichols suggests that the U.S. "must reduce this misdirected spending" and also "improve patient care by basing its purchasing decisions on value, clinical evidence and observed outcomes." He notes, "We cannot get our fiscal house back in order without slowing the rate of Medicare and health care system cost growth." Nichols concludes, "The goals of comprehensive health reform, Medicare reform and fiscal responsibility should not be viewed separately, but rather jointly" (Nichols, Washington Times, 4/20).
• Judith Stein, Washington Times: The U.S.' top priority should be "getting the economy back on track," and reforming Medicare "is an essential part" of that, Stein, executive director of the Center for Medicare Advocacy, writes. According to Stein, "Good Medicare reform could help save taxpayers and Medicare beneficiaries billions of dollars, while also improving access to health care." To "cut costs and also improve quality of care," Stein suggests three strategies: "Eliminate the wasteful subsidies being paid by taxpayers to keep private Medicare Advantage plans afloat"; "repeal the Medicare Part D prescription drug benefit ... and replace it with a stable prescription drug benefit in traditional Medicare ... that reflects beneficiaries' needs instead of business interests"; and "[a]dd a coordinated care benefit to traditional Medicare so health care providers can be reimbursed for communicating with each other about patient care and primary care providers can coordinate the various aspects of individual patient needs." Stein concludes, "Medicare should be improved again to offer access to necessary care in the most cost-efficient manner possible" (Stein, Washington Times, 4/20).

Opinion | Opinion Pieces Discuss Medicare Reform Strategies - Kaisernetwork.org

Health-Care Dialogue Alarms Obama's Allies - washingtonpost.com

By Ceci Connolly

Washington Post Staff Writer
Tuesday, April 21, 2009

During last year's campaign, Obama proposed offering a government-sponsored plan as a low-cost alternative for Americans who are having trouble purchasing insurance in the private market. Proponents say it would reduce costs because it would not need to make a profit or pay large executive salaries.

Many Republicans and industry executives say that any program modeled after Medicare -- with its power to set prices -- would have an unfair advantage over private-sector competitors and eventually force some companies out of business.....

Health-Care Dialogue Alarms Obama's Allies - washingtonpost.com

AMNews: April 20, 2009. Doctors face risk of harsh penalties from new Medicare enrollment rules ... American Medical News

Stricter requirements governing retroactive billing, changes of address kicked in April 1.

By Chris Silva, AMNews staff. Posted April 20, 2009.

---

Washington -- Physician practices are anticipating major difficulties with Medicare enrollment rules that went into effect amid protests from doctors and practice managers. A wrong step by a practice could mean that it loses Medicare revenue or even gets kicked out of the program altogether.

 

Starting April 1, the time frame under which physicians can bill retroactively for services after successful enrollment or re-enrollment in Medicare has been shortened from 27 months to only 30 days. In addition, doctors must alert contractors of a change in practice location within 30 days, or risk expulsion from Medicare for up to two years.....

AMNews: April 20, 2009. Doctors face risk of harsh penalties from new Medicare enrollment rules ... American Medical News

AMNews: April 20, 2009. Details now emerging about cuts to Medicare private plans ... American Medical News

Anticipating reductions of more than 4% next year, Medicare Advantage plans say CMS is using unrealistic estimates.

By Chris Silva, AMNews staff. Posted April 20, 2009.

 

Washington -- Medicare private plans that for years have received annual pay increases are set to sustain sizeable reductions in 2010 under cost estimates recently released by the Obama administration.

 

In an April 6 directive to Medicare Advantage plans, the Centers for Medicare & Medicaid Services updated plan payment information that it first released in February. The National Per Capita Medicare Advantage Growth Percentage -- an estimation of how much more the program will need to spend on all beneficiaries -- will be 0.81% for 2010.

 

While this is an increase over the agency's initial projection of 0.5%, it still amounts to an expected reduction in payment over 2009 levels to private insurers that administer Medicare plans.....

AMNews: April 20, 2009. Details now emerging about cuts to Medicare private plans ... American Medical News

New rules could cut physician Medicare income - FierceHealthcare

By Anne Zieger

Starting this month, Medicare rules got tougher for physician practices--in a way that could not only deny the practices revenue, but even get them kicked out of the program completely.

The rules, which became effective April 1, cut the time-frame under which physicians can bill retroactively for services after a successful enrollment or re-enrollment. The window plummeted from 27 months to a mere 30 days. At the same time, practices must alert contractors of any changes in practice locations within 30 days, or risk expulsion from Medicare for as much as two years. In other words, we're talking about serious stuff here.....

New rules could cut physician Medicare income - FierceHealthcare

Plan Changes Afoot - WSJ.com

By JANE ZHANG

Changes are coming next year to private health plans offered to Medicare enrollees.

 

Seniors covered by the so-called Medicare Advantage plans will likely see higher premiums or fewer benefits. And a small number of them will find that their plans no longer exist. Advantage plans wrap physician and hospital services in one, often with additional benefits such as vision and drug coverage.

 

Advantage plans may become more consumer-friendly, however, since they will have to abide by new government rules, such as stricter marketing standards and caps for out-of-pocket costs. Also, plans will be required to explain in clear language what they cover in things like the "doughnut hole," a coverage gap where consumers generally must pay the full cost of their medicines up to a given amount. The aim is to make it easier for consumers to compare options and costs.....

Plan Changes Afoot - WSJ.com

Some Doctors Opting out of Medicare - WBOC-TV 16, Delmarvas News Leader, FOX 21 -

Reported by Cassandra Kramer

DOVER, Del.- Some 40 million Americans have Medicare coverage, according to the federal government. However, some doctors have stopped taking new patients who use the program to pay for treatment. They say the reimbursement rates are too low.

The American College of Physicians says that by 2025 there will be 35,000 fewer physicians than the population needs, and they are also now more unwilling to accept new Medicare patients.....

Some Doctors Opting out of Medicare - WBOC-TV 16, Delmarvas News Leader, FOX 21 -

Social Security and Medicare Will Cost More Than The Value Of Everything In The United States

 John Carney|Apr. 17, 2009, 11:43 AM

Here's the good news: future costs of Social Security and Medicare won't require higher taxes. Now here's the bad news: the reason these programs won't require higher taxes is that they'll be so expensive that there's no possible way to pay for them through taxes. Everything in the US (not counting people) is worth about $50 trillion and those two programs will cost $80 trillion, unless they are reformed.....

Social Security and Medicare Will Cost More Than The Value Of Everything In The United States

When Doctors Opt Out - WSJ.com

We already know what government-run health care looks like.

By MARC SIEGEL

Here's something that has gotten lost in the drive to institute universal health insurance: Health insurance doesn't automatically lead to health care. And with more and more doctors dropping out of one insurance plan or another, especially government plans, there is no guarantee that you will be able to see a physician no matter what coverage you have.

Consider that the Medicare Payment Advisory Commission reported in 2008 that 28% of Medicare beneficiaries looking for a primary care physician had trouble finding one, up from 24% the year before. The reasons are clear: A 2008 survey by the Texas Medical Association, for example, found that only 38% of primary-care doctors in Texas took new Medicare patients. The statistics are similar in New York state, where I practice medicine.....

When Doctors Opt Out - WSJ.com

Taking Note: The Fraying of Medicare

by Maggie Mahar

 

Many Americans assume that once they finally become eligible for Medicare, their worries about skyrocketing health care bills will be over. Unfortunately, that just isn’t the case.    

 

According to Fidelity Investments a 65-year-old couple retiring this year should assume they will need approximately $240,000 to cover medical expenses in retirement--- even though they have Medicare insurance coverage.   This represents a 6.7 percent jump over Fidelity’s 2008 estimate of $225,000.

 

Just as in every other sector of our health care system, Medicare has been hit hard by the soaring cost of care. As a result, Medicare beneficiaries are paying more and more out of pocket. Some health care reformers suggest that because Medicare’s administrative costs are very low, the program is inexpensive. That just isn’t true—administrative costs represent a relatively small portion of total health care spending. As I have explained in earlier posts,  overuse of advanced medical technologies bears primary responsibility for pushing medical bills heavenward.

 

This helps explain why, in just the past seven years,  the amount a retired couple can expect to lay out in the form of co-pays, deductibles, out-of-pocket costs for prescription drugs, as well has certain services not covered by Medicare has jumped 50 percent, from $160,000 to $240,000.....

Taking Note: The Fraying of Medicare

Medicare Advantage Program More Costly, But With New Protections - WSJ.com

 

By JANE ZHANG and VANESSA FUHRMANS

Seniors will likely pay more for Medicare's private health plans next year, but new consumer protections that come with those plans could ensure they remain an attractive alternative to traditional Medicare.

 

The changes come as the Obama administration moves to tighten the screws on private plans offered under Medicare, the federal insurance program for the elderly and disabled. The Centers for Medicare and Medicaid Services, or CMS, recently unveiled stricter terms for insurers offering the so-called Medicare Advantage plans, taking effect next year, and will effectively cut payments to them by as much as 5%.

 

Enrollment in the Medicare Advantage program has surged to 10.5 million enrollees currently from 5.4 million in 2005. These plans wrap physician and hospital services into one, often with extra benefits, such as vision and dental coverage. Instead of paying doctors and hospitals directly, as it does under traditional Medicare, the federal government pays plans to manage care under the Advantage program.....

Medicare Advantage Program More Costly, But With New Protections - WSJ.com

Raja S. Cheruvu: Medicare denial risks deaths from colorectal cancer : Opinion : The Buffalo News

 

By Raja S. Cheruvu

Updated: 04/16/09 9:39 AM

Colon cancer screening, an essential tool for preventing cancer deaths and saving lives, is under-utilized by Americans across the board. Most people do not recognize that colorectal cancer is the second leading cause of death from cancer in the United States, taking the lives of 10,060 people in the state of New York alone last year. The need for colon cancer prevention and detection is critical.

 

Fortunately, there are new screening methods available that could increase screening levels, which are sadly less than 50 percent for people over age 50, and fall even lower for those 65 years and older. Recent advances in medical technology have produced a virtual colon cancer testing procedure that is minimally invasive, requires no sedation, is quick and very safe — four key points that make this testing method much more appealing to seniors.

 

However, last month, the Centers for Medicare and Medicaid Services announced that it would not pay for Medicare beneficiaries to receive a virtual colonoscopy.

 

As a medical professional who is routinely encouraging my patients to take advantage of preventative medicine, I was extremely disappointed......

Raja S. Cheruvu: Medicare denial risks deaths from colorectal cancer : Opinion : The Buffalo News

Editorial - Back in the Hospital Again - NYTimes.com

Times Topics: Health Care Reform | Medicare

An alarming one-fifth of all Medicare patients discharged from the hospital end up back in the hospital within 30 days, and fully a third return within 90 days. If this yo-yoing could be greatly reduced, Medicare could save billions of dollars. Many patients would certainly benefit from the better care.

 

High rates of rehospitalization are partly the fault of the hospitals. The more fundamental problem is the fragmented nature of the American medical system: too often, health-care providers fail to communicate with one another, patients fall between the cracks and no one seems clearly in charge of a patient’s welfare.....

Editorial - Back in the Hospital Again - NYTimes.com

Medical News: Evidence Backs Exercise for Fall Prevention - in Primary Care, Preventive Care from MedPage Today

 

By John Gever, Senior Editor, MedPage Today
Published: April 15, 2009

WHEELING, W.Va., April 15 -- At least three different types of exercise programs significantly reduce the risk of falls in the elderly, a Cochrane meta-analysis found.

Individually prescribed home exercise regimens and two forms of group exercise, including Tai Chi, reduced both rates of falls and the risk of falling, according to Lesley D. Gillespie, of Dunedin Medical School in Otago, New Zealand, and colleagues.

They reported their findings online in the Cochrane Database of Systematic Reviews.

The reductions in fall risk, calculated from pooled data, ranged from 17% for multicomponent group exercise (95% CI 3% to 28%) to 35% for Tai Chi (95% CI 18% to 49%).

"The effect of exercise programmes in reducing the risk and rate of falling should now be regarded as established," the researchers wrote.

However, they cautioned that these interventions may be less effective in people with severe vision or mobility problems......

Medical News: Evidence Backs Exercise for Fall Prevention - in Primary Care, Preventive Care from MedPage Today

Legislators seek to increase DXA reimbursement

 

In an effort to protect patient access to osteoporosis testing, lawmakers have introduced the Medicare Fracture Prevention and Osteoporosis Testing Act of 2009 to reverse the cuts in Medicare for dual-energy x-ray absorptiometry (DXA).

Sens. Blanche Lincoln, D-Ark., and Olympia Snowe, R-Maine, introduced the Senate version, S. 769, and Reps. Shelley Berkley, D-N.V., and Michael Burgess, R-Texas, introduced the House version, H.R. 1894.....

Legislators seek to increase DXA reimbursement

Medicare eyes costs in Miami - Business - MiamiHerald.com

 

Miami has been chosen as the site for a pilot project to find ways to reduce Medicare costs.

BY JOHN DORSCHNER

jdorschner@MiamiHerald.com

Long notorious for its high healthcare costs, Miami has been chosen by Medicare as one of 14 communities for a pilot project seeking to eliminate unnecessary hospital readmissions.

 

''Our data show that nearly one in five patients who leave the hospital today will be readmitted within the next month, and that more than three-quarters of these readmissions are potentially preventable,'' Medicare Acting Administrator Charlene Frizzera said in a statement.....

Medicare eyes costs in Miami - Business - MiamiHerald.com

In Georgetown Speech, Obama Offers Cautious Optimism - washingtonpost.com

By Michael D. Shear and William Branigin

Washington Post Staff Writers
Tuesday, April 14, 2009; 12:36 PM

President Obama today laid out a vision for a new era of U.S. economic prosperity and called on the nation to "get serious" about reforming entitlement programs such as Medicare, Medicaid and Social Security -- reform that he said starts with overhauling the American health care system.....

In Georgetown Speech, Obama Offers Cautious Optimism - washingtonpost.com

Oklahoma City Republican Examiner: The coming health care collapse

Robert McIntosh

Go to Robert's Home Page

 

The Wall Street Journal has a great article on what will happen to private insurance if the government passes a national health care plan. Under Obama's plan private health insurance will "compete" with the government. Individuals can choose to keep their company sponsored insurance plans or choose the government's.

All sounds pretty good until you start to apply a little common sense into the equation. If the government is giving "free" health care, why on earth would companies spend to billions every year on insurance for employees? The simple answer is they won't. They will drop insurance either to save costs or because employees won't want to pay for even a copay because they can get it "free" right? The result of that will be that the cost for employees will go up even more as these plans are based partially on the number of employees in the plan. The fewer the employees, the higher the cost. The higher the cost, the more likely they will drop it.

Want proof? It happened to Hawaii last year and that was just for child care. They abandoned the system after only 7 months.

So what you say?

Nothing the government provides is free. It is paid for by taxes, and lots of them. As the costs of the program escalate, the government will then start to enforce price controls and rationing. The current Medicare system already costs everybody, including private insurers.....

Oklahoma City Republican Examiner: The coming health care collapse

Broader approach to value-based purchasing sought for Medicare ... American Medical News

Policymakers and physicians must get beyond thinking that the concept is only about slashing spending, says a speaker at an insurance industry forum.

By Chris Silva, AMNews staff. Posted April 3.

---

Washington A comprehensive, cross-disciplinary approach to managing Medicare benefits based on the value that they provide to patients is one of the keys to major reform of the health care delivery system, said Robert A. Berenson, MD, senior fellow at the Urban Institute, a nonprofit organization based in Washington, D.C.

 

Dr. Berenson, who spoke at a March 11 policy forum hosted by America's Health Insurance Plans, said this concept of value-based purchasing goes much deeper than a simple attempt to cut dollars out of the program's budget. "It's not about just trying to get costs lower, but also about getting better quality and responsiveness to patients."

 

The Medicare physician fee schedule, for example, might be based not only on the relative costs of providing the services but also on the value provided to beneficiaries. A value-based purchaser might try to adjust payment levels to increase geriatric services for patients with multiple chronic conditions rather than boost advanced imaging services that already are overvalued, Dr. Berenson said. "Physicians should not be locked into rigid formulas that do not accomplish policy goals, and one thing we don't do well is targeting chronic diseases."

 

The reform issue also goes beyond deciding which services are most valued to deciding which ones are legitimate. Dr. Berenson said the Centers for Medicare & Medicaid Services must be better about identifying fraud and abuse. He cited the postponed competitive bidding program for durable medical equipment as a model that could help lower program costs if given sufficient resources.

 

The introduction of a Medicare Part E benefit that provides catastrophic coverage should improve cost-sharing and eliminate the need for beneficiaries to purchase supplemental medigap coverage, Dr. Berenson said. The concept of Part E, or Medicare Extra, was proposed in an October 2005 Health Affairs article co-authored by Marilyn Moon, PhD, vice president and director of the health program at the American Institutes for Research in Washington, D.C.

 

"Essentially, the idea is to create a more efficient Medicare program that would cover at least a reasonably comprehensive benefit package," Moon said. "We propose an option for Medicare that would change the deductible and cost-sharing, and add catastrophic protection."

AMNews: April 3, 2009. Broader approach to value-based purchasing sought for Medicare ... American Medical News

Technorati Tags: Medicare,Center for Medicare and Medicaid Services,Medicare Extra,Part E,catastrophic protection,Medigap,Medicare Supplement

Medicare Announces Funding for State Health Insurance Counseling Programs for 2009

Funding Designed to Help People With Medicare

(HealthNewsDigest.com) - Nearly $36 million in funding is being distributed to the 54 State Health Insurance Assistance Programs (SHIPs) to help people with Medicare get more information about their health care choices.

The $35.8 million in funding is the first installment of federal grant funds provided to SHIPs by the Centers for Medicare & Medicaid Services (CMS) for the grant year beginning April 1, 2009, and ending March 31, 2010. An additional $1.5 million in performance-based funding will be awarded in September 2009. SHIPs are state-based programs that use community-based networks to provide Medicare beneficiaries with local, personalized assistance on a wide variety of Medicare and health insurance topics.

“State Health Insurance Assistance Programs serve an important role in providing information and support to people with Medicare where they live,” said CMS Acting Administrator Charlene Frizzera. “These funds help ensure SHIPs continue their work with state and local governments, community-based organizations and others to meet the needs, beyond health care, of our Medicare beneficiaries.”

CMS expects the SHIPs to use the 2009 funding to conduct targeted community-based outreach to people with Medicare who may be unable to access other sources of information. SHIPs will also provide outreach and assistance to current and newly eligible Medicare beneficiaries and their caregivers, with a special emphasis on reaching people who will most likely be eligible for Medicare’s low-income subsidy if they enroll in Medicare prescription drug coverage.

CMS will continue to support the quality of services provided by SHIPs through training, technical assistance, the SHIP Resource Center, and the online tools at www.medicare.gov to help people with Medicare.

Medicare Announces Funding for State Health Insurance Counseling Programs for 2009: HealthNewsDigest.com

Technorati Tags: Medicare,State Health Insurance Assistance Programs,SHIPs,Center for Medicare and Medicaid Services,low-income subsidy,prescription drug coverage

Senators Criticize Proposed Medicare-Payment Cuts - WSJ.com

By PATRICK YOEST

WASHINGTON -- A bipartisan group of senators expressed concern in a letter sent Friday that proposed cuts in Medicare Advantage payment rates could increase premiums for enrollees in the programs.

The letter comes just before an expected announcement Monday on the final payment rate for the privately run Medicare plans. The Centers for Medicare and Medicaid Services, or CMS, announced a preliminary payment rate for Medicare Advantage on Feb. 20 that analysts say would translate to a 5% cut in payments.

The letter, signed by a group of 15 senators led by Maria Cantwell (D., Wash.), stated that "if the proposed changes to MA rates are implemented, MA enrollees in our states could face substantially higher premiums and lose valuable benefits." .....

Senators Criticize Proposed Medicare-Payment Cuts - WSJ.com

Technorati Tags: Medicare,Medicare Advantage Plans,Humana,United Healthcare,Aetna,Center for Medicare and Medicaid Services

Arthritis Rehab for Baby Boomers | Health and Wellness Needs

Author : Clydette Clayton

If you can remember how to spell "Mickey" as in Mickey Mouse, you are probably just the right age to recognize "Arthritis" That little voice that has been whispering to you lately, or even shouting at you, is your notice that it's time to take action before that nagging pain gets out of hand.

A trip to an orthopedic physician can be the first step in your plan to reclaim an active life-style that you have no intention of giving up You already know that dealing with stiff and sore knees, an aching shoulder, a painful wrist from repetitive work motions, or some crippling back pain, is a sure sign that you need more than over-the-counter pain remedies have to offer you.

You may have an idea that physical therapy is on the horizon Your friends who have been experiencing these same pains have warned you that you may have to 'bite the bullet' You may need to see the doctor What an unpleasant thought!
Before you take that step to see the Doc, you could try some very gentle exercise and stretching But don't over do it! For ladies, Curves seems to be a great program By the way, I think we need a Curves for gents.....

Arthritis Rehab for Baby Boomers | Health and Wellness Needs

Technorati Tags: Baby Boomers,Arthritis,pain

Alzheimer's cure on horizon? | NECN

(NECN) - Alzheimer's is an incurable disease that often runs in families and impacts not only the patient, but their caregivers.

The number of patients suffering from Alzheimer's is expected to skyrocket with the aging of the baby boomers, but there is hope.

Dr. Dennis Selkoe from Harvard Medical School and Brigham and Women's Hospital is one of the leading experts in the country and a part of "The Alzheimer's Project" -- an upcoming HBO four-part series on the disease and the quest for a cure.

"We have so much research going on and 91 trials, suggest that we have something that will really slow down or even halt the disease within 10 or 15 years," Dr. Selkoe said.....

Alzheimer's cure on horizon? | NECN

Technorati Tags: Alzheimers,Baby Boomers,caregivers,The Alzheimer's Project,Dr. Dennis Selkoe

Lessons from Medicare for Health Care Reform

By Marilyn Moon | April 2, 2009

 

Read the full report (CAP Action)

Medicare has operated successfully for over 40 years by offering essentially universal coverage to people 65 and over. The program covers some of the sickest and frailest of the U.S. population, along with a substantial number of disabled Americans. While Medicare provides an example of a universal, public health insurance program, health care reform will likely take the form of a system offering the choice of multiple private—and perhaps a public—health insurance plans.

Nonetheless, Medicare’s experience offers a number of key lessons—both positive and negative—that can help in the development of affordable health coverage for all Americans.

The following lessons can help inform the creation of health reforms that learn from and build upon Medicare’s successes and failures.

• A standard benefit package should be sufficiently comprehensive to enable enrollees to forego supplemental coverage. If supplemental coverage is available, it should “wrap around” the standard package.
• Premium and cost-sharing subsidies should be easy to obtain and sufficient to provide meaningful financial protection. Administrative barriers to enrollment and unduly restrictive eligibility rules ultimately limit access to coverage.
• A commitment to choice, particularly choice of health plans, requires a commitment to regulation and oversight—specifically, reasonable rules for plan marketing efforts, an investment in consumer information, and an appropriate degree of standardization (and therefore comparability) across plans.
• Strong data reporting requirements for health plans will strengthen our understanding of key dynamics within the health care system.
• Consumers need help in navigating the health care system and in understanding how better information can help in decision making.
• Increased attention to innovation within public programs, supported by investment in research on what works, can lead the entire system toward greater efficiency and quality.
• Flexibility should be encouraged within appropriate boundaries. Private and public plans should have the ability to develop innovative payment systems and other improvements, but not at the expense of providers’ and patients’ rights.

Read the full report (CAP Action)

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Lessons from Medicare for Health Care Reform

Technorati Tags: Medicare,Health care reform

The Associated Press: HHS nominee pledges Medicare, Medicaid fixes

By RICARDO ALONSO-ZALDIVAR – Apr 2, 2009

WASHINGTON (AP) — Kansas Gov. Kathleen Sebelius, President Barack Obama's choice for health secretary, told senators Thursday that she wants to transform Medicare and Medicaid with a focus on prevention and primary care.

It's imperative to steer resources "toward wellness rather than sickness," Sebelius said in prepared testimony for the Senate Finance Committee, where senators were expected to ask more questions about her policies and politics than about $7,000 worth of mistakes she made on her taxes.

Overseeing the giant government-run insurance programs for the elderly, disabled and poor would be a major responsibility, and Sebelius said improvements are needed.

Sebelius said that, if confirmed, she hopes to use technology to better align Medicare and Medicaid payments with quality care. The payments to health care providers are often criticized as alternately inadequate or excessive.....

The Associated Press: HHS nominee pledges Medicare, Medicaid fixes

Technorati Tags: Medicare,Medicaid,elderly,disabled,poor,Kathleen Sebelius,Barack Obama

Local Health Inurance agents meet with area Congressmen in D.C. to discuss the future of American health care

John Woods, President Elect of the Western Reserve Association of Health Underwriters
(330) 394-8901 or john@commercialfs.com
April 8, 2009
FOR IMMEDIATE RELEASE

NAHU’s Capitol Conference
One Mission, One Voice:
Working Together for the Future of American Health Care

Arlington, VA – When health insurance agents from across the country convened in Washington, DC, March 30-April 1 for the National Association of Health Underwriters (NAHU) Capitol Conference, they stressed the importance of working together to find ways to make health care accessible and affordable for all Americans. Among those attending were local agents John Woods, owner of Commercial Financial Services, Inc. and President Elect of the Western Reserve Association of Health Underwriters (Greater Youngstown area chapter); Robert Lackey of First Place Insurance and Vice President of the Ohio Association of Health Underwriters (State of Ohio chapter); and John Movay of the Movay Lytle Group and Board member of the Western Reserve Association of Health Underwriters.

NAHU’s Capitol Conference was an opportunity for health insurance agents and brokers to communicate their legislative agenda to congressional leaders. For example, our local attending agents met with House Representatives Tim Ryan (D) of the 17th district, and Charlie Wilson of the sixth district, to advance the cause of the private health insurance delivery system and to make sure that our elected officials understand the critical role that health insurance agents, brokers and consultants play in that system. Other major issues we addressed include significant market reforms to the individual and possibly small group markets, the scope and structure of a potential national connector, the potential for a public plan buy-in option and its scope and structure, a potential employer mandate and overall costs and financing.

“Members of NAHU care about increasing access to affordable health care,” said NAHU President Scott Leavitt. “We spend every day helping millions of individuals and employers find policies that will provide them with the best and most affordable coverage. With the current state of our economy, this endeavor was more important than it has ever been. Due to the changing direction of the health care industry, and the many important health care issues before Congress and the states, we are committed to finding solutions to the health insurance coverage problems facing Americans today.

“Too many Americans are unable to afford the cost of adequate health insurance coverage. Rather than take steps to preserve free market health care, many legislators are convinced that a complete overhaul of the system is required, even when faced with evidence of the pitfalls of socialized medicine. NAHU is strongly committed to working with legislators to resolve the current issues in our health care system and find affordable health insurance options for all Americans.”

The National Association of Health Underwriters represents 20,000 professional health insurance agents and brokers who provide insurance for millions of Americans. NAHU is headquartered in Arlington, VA. For more information, please call John Woods at (330) 394-8901 or email john@commercialfs.com.

###

AMNews: April 10, 2009. Medicare slammed for limiting pay for oxygen ... American Medical News

DME suppliers say stopping payments after three years while requiring equipment maintenance for another two is unfair.

By Chris Silva, AMNews staff. Posted April 10.

---

Washington An influential lawmaker has joined suppliers of oxygen therapy equipment in calling on the Centers for Medicare & Medicaid Services to reconsider a new regulation that caps Medicare payments for home oxygen supplies at 36 months.

 

The regulation, which took effect Jan. 1, dictates that suppliers are still responsible for maintenance and repair of oxygen equipment for an additional two years after the 36 months of service are up.

AMNews: April 10, 2009. Medicare slammed for limiting pay for oxygen ... American Medical News

Blog Watch | Kaiser Daily Health Policy Report Feature Highlights Recent Blog Entries - Kaisernetwork.org

"Blog Watch" offers readers a roundup of health policy-related blog posts.

The American Prospect's Ezra Klein looks at a new Lewin Group study of a public insurance plan option and says the "actual news" is the cost difference between a public plan using Medicare rates and a public plan that bids for rates, as private insurers currently do. Conn Carroll of the Heritage Foundation's The Foundry says that if the Lewin Group's predictions are correct, "we would find ourselves well on our way toward a single-payer, government-run health care system." In a related post, Igor Volsky of the Center for American Progress Action Fund's Wonk Room looks at a new report from Jacob Hacker on a public plan.

Judith Graham of the Chicago Tribune's Triage looks at a new survey from Catholic Healthcare West on health reform and says it suggests that health reform is "tricky" because the majority of respondents are satisfied with their doctors.

Louise of Colorado Health Insurance Insider says that forbidding underwriting could help people with chronic or serious illnesses gain access to health insurance on the individual market, but it "won't make much of an impact for the millions of people who can't afford health insurance."

Trudy Lieberman of Columbia Journalism Review's Campaign Desk interviews Medicare expert Marilyn Moon as part of a series designed to "offer journalists more options for their stories and encourage a deeper conversation."

James Capretta of Diagnosis says President Obama and congressional Democrats' ideas for health reform are not "inevitable" because Congress still must find sufficient funding.

Arnold Kling of Econlog responds to a Los Angeles Times opinion piece on some countries' rationing of health services, saying, "My view of the American health care system is that it hardly rations health care at all. That is why we spend so much more than other countries."

John Joseph Leppard IV of Health Care Manumission critiques the idea of increasing government spending on health programs and setting quality standards for physician care.

Insure Blog's Bob Vineyard looks at so-called "No-Insurance Clubs," or physician practices that accept uninsured patients for an annual fee. Vineyard says that the arrangements can provide a false sense of security and that a catastrophic insurance policy might be a better option.

Joe Paduda of Managed Care Matters compiles a list of the current 10 most common objections to universal health coverage.

Jacob Goldstein of the Wall Street Journal's Health Blog looks at a new analysis that found prescriptions for generic drugs rose by 12% per year from 2004-2008 while prescriptions for brand-name drugs fell by 6% per year.

Blog Watch | Kaiser Daily Health Policy Report Feature Highlights Recent Blog Entries - Kaisernetwork.org

Steven Pearlstein - A 'Public' Fix for Health Care Need Not Abandon the Market - washingtonpost.com

By Steven Pearlstein

Friday, April 10, 2009; Page A12

Although the national debate over health-care reform has only just begun, the first battle lines are being drawn over whether there should be a Medicare-like "public" insurance plan to compete with private insurers in a restructured market.

The public plan has already become a political litmus test for the Democratic left, which sees it as the only antidote to a private market that can't be trusted to deliver quality, affordable health care, and for the Republican right, which sees it as the Trojan horse for a government-run health-care system that will raise taxes and ration care.....

Steven Pearlstein - A 'Public' Fix for Health Care Need Not Abandon the Market - washingtonpost.com

FOXNews.com - A Burning Question for President Obama - Glenn Beck

 

Thursday, April 09, 2009
By Glenn Beck

President Obama, apparently feeling like there's not very much on the country's "to-do list," is reportedly going to work on immigration reform later this year and hopes to create a path for the estimated 12 million illegal aliens in America to become legal.

What a sweet, sensitive guy he is.

 

But the one thing he's missing is that it would be a lot faster and easier to just set us all on fire at this point....

FOXNews.com - A Burning Question for President Obama - Glenn Beck

CMS Issues 2010 Payment Information for Part C Medicare Advantage Plans and Part D Prescription Drug Plans - The Paramus Post

By Mel Fabrikant Thursday, April 09 2009, 12:38 PM EDT

2010 Prescription Drug Standard Benefit Deductible and Medicare Advantage Coding Pattern Differences Adjustment Announced

The Centers for Medicare & Medicaid Services (CMS) today announced calendar year 2010 Medicare Advantage payment rates and Medicare Advantage and Part D prescription drug benefit payment policies."The announcement provides Medicare Advantage and prescription drug plans the information they need to structure their benefits and beneficiary cost sharing and prepare their bids for the 2010 plan year," said Jonathan Blum, Acting Director of CMS’ Center for Drug and Health Plan Choice.

By law, CMS annually updates the Medicare Advantage capitation rates by a growth percentage that reflects growth in all Medicare expenditures, including expenditures under Part A and Part B payment rules. This growth percentage thus reflects the projected reduction in 2010 physician payments provided for under Part B payment rules. CMS announced today that this amount for 2010 will be 0.81 percent.

For prescription drug program enrollees, the Announcement includes important information about the 2010 Part D deductible, initial coverage limit, out-of-pocket threshold, and related parameters for the standard benefit. The annual percentage increase in average per capita Part D spending – used to update the deductible, initial coverage limit, and out-of-pocket threshold for the defined standard benefit for 2010 – is 4.66 percent.

For the first time, for plan year 2010, CMS will make a "coding pattern differences adjustment" to Medicare Advantage risk scores, reducing Medicare Advantage payment rates to account for differences in disease coding patterns between Medicare Advantage organizations under Part C and the Original Medicare program (Parts A and B). CMS is required by law to adjust Medicare Advantage rates where it finds differences in coding patterns between Medicare Advantage plans and Part A and Part B providers. The adjustment will be applied as a uniform 3.41 percentage reduction to all Medicare Advantage plans’ Part C risk scores in 2010.

In addition, the 2010 rates announced today reflect a provision in recently enacted legislation requiring a multi-year phase-out of the inclusion of costs of indirect medical education in Medicare Advantage rates. The maximum reduction as part of this phase-out is approximately 0.60 percent per year.

The changes announced today update and make final provisions of the Advance Notice that CMS released on February 20, 2009.

A fact sheet on today’s announcement may be viewed at http://www.cms.hhs.gov/apps/media/fact_sheets.asp
The document released today, Announcement of Calendar Year (CY) 2010 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies may be viewed at http://www.cms.hhs.gov/MedicareAdvtgSpecRateStats/AD/list.asp#TopOfPage.

CMS Issues 2010 Payment Information for Part C Medicare Advantage Plans and Part D Prescription Drug Plans - The Paramus Post

Medicare Cuts and Reform May Lead to Insurance Mergers | BNET Healthcare Blog | BNET

By Ken Terry | April 9th, 2009 @ 3:50 pm

The Obama Administration’s 4.5 percent pay cut to Medicare Advantage plans for 2010, while a bit less than expected, is helping to fuel rumors that some major health insurers will merge. Aetna is said to be interested in taking over Humana, and United is reportedly eyeing Coventry.

 

Such mergers would greatly concern health care providers, especially physicians. Many hospitals have formed larger systems that can hold their own with insurers, but most physician groups have little leverage with the big plans, and a further consolidation of insurers would place them at an even greater disadvantage. According to the AMA, a single health plan already has at least a 70 percent market share in one of six markets.....

Medicare Cuts and Reform May Lead to Insurance Mergers | BNET Healthcare Blog | BNET

North Star Writers Group - Syndicated Commentary: Opinion, Humor and Features

Dan Calabrese

April 9, 2009

How to Prevent the Coming Medicare/Medicaid Disaster

You think it would be horrible if we went to a single-payer health care system? I’ve got news for you. We already have one. And it’s a hell of a problem.

 

Forty-four years ago, the government of the United States passed a law promising to cover the health care costs of senior citizens and assorted others. Medicare is socialized medicine – covering everyone 65 and older. Medicaid is an even more complicated jumble. Funded by the federal government but administered by each of the 50 states, it serves to cover health care costs for various eligible constituencies.

 

But if you focus on Medicare alone, you quickly get the sense of the fiscal disaster awaiting the country. All you have to do is apply the laws of supply and demand.....

North Star Writers Group - Syndicated Commentary: Opinion, Humor and Features

Healthcare battle brewing: political groups gear up | csmonitor.com

 

A public insurance alternative is likely to be the most contentious of the reform proposals.

By Alexandra Marks  |  Staff writer/ April 8, 2009 edition

New York

The Obama administration hopes to give all Americans the option of buying into a public, Medicare-style health insurance plan. That is now shaping up to be the biggest flash point in the emerging debate about healthcare reform.

 

Advocates of a Medicare-style plan say it would give consumers a lower-cost alternative to private insurance, forcing those private insurers to become more responsive to consumer needs. Opponents counter that it would undermine the private health insurance market by prompting millions of businesses to switch to the cheaper, public alternative. In the long term, they argue, that would undermine consumer choice in healthcare....

Healthcare battle brewing: political groups gear up | csmonitor.com

Anheuser-Busch to freeze pension, ask retirees to contribute more - St. Louis Business Journal:

by Kelsey Volkmann

Anheuser-Busch plans to freeze its pension plan for salaried employees, eliminate retiree health coverage for new employees and ask retirees to contribute more to their health benefits.

 

The brewer said defined contribution plans, or 401(k)s, are preferred over defined benefit plans, or pension plans, “because they provide more predictable cash flows and expense for the company,” James Brickey, vice president of people, told salaried employees in an internal memo Wednesday.

Anheuser-Busch to freeze pension, ask retirees to contribute more - St. Louis Business Journal:

Medical News: Cognitive Therapy Helps Seniors Fight Anxiety - in Psychiatry, Anxiety & Stress from MedPage Today

 

By John Gever, Senior Editor, MedPage Today
Published: April 07, 2009

WHEELING, W.Va., April 7 -- Cognitive behavioral therapy in a primary care setting relieved several aspects of generalized anxiety disorder in older patients, researchers found in a randomized trial.

Compared with a beefed-up version of usual care, patients who underwent three months of cognitive behavior therapy showed more improvement in worry severity, general mental health, and depressive symptoms, reported Melinda A. Stanley, Ph.D., of Baylor College of Medicine, and colleagues.

The improvements were maintained for a year afterward, they reported in the April 8 issue of the Journal of the American Medical Association.

They acknowledged, however, that no significant difference was seen between treatments in an overall measure of generalized anxiety disorder.....

Medical News: Cognitive Therapy Helps Seniors Fight Anxiety - in Psychiatry, Anxiety & Stress from MedPage Today

Suppliers denounce Medicare bid plan

 

Tuesday, April 07, 2009

By Steve Twedt, Pittsburgh Post-Gazette

 

Medicare's plans to bring competitive bidding to durable medical equipment procurement actually will reduce competition and limit access to needed wheelchairs, oxygen tanks and other vital equipment, a group of suppliers say.

 

They also believe that the program, set to begin locally in less than two weeks, will end up costing more after big suppliers grab a larger and larger market share, freeing them to then raise their prices.

 

"You wind up with a government-created oligarchy," said John Shirvinsky, executive director for the Pennsylvania Association of Medical Suppliers, yesterday in Green Tree.....

Suppliers denounce Medicare bid plan

Study: Every 1.7 minutes a Medicare beneficiary experiences a patient safety event

 

Patients at top-performing hospitals 43 percent less likely to experience a medical error

GOLDEN, Colo. (April 7, 2009) – The 2009 HealthGrades Patient Safety Excellence Award™ recipients were identified in a report issued today by the leading independent healthcare ratings organization. These hospitals represent an elite group that save lives, save money and prevent errors at a higher rate than other U.S. hospitals.

 

If all hospitals performed at the level of Patient Safety Excellence Award™ hospitals, approximately 211,697 patient safety events and 22,771 Medicare deaths could have been avoided while saving the U.S. approximately $2.0 billion from 2005 through 2007. Between 2005 and 2007, 913,215 total patient safety events were recorded among Medicare beneficiaries, which represents 2.3 percent of the nearly 38 million Medicare hospitalizations. This equates to one reported patient safety event every 1.7 minutes.

 

For the sixth consecutive year, HealthGrades has analyzed patient safety among Medicare patients in all of the nearly 5,000 U.S. non-federal hospitals based on 15 indicators of patient safety developed by the federal government's Agency for Healthcare Research and Quality (AHRQ).

 

This year, 242 hospitals, which represent the top five percent of all hospitals in the U.S., were recognized with a HealthGrades 2009 Patient Safety Excellence AwardTM. HealthGrades developed this award to give patients more information about choosing a hospital.

Study: Every 1.7 minutes a Medicare beneficiary experiences a patient safety event

Letter - The Need to Fix Medicare - NYTimes.com

 

To The Editor:

 

Related: Doctors Are Opting Out of Medicare (April 2, 2009)

 

Re “Doctors Are Opting Out of Medicare” (Retirement section, news article April 2):

 

Thirty percent of Medicare patients who were looking for a new primary care physician say they had trouble finding one, and more of the elderly may find themselves in this situation unless Congress permanently reforms the broken Medicare physician payment system.

 

Every year, Congress must step in at the 11th hour and reverse planned cuts brought on by a system that ties payments to the economy instead of the health care needs of the elderly.....

Letter - The Need to Fix Medicare - NYTimes.com

MedlinePlus: Psychotherapy Can Ease Post-Surgical Depression

Two techniques worked for patients after heart bypass procedures, study finds

HealthDay
By Robert Preidt
Monday, April 6, 2009

MONDAY, April 6 (HealthDay News) -- Two non-drug treatments -- cognitive behavior therapy and supportive stress management -- seem to be more effective than usual care for treating depression in patients who've had coronary artery bypass graft (CABG) surgery, a new study finds.

About 20 percent of bypass patients suffer major depression and another 20 percent experience milder forms of depression, according to background information in the study by Kenneth E. Freedland, of the Washington University School of Medicine in St. Louis, and colleagues.

The study included 123 patients who had major or minor depression one year after bypass. They were randomly selected to receive either usual care (40 patients) as determined by a physician, 12 weeks of cognitive behavior therapy (41 patients), or 12 weeks of supportive stress management (42 patients).

In cognitive behavioral therapy, a psychologist or social worker helped patients identify problems and develop cognitive techniques for overcoming them. In supportive stress management, patients were counseled about how to improve their ability to cope with stressful life events.....

MedlinePlus: Psychotherapy Can Ease Post-Surgical Depression

Bainbridge News Aging In Place

 

Baby Boomers will begin turning 65 in 2011 and 10,000 Baby Boomers will be added every year until 2030. Ami Mejia, speaker at the recent weekly Bainbridge Kiwanis meeting, stated that in 2030, 1 out of every 5 Americans will be a Senior.

 

Seniors have been hit hard by the recession and current housing market, Mejia stated. Retirement accounts have lost value, some are having to seek employment to supplement their income. The downturn in the housing market has effected the equity value of their homes and with fewer buyers they often have a hard time selling their home and there are more seniors filing for bankruptcy.

Bainbridge News Aging In Place

Nightly Business Report . "Get Your Finances Ready for Retirement,"-Baby Boomer Survival Guide | PBS

 

SUSIE GHARIB: Among the five million Americans who've lost jobs in the recession, many are baby boomers. With a bleak outlook for the labor market, many of those laid-off workers are now thinking about retiring early. As we continue our series "Get Your Finances Ready for Retirement," Joe Collum looks at the challenges facing unemployed people in their 50's and 60's.....

Nightly Business Report . "Get Your Finances Ready for Retirement,"-Baby Boomer Survival Guide | PBS

WellPoint, Wall St. will watch Medicare rates | IndyStar.com | The Indianapolis Star

 

INDIANAPOLIS -- Wall Street will be watching when the federal government unveils final Medicare Advantage rates for 2010 after markets close today, nearly two months after insurance stocks sank after the release of preliminary rates.

 

Medicare Advantage allows the elderly and disabled to receive benefits through plans offered by private health insurers. These plans receive a government subsidy and generally offer more benefits than traditional Medicare.

The Centers for Medicare and Medicaid Services said in February the national, average monthly payment rate per capita for Medicare Advantage plans would rise half a percent for 2010.....

WellPoint, Wall St. will watch Medicare rates | IndyStar.com | The Indianapolis Star

Cuts Expected For 2010 Private Medicare Rates - The Hospital Review

 

Monday, 06 April 2009

 

Cuts are expected in the subsidies that the government pays health insurers to run private Medicare programs in 2010, according to a report in the Wall Street Journal.

 

In Feb. 2009, Medicare officials announced that they planned a 5 percent cut in payments after formula adjustments, according to the report. Insurers and medical societies had six weeks to provide regulators with arguments against this plan before the rates were finalized.

More than 10 million people are covered under Medicare Advantage plans, the privatized version of Medicare, according to the report. If payment cuts are little or remain unchanged from the proposed rate, insurers may raise premiums or copays by $50-$80 a month, according to the Blue Cross Blue Shield Association.

Recently, the Obama administration set limits on the amount that seniors covered under Medicare Advantage plans can spend on out-of-pocket charges.

Read the Wall Street Journal's report on the 2010 Medicare Advantage subsidy cuts.

Cuts Expected For 2010 Private Medicare Rates - The Hospital Review

Medicare Expands Coverage of PET Scans Based on Evidence Development Project

Shows pet scans as “reasonable and necessary” for initial treatment decisions of most solid tumor cancers

April 6, 2009 – The Centers for Medicare & Medicaid Services (CMS) today issued a final national coverage determination (NCD) to expand coverage for initial testing with positron emission tomography (PET) scan for Medicare beneficiaries who are diagnosed with and treated for most solid tumor cancers.

 

This NCD removes a clinical study requirement for PET scan use in these patients. 

 

Since 2005, Medicare coverage of PET scans for diagnosing some forms of cancer and guiding treatment has been tied to a requirement that providers to collect clinical information about how the scans have affected doctors’ treatment decisions.....

Medicare Expands Coverage of PET Scans Based on Evidence Development Project

10 Ways to Get and Keep Healthcare Benefits in Retirement - On Health and Money (usnews.com)

 

April 06, 2009 04:47 PM ET | Michelle Andrews

 

As the automakers search for ways to cut costs, one of the areas that are likely to take a hit is retiree healthcare benefits. This was once a perk that many workers took for granted, along with their gold watches, but the number of employers offering retiree health benefits has been declining steadily for decades. Twenty years ago, 66 percent of companies provided retiree health benefits, according to the Kaiser Family Foundation. By 2007, that percentage had fallen by half.

 

Today, the only thing that's certain about retiree health benefits is that they're likely to change. If you have or anticipate getting health insurance through an employer when you retire, those benefits may be reduced or eliminated, if current trends continue. And the Medicare program itself may change. President Obama's budget proposed requiring wealthy seniors to pay more for drug coverage under Medicare Part D, for example, and there has been talk of allowing people as young as 55 to buy into the Medicare program.

 

You can't control what changes may occur. What you can do is evaluate your own options and take steps to get the best healthcare possible once you retire.....

10 Ways to Get and Keep Healthcare Benefits in Retirement - On Health and Money (usnews.com)

Tomah Journal - Opinion

 

Privatized and voucherized Medicare is a really bad deal for recipients.

How do we know? Because Republicans don’t dare suggest imposing voucherized Medicare on anyone who has it now.

Congressional Republicans, led by Wisconsin Congressman Paul Ryan of Janesville, unveiled their alternative budget proposal last week, and one of its major features was a sharp reduction in Medicare benefits for anyone born after 1954. Instead of traditional Medicare, they would receive vouchers for a private health insurance plan.....

Tomah Journal - Opinion

Drugstore Chains Insured Against Health Cuts - WSJ.com

 

The health-care industry is braced for an assault of government reform. Can well-fortified pharmacy chains endure?

 

Events last week in Washington state suggest the chains have a fighting chance. The state government proposed cutting reimbursements on brand-name drugs for Medicaid participants. The change would save the state millions, leaving drugstores to shoulder the burden.

 

But a court stalled the changes after intervention ...

Drugstore Chains Insured Against Health Cuts - WSJ.com

AMNews: News in brief - April 6, 2009 ... American Medical News

 

Nursing homes to see Medicare P4P

Over the next three years Medicare will test a pay-for-performance program with nursing homes in four states, the Centers for Medicare & Medicaid Services announced March 27.

 

Facilities in Arizona, Mississippi, New York and Wisconsin that apply and are chosen to participate will be eligible for bonuses based on performance in maintaining adequate staffing, avoiding hospitalizations, producing positive patient outcomes and passing inspections. Bonuses will be funded through savings produced by improved care.

 

The demonstration will run from July 2009 through June 2012, after which Medicare officials will determine whether to expand it.

AMNews: News in brief - April 6, 2009 ... American Medical News

E.J. Dionne Jr. - Health Care's Year - washingtonpost.com

 

By E.J. Dionne Jr.

Monday, April 6, 2009

 

Yes, this is the year Congress will finally give every American access to health insurance.

 

Getting there won't be pretty. But for the first time since the passage of Medicare in the 1960s, the forces favoring action on health-care reform are stronger than the forces of cynicism and obstruction.

 

Feel free to be skeptical. Since Bill and Hillary Clinton's reform efforts foundered in 1994, predicting the death of any comparable venture has been the safest bet in Washington.

 

But this conclusion misses almost everything that has been happening. It's not just that the public (including business) is frustrated with the status quo. And it has little to do with the details that policy wonks are necessarily hashing over.....

E.J. Dionne Jr. - Health Care's Year - washingtonpost.com

Making the public and private sectors partners in healthcare reform - Los Angeles Times

Merely tweaking what we already have won't do; we need bold new thinking that reduces costs and improves care.

By Harold Luft

April 6, 2009

 

It's a question to which seemingly no one has the correct answer: What's the right model for healthcare reform in America? As The Times' March 27 editorial, "," explains, although negotiations between insurers, consumer groups and lawmakers have shown signs of progress lately -- namely, insurers offered to stop basing policyholders' premiums on medical history -- there are still several non-trivial details to work out. Should the government require everyone who can afford coverage to buy insurance, a provision the industry seeks? Should there be a public insurance plan open to everyone? .....

Making the public and private sectors partners in healthcare reform - Los Angeles Times

Finding a Doctor Who Accepts Medicare Isn’t Easy - NYTimes.com

By JULIE CONNELLY

Published: April 1, 2009

EARLY this year, Barbara Plumb, a freelance editor and writer in New York who is on Medicare, received a disturbing letter. Her gynecologist informed her that she was opting out of Medicare. When Ms. Plumb asked her primary-care doctor to recommend another gynecologist who took Medicare, the doctor responded that she didn’t know any — and that if Ms. Plumb found one she liked, could she call and tell her the name?

 RX Harold and Margret Thomas, with Dr. Steven Knope, a concierge doctor in Tucson who charges a yearly retainer.

Many people, just as they become eligible for Medicare, discover that the insurance rug has been pulled out from under them. Some doctors — often internists but also gastroenterologists, gynecologists, psychiatrists and other specialists — are no longer accepting Medicare, either because they have opted out of the insurance system or they are not accepting new patients with Medicare coverage. The doctors’ reasons: reimbursement rates are too low and paperwork too much of a hassle.

When shopping for a doctor, ask if he or she is enrolled with Medicare. If the answer is no, that doctor has opted out of the system. Those who are enrolled fall into two categories, participating and nonparticipating. The latter receive a lower reimbursement from Medicare, and the patient has to pick up more of the bill.

Doctors who have opted out of Medicare can charge whatever they want, but they cannot bill Medicare for reimbursement, nor may their patients. Medigap, or supplemental insurance, policies usually do not provide coverage when Medicare doesn’t, so the entire bill is the patient’s responsibility.

The solution to this problem is to find doctors who accept Medicare insurance — and to do it well before reaching age 65. But that is not always easy, especially if you are looking for an internist, a primary care doctor who deals with adults. Of the 93 internists affiliated with New York-Presbyterian Hospital, for example, only 37 accept Medicare, according to the hospital’s Web site.

Two trends are converging: there is a shortage of internists nationally — the American College of Physicians, the organization for internists, estimates that by 2025 there will be 35,000 to 45,000 fewer than the population needs — and internists are increasingly unwilling to accept new Medicare patients.....

Finding a Doctor Who Accepts Medicare Isn’t Easy - NYTimes.com

Technorati Tags: Doctors,Medicare,medicare.gov

Many Medicare Patients Rehospitalized, Study Finds - NYTimes.com

By REED ABELSON

Published: April 1, 2009

The nation spends billions of dollars a year on patients’ return visits to the hospital — many of which are readmissions that could be prevented with better follow-up care, according to a study published Wednesday in the New England Journal of Medicine.

As many as a fifth of all Medicare patients are readmitted within a month of being discharged, according to the study, and a third are rehospitalized within 90 days.

Half the patients who returned to the hospital within 30 days of undergoing treatment other than surgery apparently did not see a doctor before they went back.

The high rate of hospital readmissions is “one of the fruits of an increasingly fragmented health care system,” said Dr. Stephen F. Jencks, a former Medicare official who is an author of the study, which analyzed Medicare claims information for 2003 and 2004. He estimated that the cost of the unplanned return trips was $17 billion in 2004 alone.

Policy analysts say that while high return rates have long been a problem, controlling those costs is increasingly urgent.....

Many Medicare Patients Rehospitalized, Study Finds - NYTimes.com

Technorati Tags: Medicare,hospitals,heart failure,diabetes,Nursing homes

CMS announces new rules for Medicare Advantage plans that aim to protect sick beneficiaries from high out-of-pocket costs

CMS on Monday announced that insurers looking to offer Medicare Advantage plans this year must cap out-of-pocket charges and that the agency will eliminate MA plans that have 10 or fewer beneficiaries, the Wall Street Journal reports.

CMS said insurers will be asked by the government to scale back their charges if they do not cap beneficiaries' annual out-of-pocket costs at $3,400 or less, or if they charge beneficiaries more than traditional Medicare for services such as dialysis and home health care. Insurers also will not be allowed to charge sick, low-income beneficiaries more than what they would contribute under traditional Medicare, according to the new rules (Zhang, Wall Street Journal, 3/31).

In addition, CMS will prohibit a practice by Medicare prescription drug plans that charges both a higher copayment for brand-name medication and the difference between the cost of the brand-name drug and a generic version. Higher copays still will be permitted, but the extra cost for the difference between the drugs will no longer be charged to beneficiaries (Alonso-Zaldivar, AP/Boston Globe, 3/30). Insurers offering prescription drug plans will be required to list on their Web sites "all the tools used by the plan to lower costs and improve outcomes," according to CMS. Insurers also will be required to provide more detailed, easier-to-understand information about coverage during the drug benefit's so-called "doughnut hole" coverage gap, in which beneficiaries pay 100% of prescription drug costs.

CMS said it will bar a number of enrollment incentives for the plans, while considering a separate incentives program to encourage plans to focus more on preventive care. The agency said it also will conduct stricter audits of MA and prescription drug plan data (Reichard, CQ HealthBeat, 3/30).

CMS officials said that reducing the number of MA plans offered would lessen confusion among beneficiaries. According to officials, nearly 1,400 of the 7,000 MA plans offered have fewer than 10 beneficiaries. "These low-volume plans crowd the field and make selecting a plan much more difficult," CMS said in a statement (AP/Boston Globe, 3/30). The statement said that less than 1% of MA beneficiaries would be affected by dropping the plans. According to CMS, eliminating the low-volume plans would allow beneficiaries to see positive changes in benefits, formularies and out-of-pocket costs (CQ HealthBeat, 3/30).

CMS announces new rules for Medicare Advantage plans that aim to protect sick beneficiaries from high out-of-pocket costs

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