Ohio Premier Health Solutions

Medical News: ADA: Wal-Mart, Mail-Order Pharmacies Top Affordable Drug List - in Meeting Coverage, ADA from MedPage Today

2009-06-10T12:46:00.001-04:00

By Crystal Phend, Staff Writer, MedPage Today
Published: June 09, 2009
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

NEW ORLEANS, June 9 -- Diabetes patients who shop for the best prices on prescription drugs at mail-order retailers and big-box discounters may save thousands of dollars a year, researchers found.
In an analysis of pricing data obtained from state attorneys general, Medco by Mail and Wal-Mart were the least expensive, while neighborhood and chain pharmacies generally charged the most, Clifton M. Jackness, M.D., and Ronald Tamler, M.D., Ph.D., both of the Mount Sinai School of Medicine in New York, N.Y., reported.
"Being an informed consumer is clearly beneficial," they said here at the American Diabetes Association meeting.
The total monthly out-of-pocket price for all 10 drugs most commonly prescribed to diabetes patients for any indication ranged from a low of $428.35 with Medco to a high of $641.90 with Rite Aid……

Medical News: ADA: Wal-Mart, Mail-Order Pharmacies Top Affordable Drug List - in Meeting Coverage, ADA from MedPage Today

NAHU Washington Update

2009-06-03T14:11:00.001-04:00

Grassroots Efforts Needed to Preserve Account-Based Plans

Thanks to the great work of all of you and your faithful clients, we sent over 75,000 letters to Congress and the White House in May alone. As the weeks go on, please continue to not only participate in the calls to action, but keep encouraging members in your chapters to do so as well.
This week, we are calling on you to help protect and save consumer-driven health care products. Some members of Congress believe that changing the tax treatment of HSAs, FSAs and HRAs will help produce higher federal revenues that could be used to support comprehensive health care reform. Some even believe that there is no place for these plans in comprehensive health care reform.
There are three things you can do in defense of consumer-driven health care. The first step is to e-mail your representatives and senators urging them to oppose making any changes to the tax-preferred status of HSAs, FSAs and HRAs.
After you've sent your letter, direct your clients to one of the following links so they can e-mail their members of Congress with their support for these products. We have written three separate client letters this week. Each is specific to the plan type your clients may have so that they can reach out in support of the plans that they specifically offer to their employees:

Client letter in support of HSAs
Client letter in support of HRAs
Client letter in support of FSAs

Finally, we are compiling stories in defense of consumer-directed health care plans just as we did with Brokers Making a Difference. If you or any of your clients have success stories about HSAs, HRAs or FSAs, we want to hear about them. Submit your stories to CDHCstories@nahu.org. Also be sure to check out our HSA Alliance webpage and sign up for e-mail alerts so you can keep on top of developments regarding HSAs in Washington, DC.

NAHU Washington Update

Nursing Homes Rated - WSJ.com

2009-06-01T17:44:00.001-04:00

By JANE ZHANG

The federal government is stepping up efforts to improve the quality of nursing-home care and now has an online tool consumers can use in evaluating facilities.

The Centers for Medicare and Medicaid Services, or CMS, will start running a pilot program this summer to see if cash incentives to nursing homes can improve the care they provide, especially in areas such as nurse staffing and preventable hospitalizations.

Separately, in December, the agency started ranking facilities based on government inspection results, staffing data and quality measures. This "Nursing Home Compare" system, which gives one to five stars to 16,000 nursing homes, is available at medicare.gov/NHCompare.

The agency also flags some of the most troubled nursing homes -- now about 135 -- on the Web site.....

Nursing Homes Rated - WSJ.com

AMNews: June 1, 2009. Senate panel finishes health reform hearings, foresees bill by mid-June ... American Medical News

2009-06-01T17:39:00.001-04:00

One option being studied is limiting Medicare spending for physicians and hospitals based on adjusted national or regional averages.

By Doug Trapp, AMNews staff. Posted June 1, 2009.

Washington -- The Senate Finance Committee, fresh from public and private roundtable discussions on health system reform, appears on schedule to debate comprehensive legislation by mid-June. The measure is expected to establish a health insurance exchange for people to obtain coverage but would not include a long-term Medicare payment fix for physicians.

Senate Finance Committee Chair Max Baucus (D, Mont.) said on May 21 that he is confident the panel will reach a bipartisan agreement on reform legislation. But committee members disagree on how to pay for provisions in the bill and on the need for a national public health insurance plan to compete with private plans, according to Baucus and Sen. Charles Grassley (Iowa), the highest-ranking Republican on the Finance panel.....

AMNews: June 1, 2009. Senate panel finishes health reform hearings, foresees bill by mid-June ... American Medical News

Workers’ vote: Yes - TribToday.com - Tribune Chronicle - Warren, OH

2009-06-01T17:34:00.001-04:00

Lordstown UAW members OK pact; GM awaits national results
By LARRY RINGLER Tribune Chronicle

Girard resident Laray Thomas, 62, who stopped to get information, didn't like losing vision, dental and catastrophic health insurance as of July 1.

''You come to the age where you need it, and now you have to pay the full cost. It'll make it harder to live on a fixed income,'' said Thomas, who retired in 1998 after 30 years.

Scott Lee, outgoing vice president for Local 1714, said the weak economy forced the union to make concessions but added he doesn't like the way retirees are being hurt.

''They say these are legacy costs, but these are the people who built the company,'' said Lee, whose family history at Lordstown goes back to his grandfather. ''Hopefully, Washington will wake up to the middle class and stop or reduce imports'' of vehicles.

Workers’ vote: Yes - TribToday.com - News, Sports, Jobs, Community Information - Tribune Chronicle - Warren, OH

Medicare discounts offered | NewsOK.com

2009-06-01T17:26:00.001-04:00

POINT OF VIEW Value-Based Care Centers

BY STEVEN LANDGARTEN, M.D.

Published: May 30, 2009

Evidence-based medicine and public reporting of results have been strongly encouraged by the federal government, which is the largest purchaser of medical care in the United States. In recent years, the government has moved from simply paying for care to providing financial incentives to encourage health care providers to collect and report data for a standard set of quality measures. Today, consumers can visit a government Web site (hospitalcompare.hhs.gov) to view a hospital’s performance in providing recommended care to patients.

A new demonstration project from the Centers for Medicare and Medicaid Services (CMS) takes this initiative one step further by providing financial incentives to qualifying Medicare patients who select a health care provider based on quality and price.

Medicare discounts offered | NewsOK.com

Annals of Medicine: The Cost Conundrum: Reporting & Essays: The New Yorker

2009-06-01T17:20:00.000-04:00

What a Texas town can teach us about health care.

by Atul Gawande June 1, 2009

The explosive trend in American medical costs seems to have occurred here in an especially intense form. Our country’s health care is by far the most expensive in the world. In Washington, the aim of health-care reform is not just to extend medical coverage to everybody but also to bring costs under control. Spending on doctors, hospitals, drugs, and the like now consumes more than one of every six dollars we earn. The financial burden has damaged the global competitiveness of American businesses and bankrupted millions of families, even those with insurance. It’s also devouring our government. “The greatest threat to America’s fiscal health is not Social Security,” President Barack Obama said in a March speech at the White House. “It’s not the investments that we’ve made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care. It’s not even close.”

The question we’re now frantically grappling with is how this came to be, and what can be done about it. McAllen, Texas, the most expensive town in the most expensive country for health care in the world, seemed a good place to look for some answers.....

Annals of Medicine: The Cost Conundrum: Reporting & Essays: The New Yorker

Ask Medicare, May/June 2009

2009-06-01T12:37:00.001-04:00

Note: Click the hyperlink to view the full story.

Welcome to Ask Medicare, the e-newsletter for caregivers. Read the May/June edition here:
www.cms.hhs.gov/MyHealthMyMedicare/downloads/AskMedicare_may2009.pdf

In this edition:

Stay Active, Stay Healthy
CHIP Covers More Kids
Prevent Broken Bones
Pay $2.40 for Prescription Drugs
Get the Most from Doctor Visits
7 Questions to Ask About Your Medicine

To let us know what YOU care about, email Ask Medicare at caregiver_comments@cms.hhs.gov.

Medicare Educational Seminar June 2, 2009

2009-06-01T11:29:00.001-04:00

WHEN: The first Tuesday of every month, next program: June 2, 2009 at 7:00 pm

WHERE: 164 Valley Circle (model home) within the Shepherd of the Valley-Howland
Community, 4100 North River Road, Warren

WHY: Confused About Medicare? Don’t worry. We can help! Ohio Premier Health Solutions has partnered with Shepherd of the Valley to bring you this informative introductory seminar on Medicare. With all of the options available today, it is no wonder everyone is confused. From Medicare supplements to Medicare Advantage plans to discount prescription programs, how can you know what the best option is for YOU?!? The program will be presented in Shepherd of the Valley-Howland’s beautiful model home. Refreshments will be provided.

Featured Speaker: Leslie Brazel. Leslie brings 15 years of experience in developing service coordination programs for seniors. She is licensed in Life and Health Insurance and was certified as a Medicare Specialist by the Ohio Senior Health Insurance Information Program.

For more information contact either:

Leslie Brazel, Ohio Premier Health Solutions
330.394.7400 or leslie@premierhealthsolution.com

Carole Moore, Shepherd of the Valley-Howland
330-856-9232 or cmoore@ShepherdoftheValley.com

###

Health care: Keep treatment costs down - Letters Unlimited - Cleveland.com

2009-05-31T14:14:00.000-04:00

Posted by Janet Trautwein, Arlington, Va. May 31, 2009 04:29AM

Trautwein is executive vice president and CEO of the National Association of Health Underwriters.

Demonizing private health insurers with such tactics as antitrust investigations may make for good political theater, but it will do nothing about America's skyrocketing health care costs ("Activists seek Justice Dept. probe of insurers," May 20).

Health care isn't expensive because of insurance -- it's the other way around. Insurance has become so costly because the medical goods and services it pays for have become so costly.

Injecting more government into the health care system by creating a public insurance plan would only make things worse. Because of the systematic underpayment of hospitals and doctors by existing government health programs like Medicare and Medicaid, the average family of four is saddled with an extra $1,500 a year in premiums.

Policymakers can bring down health costs by expanding access to consumer-driven offerings like high-deductible individual policies.

Health care: Keep treatment costs down - Letters Unlimited - Cleveland.com

Newswise Law and Public Policy News | Education Campaign Needed on Social Security, Medicare Woes, Expert Says

2009-05-29T12:58:00.000-04:00

Source: University of Illinois at Urbana-Champaign

Newswise — Painful but inevitable Social Security and Medicare reforms will be difficult to sell because years of partisan wrangling have clouded the public’s grasp of the programs’ dire financial problems, a former government economic adviser warns.

University of Illinois finance professor Jeffrey R. Brown hopes this week’s report that both programs will run out of money sooner than previously thought will help cut through confusion over the fiscal outlook of the federal retirement and health-care systems.

He blames years of political rancor, including a 2005 standoff during which Democrats sank reforms proposed by President Bush, arguing that his forecast of a funding crisis was fabricated and that both systems would be financially sound for decades. Many Republicans contributed, too, saying the problem was real but could be solved relatively painlessly by allowing people to invest their contributions in the stock market.

“So on one hand, the public hears all of these daunting reports about the need to reform these programs, but on the other hand they hear political leaders saying this is a phony crisis and everything will be fine, or that the problem is real but painless to fix,” said Brown, a former member of the bipartisan Social Security Advisory Board. “Neither of those positions is tenable.”

Brown warns that the challenge is real and worsening, and suggests the U.S. follow Britain’s lead by mounting an extensive public awareness campaign to clear up confusion and make a case for change.....

Newswise Law and Public Policy News | Education Campaign Needed on Social Security, Medicare Woes, Expert Says

Newswise Medical News | Overwhelming Medicare Plan Choices Spell Confusion

2009-05-28T17:06:00.000-04:00

Source: Health Behavior News Service

Newswise — In a sign of the challenges facing seniors on Medicare, a new study finds that older Americans are more likely to make poor choices when faced with a wide array of drug-coverage plans. Making matters worse, many are confident they made the right decisions.

“There is information overload when there are too many drug plans for seniors to choose from,” said study co-author Thomas Rice, vice chancellor at the University of California at Los Angeles. “Congress needs to take this issue very seriously.”

The risk, he said, is that seniors will choose the wrong plans and end up needlessly spending hundreds of dollars a year.

Medicare, which mostly serves seniors, has offered coverage for prescription drugs since 2006. A typical senior chooses from a list of 50 drug plans, Rice said.

Advocates for the elderly have expressed concern that the choices are overwhelming. In the new study, published online in the journal Health Services Research, Rice and colleagues sought to understand how the number of choices affects decision-making.

The researchers created hypothetical drug plans and asked 180 adults in Claremont, Calif., to consider which one they would recommend that a friend choose. Half of the adults were age 65 or older. The researchers randomly divided the participants into groups and gave them information about three, 10 or 20 plans.

The researchers found that older people fared worse when asked to make a choice. People age 65 and older were only 41 percent as likely as younger people were to know which plan was the cheapest.....

Newswise Medical News | Overwhelming Medicare Plan Choices Spell Confusion

CQ Politics | Millions of Medicare Beneficiaries Face Reduced Social Security Benefits

2009-05-28T12:53:00.000-04:00

By CQ Staff

New Social Security recipients and upper-income seniors could face a steep increase in their monthly Medicare premiums for the next two years, according to an analysis released Tuesday by a nonprofit health research group.

Millions more will see their finances squeezed if their premiums for Medicare Part D prescription drug coverage go up during that period.

Congress could intervene to soften the blow, but doing so would be costly at a time of ballooning deficits.

The study, by the Kaiser Family Foundation, points out that Social Security and Medicare trustees project no cost-of-living adjustment (COLA) to Social Security benefits in 2010 and 2011, and only a tiny one in 2012. The COLA is pegged to an inflation index, and the economic recession has erased increases in the relevant index.

This year, seniors received a 5.8 percent COLA, the largest in more than a quarter-century, but those days are gone for the near future.

Over the next two years, however, monthly premiums for Medicare Part B coverage will increase sharply under existing law, which requires premiums to cover 25 percent of program costs. Part B pays for doctor bills and other outpatient costs, and the monthly premiums that seniors pay are deducted from their Social Security benefits. The 2009 premium for most beneficiaries is $96.40 per month.

Medicare trustees project Part B premium increases to $104.20 per month in 2010 and $120.20 per month in 2011.....

CQ Politics | Millions of Medicare Beneficiaries Face Reduced Social Security Benefits

The Associated Press: States consider cutting drug help for seniors

2009-05-28T12:49:00.000-04:00

By RAY HENRY – 4 days ago

PAWTUCKET, R.I. (AP) — Joanne Devlin needs about 20 prescription drugs to regulate her blood pressure, keep her arthritic joints limber and pain-free and control her asthma.
She counts on financial help from Rhode Island when her Medicare Part D insurance plan maxes out and no longer pays her drug bills, which can reach $3,000 every three months. But that state help may no longer be an option after Jan. 1.
The financial crisis has grown so severe that lawmakers in Rhode Island and five other states have debated whether to cut or reduce the state funding that helps seniors and disabled people like Devlin buy their drugs.
Devlin, 62, who lives off about $10,000 a year, worries she may need to stop taking her arthritis medication to make ends meet. She stocks shelves and helps distribute food as a volunteer at a Salvation Army food shelter.
"I wouldn't be able to move a lot," she said. "I probably wouldn't even be able to come here. I'd probably have to stay home and some days be bedridden, probably."
Devlin's predicament is shared by many of the nearly 27 million people enrolled nationally in Medicare Part D, the federal insurance plan that covers prescription drugs for seniors until the total bill reaches $2,700.
Seniors then hit what's commonly called the "doughnut hole," and must personally pay the drug bill until their out-of-pocket costs reach $4,350, at which point Medicare coverage resumes. When seniors fall into this gap, 16 states offer financial assistance, said Thomas McCormack, a consultant for the Community Access National Network and editor of the Medicaid Watch newsletter.

The Associated Press: States consider cutting drug help for seniors

Reimbursement Issues with Medicare / Medicaid: A Free Article from Clifford Law Offices, Personal Injury Attorneys in Chicago

2009-05-28T12:44:00.000-04:00

The Chicago law office, Clifford Law Offices, is posting legal articles on their website (http://www.cliffordlaw.com) in an effort to educate the public about legal matters such as personal injury. An introduction is provided, with a link to the full article.

Chicago, IL (PRWEB) May 28, 2009 -- A new law is slated to take effect July 1 that impacts claims involving Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA). While Medicare has the right to reimbursement of money it paid for medical care rendered to injury victims since 1980, the MMSEA will require insurance companies to register on behalf of a Medicare claimant in an injury case. The aim is to insure that Medicare is compensated and parties that fail to repay will be subject to a $100 per day penalty.
Robert Clifford, nationally renowned personal injury attorney based out of Chicago, wrote about potential solutions to the anticipated issues arising from the new MMSEA requirements in a piece originally published in Chicago Lawyer entitled, 'Reimbursement Issues.' In the article, Clifford advocates for a course of action that is guided by protecting the client's due process that would otherwise be violated if an unusual length of time were to pass before settlement money was distributed to victims. Clifford goes on to describe a Medicare compliance process instituted by plaintiff's firms that would verify, negotiate, and resolve Medicare's reimbursement claims.
Read the full Medicare / Medicaid Reimbursement Issues article here.
"Clifford Law Offices offers these free articles to help educate people about subjects such as Reimbursement Issues for Medicare and Medicaid," says Robert A. Clifford, Founder.
###

Reimbursement Issues with Medicare / Medicaid: A Free Article from Clifford Law Offices, Personal Injury Attorneys in Chicago

Health insurer suggests ways to save government $500 billion - San Jose Mercury News

2009-05-28T12:41:00.000-04:00

By Erica Werner

Associated Press

Posted: 05/27/2009 06:17:11 PM PDT

Updated: 05/28/2009 08:40:20 AM PDT

WASHINGTON — A major health insurer says the government can save more than $500 billion in Medicare spending by sending patients to less expensive, more efficient doctors, reducing hospital visits by the elderly and cutting unnecessary care.

Those are among 15 suggestions made Wednesday by UnitedHealth Group, a Minnesota-based health management company that is the biggest participant in the government's Medicare insurance program for the elderly. United said the proposals added up to $540 billion in savings over 10 years.....

Health insurer suggests ways to save government $500 billion - San Jose Mercury News

Healthcare Reform that Doesn't Address Long Term Care Would Be a Failure - John A. Farrell (usnews.com)

2009-05-22T16:03:00.001-04:00

May 22, 2009 03:36 PM ET | John Aloysius Farrell

By John Aloysius Farrell, Thomas Jefferson Street blog

"It is absurd," writes Howard Gleckman, "to expect someone to clean feces from a dementia patient every day for nine dollars an hour for no benefits."

But, as anyone who has cared for an aging parent or terminally ill friend or disabled neighbor or relative knows, America's hodge-podge system of long-term care is packed with such assumptions. And some 54 million of us wrestle with them every day.

Here is one of my favorites: if you suffer a massive heart attack and need expensive medical care in your golden years, it is likely that Medicare will cover your bills.

But if you have the bad luck to contract Alzheimer's disease, it's sorry pal, you're on your own.....

Healthcare Reform that Doesn't Address Long Term Care Would Be a Failure - John A. Farrell (usnews.com)

AARP Ramps Up Effort To Close Medicare Doughnut Hole - KYPost.com

2009-05-19T17:50:00.000-04:00

Web Produced: Jessica Noll
Email: Jessica.Noll@kypost.com
Last Update: 5/19 3:45 pm

(Getty Images)

LOUISVILLE, Ky – AARP’s Health Action Now campaign turns its attention this week to the growing problem of prescription drug costs and reducing the gap in prescription drug coverage for people in Medicare.

Closing the Part D doughnut hole could save people in the program thousands of dollars in drug costs and keep them healthier by ensuring they can afford their medications.

The Association is pressing lawmakers to lower individuals’ drug costs as a part of health reform, including closing the doughnut hole—[which forces more than 3 million people in Medicare to pay their full drug costs each year]—and increasing the availability of generic drugs, particularly generic versions of costly biologics.....

AARP Ramps Up Effort To Close Medicare Doughnut Hole - KYPost.com

AMNews: Editorial - May 18, 2009. Help for physicians on Medicare deadlines ... American Medical News

2009-05-18T12:21:00.000-04:00

CMS is making it tougher for doctors to enroll or update Medicare information. An AMA resource lets members cut through red tape.

Editorial. Posted May 18, 2009.

Physicians re-enrolling in or reporting changes to Medicare lately understandably might feel that one inadvertent false move could have catastrophic results.

That's because the Centers for Medicare & Medicaid Services has put even stricter rules on how long physicians and others have to report on certain practice-related changes -- with failure to comply possibly resulting in a year or two of banishment from the program.....

AMNews: Editorial - May 18, 2009. Help for physicians on Medicare deadlines ... American Medical News

AMNews: May 18, 2009. 2010 HHS budget looks to use Medicare savings for reform ... American Medical News

2009-05-18T12:20:00.000-04:00

The Obama administration also will look into removing physician-administered drugs from the calculation of the Medicare pay formula.

By Chris Silva, AMNews staff. Posted May 18, 2009.

Washington -- Preventing Medicare pay cuts for physicians and finding funding for additional rate updates could prove easier if Congress follows a health budget released May 7 by President Obama.

The president's fiscal 2010 budget for the Dept. of Health & Human Services totals $879 billion in outlays, an increase of $63 billion over fiscal 2009. Although it calls for additional spending in several areas, it also proposes saving hundreds of billions of dollars from Medicare so the money can be spent elsewhere, possibly on boosting physician pay or other reforms.....

AMNews: May 18, 2009. 2010 HHS budget looks to use Medicare savings for reform ... American Medical News

Medical News: Senators Disagree on Public Health Insurance Plan - in Washington-Watch, Washington Watch from MedPage Today

2009-05-15T13:19:00.000-04:00

By Emily P. Walker, Washington Correspondent, MedPage Today
Published: May 15, 2009

WASHINGTON, May 15 -- With just a month to go until a bipartisan healthcare reform bill is to be unveiled, Democratic and GOP senators remain at an impasse over the public plan portion of reform.
After an eight-hour, closed-door meeting of the Senate Finance Committee on Thursday, Sen. Charles Grassley of Iowa, the committee's ranking Republican, said members are no closer to consensus on the most controversial part of reform: the inclusion of a government-run insurance plan that would be an alternative to private insurance.
"We haven't been able to reach an agreement," Grassley said during a postmeeting recap for reporters.....

Medical News: Senators Disagree on Public Health Insurance Plan - in Washington-Watch, Washington Watch from MedPage Today

Health Plans Would Add to Controls on Insurers - NYTimes.com

2009-05-15T12:18:00.000-04:00

By ROBERT PEAR Published: May 15, 2009

WASHINGTON — The government could rein in aggressive marketing practices of health insurance companies, regulate their premiums and allow workers to drop out of group health plans to seek a better deal on their own under legislation being developed by leading Democratic senators.

The Senate proposals, which emerged this week, are broadly similar to ones being drafted by the chairmen of three House committees. Democrats in both houses would vastly expand federal regulation of insurance to guarantee that all Americans have access to affordable coverage, a top priority of President Obama.

Lawmakers have not figured out how to pay for their proposals, which could easily cost more than $1 trillion over a decade. And they have not resolved the politically explosive question of whether to create a public insurance program, to compete with private insurers.

But after a week of intense discussions, in which members of the House and the Senate immersed themselves in the details of health care, Democrats began to line up in favor of several basic ideas.....

Health Plans Would Add to Controls on Insurers - NYTimes.com

Extending Medicare: Medical and National Suicide -- Seeking Alpha

2009-05-15T12:11:00.000-04:00

By Simon Smelt | May 15, 2009

Medicare and social welfare are heading for insolvency more rapidly than previously forecast. The $50 trillion plus of their unfunded liabilities (according to the government’s “Financial Report of the United States” is beginning to appear over the horizon. At the same time, the U.S. Congress is discussing extending Medicare to those not covered.

But maybe that’s OK because the industry has said it is going to get costs under control and save literally trillions.

Alas, closer inspection shows the idea of extending Medicare to be suicidal and the trillions in savings do not exist, based on the government’s own figures.....

Extending Medicare: Medical and National Suicide -- Seeking Alpha

Medical News: Pfizer Offers Year of Free Meds to Unemployed - in Product Alert, Prescriptions from MedPage Today

2009-05-15T12:08:00.000-04:00

By John Gever, Senior Editor, MedPage Today
Published: May 14, 2009

WHEELING, W.Va., May 14 -- Drug giant Pfizer said unemployed people who have been taking its branded products could receive them free for up to a year in a new program -- with some exceptions.

The program, called MAINTAIN, will provide access to more than 70 Pfizer drugs including atorvastatin (Lipitor), celecoxib (Celebrex), pregabalin (Lyrica), and sildenafil (Viagra).

But the program excludes biologics, most cancer drugs, and other of Pfizer's most expensive products.

Individuals who became unemployed after Jan. 1 of this year are eligible for the program and may sign up through Dec. 31.

Other eligibility requirements include having taken the branded Pfizer drug for at least three months prior to losing a job, having no other prescription drug coverage, and being able to attest to financial hardship.

Income prior to becoming unemployed is not a factor, Pfizer said. But participants who regain employment or prescription drug coverage will have to start paying again.

A stock analyst quoted by the Associated Press pointed out that the program is likely to prevent some current Pfizer drug customers from switching to generic equivalents.

The company said it was taking signups today, although the program would not be fully operational until July 1.

Pfizer said signups and additional information on the MAINTAIN program would be available at Pfizer Helpful Answers or by calling 866-706-2400 toll-free.

Medical News: Pfizer Offers Year of Free Meds to Unemployed - in Product Alert, Prescriptions from MedPage Today

Higher Medicare Premiums in Store For Some Retirees - Planning to Retire (usnews.com)

2009-05-15T12:02:00.000-04:00

May 14, 2009 05:40 PM ET | Emily Brandon

The recession is taking its toll on Social Security and especially Medicare. This year’s annual checkup found that the Social Security trust fund is predicted to be exhausted until 2037, 4 years sooner than last year, according to the Social Security Board of Trustees report. Medicare’s hospital insurance trust fund is expected to be emptied even sooner, in 2017.

Costs for Medicare Parts B and D, which cover doctors' bills and prescription drugs respectively, are predicted to increase an average of 6.4 annually over the long-term, according to the report. That means higher enrollee premiums and the need for more general revenue funding.

Most retirees won’t have to pay higher premiums in the near future because a current law doesn’t allow Medicare Part B premiums to be raised higher than Social Security increases for most retirees. The Congressional Budget Office predicts that there will be no cost-of-living increases for Social Security beneficiaries in 2010 through 2012, which also means no Medicare Part B premium hike for the majority of beneficiaries.

But about one quarter of Medicare Part B enrollees will be subject to unusually large premium increases in the next two years, according to the Trustees report.....

Higher Medicare Premiums in Store For Some Retirees - Planning to Retire (usnews.com)

Health Costs Are the Real Deficit Threat - WSJ.com

2009-05-13T12:01:00.000-04:00

By PETER R. ORSZAG

This week confirmed two important facts -- that health-care costs are the key to our fiscal future, and that even doctors and hospitals agree that substantial efficiency improvements are possible in how medicine is practiced.

David Gothard

The numbers speak for themselves. The Medicare and Social Security trustees' reports released this week show that health-care costs drive our long-term entitlement problem. An example illustrates the point: If costs per enrollee in Medicare and Medicaid grow at the same rate over the next four decades as they have over the past four, those two programs will increase from 5% of GDP today to 20% by 2050. Despite the attention often paid to Social Security, spending on that program rises much more modestly -- from 5% to 6% of GDP -- over the same time period. Over the long run, the deficit impact of every other fiscal policy variable is swamped by the impact of health-care costs.

Spiraling health-care costs are not just some future abstraction, however. Right now, families across America who have health insurance are seeing their take-home pay reduced and their household budgets strained by high costs and spiraling premiums. State and local governments also are feeling this pinch. And the growing weight of health costs on state budgets translates into an inability to make investments in areas such as education, hindering our overall economic growth.

The good news is that there appear to be significant opportunities to reduce health-care costs over time without impairing the quality of care or outcomes. In health care, unlike in other sectors, higher quality currently seems to be associated with lower cost -- not the opposite.....

Health Costs Are the Real Deficit Threat - WSJ.com

Medical News: Medicare Finalizes Denial of Virtual Colonoscopy Coverage - in Public Health & Policy, Medicare from MedPage Today

2009-05-13T11:58:00.000-04:00

By John Gever, Senior Editor, MedPage Today
Published: May 13, 2009

BALTIMORE, May 13 -- CT colonography for colorectal cancer screening will not be covered under Medicare, the Centers for Medicare and Medicaid Services has confirmed.

The agency issued a final decision memo yesterday that reiterates the coverage denial proposed in February in draft form. (See Medicare to Deny Coverage of CT Colonography Screening)

"The evidence is inadequate to conclude that CT colonography is an appropriate colorectal cancer screening test under § 1861(pp)(1) of the Social Security Act," according to the final CMS memo.

Although the 30-day comment period following publication of the draft memo brought many requests to allow at least some coverage for the procedure, CMS stuck to its conclusion that there is not enough evidence to support the procedure in the Medicare population.

Agency analysts cited evidence from numerous studies that found CT colonography less sensitive for smaller lesions.

Medical News: Medicare Finalizes Denial of Virtual Colonoscopy Coverage - in Public Health & Policy, Medicare from MedPage Today

Health Care Reform Outlook Clear? Don't Count on It | 44 | washingtonpost.com

2009-05-13T11:41:00.000-04:00

By Dan Balz
The gathering of industry leaders standing with President Obama in the White House pledging to cut up to $2 trillion in health care costs over the next decade suggests a gathering of momentum behind one of the president's signature domestic initiatives. The train is leaving the station. All aboard!

Perhaps. While 2009 may not be 1993-94, the truth is that it still may be too early to declare that the constellation of forces in favor of reform is cohesive and strong enough to weather the battle that will surely come. Whatever goodwill Obama can create now he will need later this year to persuade the House and Senate -- and the array of special interests involved in health care -- to enact a comprehensive reform package.

The story line is developing that the political climate is dramatically different today than it was during the Clinton administration, when health care reform ultimately crashed and burned without ever coming to a vote on the floor of the House or Senate. There is some truth to that, but not so much as people might assume......

Health Care Reform Outlook Clear? Don't Count on It | 44 | washingtonpost.com

Report: Medicare faces cash crunch - UPI.com

2009-05-13T11:38:00.000-04:00

Do you worry about Social Security and Medicare?

WASHINGTON, May 12 (UPI) -- A U.S. government report by the trustees who monitor Medicare and Social Security predicts the Medicare trust fund will run out of money by 2016.

The U.S. Department of Health and Human Services said in a statement Tuesday that last year 45.2 million people were covered by Medicare. About 22 percent of beneficiaries have enrolled in private health plans that contract with Medicare to provide healthcare services.

The report said the Medicare hospital insurance fund "does not meet the short-range test of financial adequacy," noting that the fund has not been considered satisfactory since 2003. The report said the fund's financial health has dipped amid the nation's current recession.

"The HI trust fund is not adequately financed over the next 10 years," the report said. "At the beginning of 2009 the assets of the HI trust fund were $321 billion and are projected to be exhausted during 2017, under the intermediate assumptions."

As for Medicare Part B and Part D accounts in the Supplemental Medical Insurance trust fund, the report said they are "adequately financed" since premium and general revenue income are reset each year to match expected costs.

The report said total Medicare expenditures were $468 billion in 2008, and were expected to increase faster than workers' earnings or the overall economy in the coming years.

"This isn't just another government report. It's a wake up call for everyone who is concerned about Medicare and the health of our economy," said Health and Human Services Secretary Kathleen Sebelius said. "And it's yet another sign that we can't wait for real, comprehensive health reform."

Report: Medicare faces cash crunch - UPI.com

Recession puts Social Security in spotlight - May. 11, 2009

2009-05-12T11:33:00.001-04:00

The forgotten fiscal problem

The recession has put the debate over Social Security's fiscal health in the shadows. A report Tuesday could revive it - at least for awhile.

By Jeanne Sahadi, CNNMoney.com senior writer

Last Updated: May 12, 2009: 9:24 AM ET

NEW YORK (CNNMoney.com) -- The financial crisis has cast a shadow over a perennial debate in Washington: How to ensure the long-term financial health of Social Security.
While President Obama has taken on more major issues in his first few months than most presidents, the entitlement program for retirees hasn't made the list.
But on Tuesday, the reform debate is likely to be revived, if only temporarily, with the release of the annual report from the trustees who oversee Social Security and Medicare.
Experts expect the trustees' short-run projections for both programs to be worse than they were a year ago.....

Recession puts Social Security in spotlight - May. 11, 2009

» WH Release: “Coming Together to Bring Down the Cost of Health Care” Row 2, Seat 4 « FOXNews.com

2009-05-12T11:23:00.000-04:00

Daniela Sicuranza
Contributing Editor

White House Press Release: "Coming Together to Bring Down the Cost of Health Care Fact Sheet "

RISING HEALTH CARE COSTS ARE BURDENING FAMILIES, BUSINESSES, GOVERNMENTS, AND THE ECONOMY: For years, rising health care costs have been a burden on families, businesses, and the entire economy. Since 2000, health insurance premiums have almost doubled and health care premiums have grown three times faster than wages. These rising costs have eroded the financial stability of all Americans as families have had to pay more for insurance coverage; have been exposed to a greater risk of personal bankruptcy as deductibles and co-payments increase; and have seen their actual benefits decrease as employers search for ways to rein in escalating health care costs. As families and businesses have struggled with these rising costs, states have also been forced to cut back on investments in areas that are critical to long-term prosperity such as higher education and infrastructure. Overall, health care is consuming an ever-increasing amount of our nation's resources: at the current rate, health care will eat up more than 20 percent of GDP in 2018. Reforming health care is the key to restoring financial stability for American families and businesses and for securing our fiscal future.....

» WH Release: “Coming Together to Bring Down the Cost of Health Care” Row 2, Seat 4 « FOXNews.com

New Report: Home Health Care Saves Billions for Medicare

2009-05-12T11:21:00.000-04:00

Avalere Health Finds Home Health Use Saved $1.71 Billion for Medicare in 2005-2006

AHHQI Believes Medicare Could Realize More Than $30 Billion in Savings for Chronic Disease Patients in Next Ten Years By Expanding Access to Home Health

Early use of home health care services following a hospital stay by patients with at least one chronic disease saved Medicare $1.71 billion in the two-year 2005-2006 period, according to a study released today by Avalere Health LLC. The study, sponsored by the Alliance for Home Health Quality and Innovation (AHHQI), also found that an additional $1.77 billion would have been saved in the same period if all Medicare beneficiaries with similar chronic diseases had accessed home health care services. Approximately 12.7% of the savings is attributable to reductions in hospital readmissions, and it is presumed that the remaining savings accrue from avoiding more costly institutional settings. AHHQI believes that the unrealized savings identified in this study could allow Medicare to save $31.1 billion over the next ten years by expanding access to home health for chronic disease patients.....

New Report: Home Health Care Saves Billions for Medicare

The Associated Press: Obama wants $58 billion in taxes to offset errors

2009-05-12T11:18:00.000-04:00

By STEPHEN OHLEMACHER – May 11, 2009

WASHINGTON (AP) — The Obama administration on Monday proposed $58 billion in additional taxes to offset budgeting errors that overstated revenues in the president's plan to finance health care reform.

The tax measures target a host of activities, including people who for tax purposes aggressively reduce the value of property received as gifts or in estates. To reduce fraud, other provisions would require investors, contractors and taxpayers to provide more information about certain transactions to the Internal Revenue Service.

The largest budgeting error overstated the amount of money that would be raised by limiting charitable and other deductions for high-income taxpayers. The limits would generate $267 billion over the next 10 years — $51 billion less than the administration projected in February.....

If I made an error like that, I would get fired!!!

The Associated Press: Obama wants $58 billion in taxes to offset errors

It's time to heal our health care system

2009-05-12T11:08:00.000-04:00

May 11, 2009

BY BOBBY L. RUSH

One of the most profound questions Jesus asked during his ministry was put before a sick man who had spent 38 years waiting near the base of the Bethesda well for his turn at treatment. ''Do you want to get well?'' Jesus queried, as the man lay surrounded by other broken, paralyzed, blind, mentally and spiritually infirmed people waiting for his turn to be healed.

Today, the man from this story could be any one of America's poor or uninsured who lay in wait within the nation's many overburdened hospital emergency rooms. It is only because of faith and perseverance that I am not one of them. As a recovering cancer patient, I have experienced firsthand the lifesaving work of physicians, nurses and other health care workers who are able to focus on restoring a person's health rather than being saddled by administrative policy and financial restrictions.

Recently, a hospital in my district has come under fire for reportedly engaging in a deplorable practice known as "patient dumping," the inhumane exercise of turning away poor, uninsured and elderly patients to other facilities, refusing to administer care due to overcrowding and other obstacles. It should be no surprise that a majority of the patients being turned away are poor, and often people of color. This practice is even more startling when you consider that six hospitals have closed on Chicago's South Side, placing an enormous burden on any hospital whose doors are still open, with thousands of people depending on fewer hospitals, atop the over restrictive nature of an already-broken health care system.

Nearly 47 million Americans are without health insurance. Since the beginning of the recession, an estimated 4 million more Americans have lost their health insurance. On average, 14,000 Americans lose their coverage every day. Where, then, do these citizens go and to whom do they turn when they need to get well? Are they condemned to suffer silently, waiting for 38 years like the man at the foot of the Bethesda well?

Health care reform is the single most important domestic issue facing our nation. In 2007, we spent $2.2 trillion on health care. This is why expanding coverage and making insurance affordable has been one of my top priorities since taking office in 1993. We are increasingly becoming a nation of the "have-mores" vs. the "have-nots" -- the invisible people who linger on the margins of society as they seek the American Dream.

This is why I have co-sponsored the "Access to Emergency Medical Services Act of 2009" (H.R.1188/S.468) and am an original co-sponsor to H.R. 1678, both of which will improve access, quality and efficiency of emergency care.

I also sponsored pioneering health legislation called the Melanie Blocker Stokes Postpartum Depression Research and Care Act (H.R.20/S.324). This bill will provide immediate attention and resources toward one of the most underdiagnosed conditions after childbirth. It has passed the House and is on its way to becoming law.

There is growing support for my Medicare bill (H.R. 444), which will expand the federal discount drug program to make it easier for the underinsured and low-income patients to access the medication they need. These efforts are just a small piece of the health care reform puzzle that must be put together. And I urge all of you to call on your elected officials to get engaged in these issues, as well.

President Obama and Congress have made it a top priority to pass comprehensive health care reform legislation this year that lowers costs, improves quality, increases coverage and preserves patient choice of plan and doctors. Left alone, our broken health care system will cost the American people another $2.2 trillion. We need reform now. Families cannot wait. America cannot wait.

When it comes to U.S. health care reform, lawmakers can no longer act like Sisyphus, a man condemned to forever roll a ball up a never-ending hill, moving forward but never making progress. It is time for America's health care system to answer the question, "Do we want to get well?"

U.S. Rep. Bobby L. Rush represents the 1st Congressional District of Illinois.

Thyatiria Towns

Office of Congressman Bobby L. Rush

700 East 79th Street

Chicago, Illinois 60619

773-224-6500 (office)

773-224-9624 (fax)

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Sign up for Congressman Bobby L. Rush's Issue Alerts and our E-Newsletter at: http://www.house.gov/rush/

AMNews: May 11, 2009. Senate panel suggests delay in long-term reform of Medicare pay ... American Medical News

2009-05-12T11:03:00.000-04:00

The proposal would put off changing the formula for a few years until reform demonstrations proved effective.

By Doug Trapp, AMNews staff. Posted May 11, 2009.

Washington -- Senate Finance Committee leaders on April 28 offered a list of ideas for the first third of a national health reform bill, but a private discussion between senators and their staffs the next day did not produce significant agreements on the proposed solutions.

Nevertheless, the 48-page draft, which addressed improving patient care and reducing costs, provided more detail on the direction Senate Finance Committee Chair Max Baucus (D, Mont.) and highest-ranking Republican Charles Grassley (Iowa) would like to take health system reform. The draft was released after the first of three Finance public roundtable discussions. More policy option papers and private discussions were to follow the two remaining roundtable meetings, scheduled for May 5 and May 12.....

AMNews: May 11, 2009. Senate panel suggests delay in long-term reform of Medicare pay ... American Medical News

AMNews: May 11, 2009. Congressional budget short on answers for Medicare pay formula ... American Medical News

2009-05-11T11:05:00.000-04:00

The blueprint provides physicians some exemption from deficit spending rules in the House, but the bulk of any payment changes will require budgetary offsets.

By Chris Silva, AMNews staff. Posted May 11, 2009.

Washington -- Congress on April 29 adopted a fiscal 2010 budget resolution that leaves some room for Medicare physician payment reform, but not nearly as much as doctors would have liked.

The $3.56 trillion budget allows the House to pass reform legislation costing up to $38 billion without the need to find offsets in the form of new revenue or cuts from other parts of Medicare. That would cover the expected cost of freezing Medicare rates at current levels in 2010, 2011 and part of 2012 instead of implementing the reductions required by current law. The Senate, however, still would need to find full offsets for any bill that prevents the cuts or boosts Medicare pay.....

AMNews: May 11, 2009. Congressional budget short on answers for Medicare pay formula ... American Medical News

Funds in 2010 Budget Could Increase Access to Care for Medicare Beneficiaries

2009-05-07T22:36:00.001-04:00

ALEXANDRIA, Va., May 6 /PRNewswire-USNewswire/ -- Funds in the FY 2010 budget aimed at transforming the nation's health care system may be used to improve access to outpatient physical therapy services for Medicare beneficiaries by repealing the therapy caps, says the American Physical Therapy Association (APTA).
S.Con.Res.13, which recommends budgetary levels and amounts for FY 2009-FY 2014, was passed April 29 by the House of Representatives by a 233 to 193 vote and by a 53 to 43 Senate vote. An amendment by Senators Ben Cardin (D-MD) and John Ensign (R-NV) to the budget's existing deficit neutral reserve fund relating to health care reforms allows for improvements to the Medicare program for beneficiaries and protects access to outpatient therapy services, including physical therapy, through measures such as repealing the current outpatient caps while protecting beneficiaries from associated premium increases.
"APTA applauds Congress for recognizing the critical need to repeal the caps on physical therapy services so that Medicare beneficiaries can receive the care they require," said APTA President R Scott Ward, PT, PhD. "By including this provision in the budget, our nation's aging adults are one step closer to having increased access to the rehabilitative and health services provided by physical therapists that are necessary for many conditions, such as stroke, diabetes, Parkinson disease, and cardiovascular disease, that lead to pain and some level of loss of function."
Earlier this year, Senators John Ensign (R-NV), Blanche Lincoln (D-AR), Susan Collins (R-ME), and Ben Cardin (D-MD), and Representatives Xavier Becerra (D-CA), Mike Ross (D-AR), and Roy Blunt (R-MO) introduced the Medicare Access to Rehabilitation Services Act (S 46/HR 43), which calls for the repeal of the Medicare therapy caps that limit coverage of outpatient rehabilitation services to $1,840 for physical therapy and speech language pathology combined and $1,840 for occupational therapy services.
Physical therapists are highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility - in many cases without expensive surgery or the side effects of prescription medications. APTA represents more than 72,000 physical therapists, physical therapist assistants, and students of physical therapy nationwide. Its purpose is to improve the health and quality of life of individuals through the advancement of physical therapist practice, education, and research. In most states, patients can make an appointment directly with a physical therapist, without a physician referral. Learn more about conditions physical therapists can treat and find a physical therapist in your area at www.moveforwardpt.com.
SOURCE American Physical Therapy Association

Funds in 2010 Budget Could Increase Access to Care for Medicare Beneficiaries

Coventry joins WellCare in ending plans next year - Forbes.com

2009-05-06T22:31:00.001-04:00

By TOM MURPHY , 05.05.09, 04:34 PM EDT

Coventry Health Care Inc. on Tuesday became the second health insurer this week to announce that it will leave a fast-growing segment of the Medicare Advantage market next year, forcing more than 300,000 people to find new coverage.
The Bethesda, Md.-based insurer said in a statement it will not renew its private fee-for-service product. The company cited profitability "in light of federal reimbursement rates and medical cost trends."
Coventry has 318,000 people enrolled in that Medicare Advantage product, a total that has grown 65 percent over the past year.
Private fee-for-service plans do not have networks, allowing patients to see any health care provider they wish as long as the provider accepts the plan.
WellCare Health Plans ( WCG - news - people ) Inc. said Monday it would not renew its Medicare Advantage private fee-for-service contracts for next year. The Tampa, Fla.-based insurer has about 110,000 members receiving that coverage.
Medicare Advantage plans allow the elderly and disabled to receive benefits through private health insurers. The plans receive a government subsidy and generally offer more benefits than traditional Medicare, but they've drawn criticism for their cost.
Many analysts who follow the insurance industry expect government reimbursement rates for the plans to fall as much as 5 percent next year.
The private fee-for-service plans also will be required to develop networks starting in 2011. Analysts have said that could force many insurers to drop the products. WellCare cited that as a reason for ending its contracts.
"Investing to build the provider networks ... would be unwise given the geographic dispersion of our membership and the uncertainty of Medicare rates in rural markets," a company spokeswoman said in an e-mail.
A lack of networks allows insurers to increase membership quickly because they don't have to negotiate contracts with doctors and hospitals, Wachovia analyst Matt Perry said in an interview.
"They just blanketed markets with private fee-for-service plans, and it didn't take any investment for them," he said.
Oppenheimer analyst Carl McDonald said in a research note that seniors will see increases in premiums and a reduction in benefits next year, which will force them to spend more out of pocket.
"But seniors who are forced to pick a new plan are going to be even more displeased, particularly if it means that a favored physician or specialist is no longer accessible," he wrote.

Coventry joins WellCare in ending plans next year - Forbes.com

Patient Advocacy Groups Support Legislation To Eliminate Two-Year Medicare Waiti by Adviatech.com

2009-05-05T22:15:00.000-04:00

The Coalition to End the Two-Year Wait for Medicare enthusiastically supports the introduction of the Ending the Medicare Disability Waiting Period Act of 2009. The Act would eliminate the current two-year delay in coverage for people with severe disabilities who are waiting to become eligible for Medicare coverage.

(1888PressRelease) May 04, 2009 - Among the advocacy groups in support of this bill, are the Special Needs Alliance (SNA) and the National Academy of Elder Law Attorneys (NAELA). Bernard A. Krooks, a founding partner of Littman Krooks LLP, is current President of the SNA and past President of the NAELA.

The Coalition consists of over 115 organizations that work to ensure access to health care for people with disabilities. The Coalition is urging Congress to make coverage for people with disabilities a priority while addressing the issue of national health care reform.

The 24 month waiting period has been in effect since 1972 when Congress stipulated that people with disabilities must first receive Social Security Disability Insurance (SSDI) for 24 months before gaining Medicare eligibility. The legislation to address this issue, introduced by Senator Jeff Bingaman and Representative Gene Green, will phase-out the waiting period for all people with disabilities over ten years, while immediately eliminating the waiting period for people with life-threatening conditions.

The 24 month waiting period has resulted in many individuals with disabilities going without health insurance during their wait. Nearly 40 percent of people with disabilities are without health insurance coverage at some point during their wait for Medicare; 24 percent have no health insurance during this entire period. The waiting period forces people with severe disabilities to endure two years during which treatment and care of their conditions are put at risk. Many forgo medical treatment and/or stop taking medications, compromising their already fragile health and resulting ultimately in conditions that are often more costly to treat when Medicare coverage finally begins.

The Special Needs Alliance (SNA) is a national, not-for-profit organization of attorneys dedicated to the practice of disability and public benefits law. Individuals with disabilities, their families and their advisors rely on the SNA to connect them with nearby attorneys who focus their practices in the disability law arena. SNA membership is based on a combination of relevant legal experience in the disability and special needs planning fields, direct family experience with disability, active participation with national, state and local disability advocacy organizations, and professional reputation. SNA members average 20 years of experience in special needs planning and disability law.

Patient Advocacy Groups Support Legislation To Eliminate Two-Year Medicare Waiti by Adviatech.com

Nursing home operators howl as government proposes slashing Medicare payments by $1 billion - McKnight's Long Term Care News

2009-05-05T22:14:00.000-04:00

The Centers for Medicare & Medicaid Services set off a backlash from nursing home operators late Friday afternoon when it proposed “adjustments” that would cut Medicare payments by $1.05 billion in fiscal 2010. The 3.3% reduction will “largely” be offset by a 2.1% market basket increase, officials said.

Regulators stressed they would be simply closing a four-year window in which providers were paid far more than originally forecasted after a 2006 payment adjustment for certain therapy groupings. Providers, however, claimed the cut would be working against the spirit of the recently passed economic stimulus bill, endangering resident care and causing thousands of caregiver job losses.....

Nursing home operators howl as government proposes slashing Medicare payments by $1 billion - McKnight's Long Term Care News

Baucus on health care: 'Crisis' not too strong a word - Sen. Max Baucus - POLITICO.com

2009-05-04T22:21:00.000-04:00

By SEN. MAX BAUCUS | 5/3/09 10:32 PM EDT

Our health care system is in crisis. This isn’t being dramatic or hyperbolic. There is no better, or more accurate, term to describe our current situation than “crisis.”

It isn’t just a crisis for those who can’t receive care, and it isn’t just a crisis that affects people’s health. It’s a crisis that affects our economy and affects each of us. More important, it is not just me, or doctors, or economists, or executives, or health care experts, or the 46 million uninsured people saying this. The numbers say it all.
In 2007, our economy lost more than $200 billion as a result of the poor health and the shorter life span of the uninsured. ... That’s a crisis.

Every day, 14,000 people lose their health care coverage on account of our economic downturn. ... That’s a crisis.
Uncompensated care forces the average family with insurance to pay approximately $1,100 a year in additional premiums. ... That’s a crisis.

Between 2000 and 2008, health care premiums rose more than 78 percent, while wages rose only 15 percent. ... That’s a crisis.

During this same time, in my home state of Montana, health care premiums rose 88 percent, while earnings rose only 16 percent. ... That’s a crisis.

One-and-a-half million families lose their homes each year to foreclosure because of unaffordable medical costs. ... That’s a crisis.

It’s estimated that if we don’t act now, in just seven years, most Americans will spend nearly half their income on health insurance. ... That’s a crisis.

The cost of covering people insured by Medicare and Medicaid is projected to increase by 114 percent in 10 years, while our economy will grow only 64 percent. ... That’s a crisis.

And these numbers don’t even begin to touch on the hundreds of small businesses across the country that can’t afford health care for their employees or the corporations that can’t compete in the global marketplace because health care costs are so high.....

Baucus on health care: 'Crisis' not too strong a word - Sen. Max Baucus - POLITICO.com

AHCA/Alliance: New Medicare Regulation Will Hurt Seniors, Cost Jobs, Perpetuate Inefficiency

2009-05-02T22:00:00.000-04:00

Turning Back Clock to Implement Bush Administration Proposal at Odds With Intent of Economic Stimulus, Broader Health Reform Goals

WASHINGTON, May 1 /PRNewswire-USNewswire/ -- Reaching back in time to propose implementing a Medicare regulation first proposed by the Bush Administration to cut seniors' Medicare funding by $1.05 billion in FY 2010 (estimated to be $5.6 billion over five years) is completely at odds with the intent of the American Recovery and Reinvestment Act (ARRA) in terms of creating jobs and spurring economic growth, and will hinder ongoing efforts to modernize Medicare for the benefit of seniors and taxpayers, according to two national long term care leaders.

Last summer, forty Democratic and Republican Senators joined together to actively oppose the rule, and noted in one letter to the Administration that the proposed cuts "will jeopardize the significant quality improvements made by the Skilled Nursing Facility (SNF) community in recent years as well as the ability of SNFs to continue caring for high-acuity patients. Because SNFs rely on Medicare to make up for chronic underfunding by the Medicaid program. We believe that if CMS were to finalize its proposed rule, the ability of providers to care for our nation's most vulnerable population - the frail elderly and disabled - would be severely threatened."

Bruce Yarwood, President and CEO of the American Health Care Association (AHCA), said, "Implementing this old Bush Administration Medicare regulation will undermine seniors' future access to quality care in the setting of their choice, sidetrack our sector's ongoing ability to create good-paying health jobs, and place at risk the delivery system reforms now successfully underway to make this vital program more efficient for patients and more accountable to taxpayers. With Congress and the Obama Administration so effectively focused on job creation in the face of poor national and state economic conditions, this CMS proposal is at fundamental odds with our broader economic and health policy objectives, not complementary to them."

Alan Rosenbloom, President of the Alliance for Quality Nursing Home Care, said the Bush CMS rule, and the damaging impact of its sharp funding cuts, would slow the flow of post-acute patients into the lowest cost setting most appropriate to their care needs. "Backtracking in the manner CMS proposes will undermine the very core principles of the Administration's health policy goals, and is antithetical to the health system delivery reforms America needs and seniors deserve," he said. "As the nature of America's nursing home patient population continues to change and evolve, it should logically be the policy of CMS to help facilitate the ability of nursing homes to care for higher-acuity, post-acute Medicare beneficiaries."

Yarwood and Rosenbloom said one of the many flaws associated with the proposal is that because approximately 70 percent of facility operating costs are directly related to staff, the proposed rule's deep cuts will result in thousands of lost jobs in the very sector well positioned to create them.

This comes at a time when the long term care industry is already facing major challenges due to the economic recession. A recent study of proprietary nursing homes by Dobson DaVanzo & Associates LLC found that "while there may be vacant positions that could be filled, one third of our respondents spoke of having to freeze jobs in their facilities and forgo filling these positions." Wages for current employees were also not increasing as a result of the economy, the study found.

On a health policy level, many Medicare beneficiaries have sought and received quality care in skilled nursing facilities (SNFs) rather than a higher cost setting. Yarwood and Rosenbloom observed that SNFs have invested heavily in recent years to increase capabilities to admit, treat and return to home a growing number of patients requiring intensive rehabilitative care, and care for patients with multiple chronic illnesses. Implementing the proposed funding cuts, the long term care leaders said, would inhibit continued investments in cost effective care - contrary to the Obama Administration's stated health policy objectives.

The AHCA and Alliance leaders also expressed concern the CMS action to cut Medicare-financed nursing home care will be especially damaging to seniors in the many states across the nation who have already endured or soon face substantial Medicaid funding cuts as a result of recent state legislative actions.

"Medicare and Medicaid funding are inextricably linked, and the combination of cuts to both programs squeezes facilities in a manner harmful to Medicare beneficiaries' rising care needs, as well as to our local economy and caregiver jobs base," Yarwood said. "As this is our initial analysis of the CMS rule, and we will continue to evaluate and comment, we urge the Administration and Congress to avoid adopting short-term, budget-driven policies that are inconsistent with the goal of improving post-acute care coordination and payment efficiency," concluded Rosenbloom.

SOURCE American Health Care Association

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AHCA/Alliance: New Medicare Regulation Will Hurt Seniors, Cost Jobs, Perpetuate Inefficiency

Medicare System Overhaul Proposed by Two Senators - NYTimes.com

2009-05-01T21:46:00.000-04:00

By ROBERT PEAR

Published: April 30, 2009

WASHINGTON — Leading senators from both parties said Wednesday that they would make sweeping changes in Medicare to reward or penalize doctors, hospitals and nursing homes according to the quality of care they provided.

The proposals, the opening salvo in a broad effort to overhaul the health care system at the urging of President Obama, would also create strong financial incentives for doctors and hospitals to coordinate the care they now provide in a fragmented way.

The White House and Congressional Democrats have stacked the deck for Mr. Obama’s health plan by making sure it is filibuster-proof. Despite their objections to such expedited procedures, Republicans continue working with Democrats in the Senate Finance Committee.....

Medicare System Overhaul Proposed by Two Senators - NYTimes.com

Medicare Part D shows market-based solutions work | ajc.com

2009-05-01T21:15:00.000-04:00

By Gary E. Applebaum

Wednesday, April 29, 2009

Before President Obama and his team overhaul the American health care system, they should note what currently works.

Consider Medicare Part D. This prescription drug benefit for seniors has a huge price tag, but by allowing the market to set prices, Part D has actually reduced costs and improved services for seniors.

Under Part D, seniors select a prescription drug plan offered by a private insurer. The federal government subsidizes these plans, and insurers compete to offer seniors the best deal. Competition among insurers drives down costs to enrollees and provides them with multiple choices so that they can pick a plan that suits their medical needs and budget.

Medicare Part D stands out as a rare success among the scores of bloated, inefficient government programs we encounter on a daily basis. It has managed to deliver great service to its beneficiaries — at a fraction of the projected cost to taxpayers.

The Congressional Budget Office put the original 10-year price tag of the program at a whopping $634 billion. Premiums for a standard plan were projected to be $44 by 2009.

CBO recently revised its 10-year estimate of Part D’s cost down to $395 billion. And today, standard plan premiums are $28 — 37 percent less than anticipated.

Seniors have also been tremendously satisfied. Of the more than 25 million seniors enrolled in Medicare Part D in 2008, 87 percent expressed satisfaction with their plans, according to a Harris Interactive Poll. In fact, three-quarters of seniors said that their plan saves them money.

Part D is also lowering health care costs nationally.....

Medicare Part D shows market-based solutions work | ajc.com

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

2009-04-27T21:09:00.000-04:00

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

2009-04-27T19:34:00.000-04:00

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

2009-04-27T19:32:00.000-04:00

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

2009-04-24T19:20:00.000-04:00

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

2009-04-23T19:17:00.000-04:00

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

2009-04-23T18:57:00.000-04:00

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

2009-04-23T18:55:00.000-04:00

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

2009-04-23T18:53:00.000-04:00

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

2009-04-21T18:25:00.000-04:00

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

2009-04-21T18:20:00.000-04:00

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

2009-04-21T17:19:00.000-04:00

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

2009-04-21T17:18:00.000-04:00

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

2009-04-20T18:22:00.000-04:00

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

2009-04-19T17:13:00.000-04:00

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 -

2009-04-19T16:33:00.000-04:00

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

2009-04-17T17:01:00.000-04:00

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

2009-04-17T16:53:00.000-04:00

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

2009-04-16T16:57:00.000-04:00

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

2009-04-16T16:44:00.000-04:00

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

2009-04-16T16:39:00.000-04:00

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

2009-04-15T16:42:00.000-04:00

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

2009-04-15T16:37:00.000-04:00

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

2009-04-14T16:46:00.000-04:00

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

2009-04-14T16:26:00.000-04:00

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

2009-04-14T16:24:00.000-04:00

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

2009-04-13T16:21:00.000-04:00

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

2009-04-11T20:46:00.001-04:00

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

2009-04-11T20:38:00.001-04:00

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

2009-04-11T20:30:00.001-04:00

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

2009-04-11T17:08:00.001-04:00

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

2009-04-11T17:01:00.001-04:00

(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

2009-04-11T16:45:00.001-04:00

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)

To speak with our experts on this topic, please contact:

For print and radio, John Neurohr, Deputy Press Secretary
202.481.8182 or jneurohr@americanprogressaction.org

For TV, Sean Gibbons, Director of Media Strategy
202.682.1611 or sgibbons@americanprogressaction.org

For web, Erin Lindsay, Online Marketing Manager
202.741.6397 or elindsay@americanprogressaction.org

Lessons from Medicare for Health Care Reform

Technorati Tags: Medicare,Health care reform

The Associated Press: HHS nominee pledges Medicare, Medicaid fixes

2009-04-11T16:43:00.001-04:00

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

2009-04-11T02:24:00.004-04:00

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

2009-04-10T18:24:00.000-04:00

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

2009-04-10T18:21:00.000-04:00

"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

2009-04-10T17:55:00.000-04:00

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

2009-04-09T18:15:00.000-04:00

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

2009-04-09T18:12:00.000-04:00

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

2009-04-09T17:59:00.000-04:00

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

2009-04-09T17:33:00.000-04:00

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

2009-04-08T17:41:00.000-04:00

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:

2009-04-08T17:37:00.000-04:00

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

2009-04-07T17:13:00.000-04:00

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

2009-04-07T17:10:00.000-04:00

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

2009-04-07T17:08:00.000-04:00

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

2009-04-07T17:06:00.000-04:00

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

2009-04-06T17:48:00.000-04:00

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

2009-04-06T17:01:00.000-04:00

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

2009-04-06T17:00:00.000-04:00

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

2009-04-06T16:58:00.000-04:00

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

2009-04-06T16:57:00.000-04:00

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

2009-04-06T16:55:00.000-04:00

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)

2009-04-06T16:53:00.000-04:00

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

2009-04-06T16:50:00.000-04:00

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

2009-04-06T16:47:00.000-04:00

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

Ohio Premier Health Solutions

Medical News: ADA: Wal-Mart, Mail-Order Pharmacies Top Affordable Drug List - in Meeting Coverage, ADA from MedPage Today

NAHU Washington Update

Nursing Homes Rated - WSJ.com

AMNews: June 1, 2009. Senate panel finishes health reform hearings, foresees bill by mid-June ... American Medical News

Workers’ vote: Yes - TribToday.com - Tribune Chronicle - Warren, OH

Medicare discounts offered | NewsOK.com

POINT OF VIEW Value-Based Care Centers

BY STEVEN LANDGARTEN, M.D.

Published: May 30, 2009

Annals of Medicine: The Cost Conundrum: Reporting & Essays: The New Yorker

Ask Medicare, May/June 2009

Medicare Educational Seminar June 2, 2009

Health care: Keep treatment costs down - Letters Unlimited - Cleveland.com

Newswise Law and Public Policy News | Education Campaign Needed on Social Security, Medicare Woes, Expert Says

Newswise Medical News | Overwhelming Medicare Plan Choices Spell Confusion

CQ Politics | Millions of Medicare Beneficiaries Face Reduced Social Security Benefits

The Associated Press: States consider cutting drug help for seniors

Reimbursement Issues with Medicare / Medicaid: A Free Article from Clifford Law Offices, Personal Injury Attorneys in Chicago

Health insurer suggests ways to save government $500 billion - San Jose Mercury News

Healthcare Reform that Doesn't Address Long Term Care Would Be a Failure - John A. Farrell (usnews.com)

AARP Ramps Up Effort To Close Medicare Doughnut Hole - KYPost.com

AMNews: Editorial - May 18, 2009. Help for physicians on Medicare deadlines ... American Medical News

AMNews: May 18, 2009. 2010 HHS budget looks to use Medicare savings for reform ... American Medical News

Medical News: Senators Disagree on Public Health Insurance Plan - in Washington-Watch, Washington Watch from MedPage Today

Health Plans Would Add to Controls on Insurers - NYTimes.com

Extending Medicare: Medical and National Suicide -- Seeking Alpha

Medical News: Pfizer Offers Year of Free Meds to Unemployed - in Product Alert, Prescriptions from MedPage Today

Higher Medicare Premiums in Store For Some Retirees - Planning to Retire (usnews.com)

Health Costs Are the Real Deficit Threat - WSJ.com

Medical News: Medicare Finalizes Denial of Virtual Colonoscopy Coverage - in Public Health & Policy, Medicare from MedPage Today

Health Care Reform Outlook Clear? Don't Count on It | 44 | washingtonpost.com

Report: Medicare faces cash crunch - UPI.com

Recession puts Social Security in spotlight - May. 11, 2009

The forgotten fiscal problem

The recession has put the debate over Social Security's fiscal health in the shadows. A report Tuesday could revive it - at least for awhile.

» WH Release: “Coming Together to Bring Down the Cost of Health Care” Row 2, Seat 4 « FOXNews.com

New Report: Home Health Care Saves Billions for Medicare

The Associated Press: Obama wants $58 billion in taxes to offset errors

It's time to heal our health care system

AMNews: May 11, 2009. Senate panel suggests delay in long-term reform of Medicare pay ... American Medical News

AMNews: May 11, 2009. Congressional budget short on answers for Medicare pay formula ... American Medical News

Funds in 2010 Budget Could Increase Access to Care for Medicare Beneficiaries

Coventry joins WellCare in ending plans next year - Forbes.com

Patient Advocacy Groups Support Legislation To Eliminate Two-Year Medicare Waiti by Adviatech.com

Nursing home operators howl as government proposes slashing Medicare payments by $1 billion - McKnight's Long Term Care News

Baucus on health care: 'Crisis' not too strong a word - Sen. Max Baucus - POLITICO.com

AHCA/Alliance: New Medicare Regulation Will Hurt Seniors, Cost Jobs, Perpetuate Inefficiency

Medicare System Overhaul Proposed by Two Senators - NYTimes.com

Medicare Part D shows market-based solutions work | ajc.com

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

Sen. Tom Coburn, Regina E. Herzlinger

Ohio.com - Prices bleed uninsured

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

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.

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

New Medicare policy may pose risks to black kidney patients

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

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

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

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

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.

New rules could cut physician Medicare income - FierceHealthcare

Plan Changes Afoot - WSJ.com

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

When Doctors Opt Out - WSJ.com

By MARC SIEGEL

Taking Note: The Fraying of Medicare

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

By JANE ZHANG and VANESSA FUHRMANS

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