Prostate cancer screening has little benefit for men aged 75 and older, yet over three years, the Medicare fee-for-service program spent $447 million annually on PSA-based screenings — one-third of which was for men in the over 75 age group, according to study by researchers at the Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center. Published in the Oct. 4 issue of the journal Cancer, the study also found considerable geographic variation in the cost of prostate cancer screening. Many prostate cancers are slow-growing and unlikely to become problematic. Widespread screening with a serum-based PSA test may result…
In another sales-sapping blow to Eli Lilly and Co., the Centers for Medicare and Medicaid Services has decided not to pay for patient use of a Lilly imaging drug used in Alzheimer’s assessments. The Indianapolis drugmaker said that it’s disappointed in the decision, which it called “contrary to expert opinion.” The CMS decision is a financial blow to Lilly’s Amyvid, a new drug marketed for use in brain scans to evaluate patients for Alzheimer’s disease and other brain dysfunctions. Approved by the Food and Drug Administration last year, Amyvid is the only drug of its kind on the market. In…
Seniors who fit a particular personality profile are more than twice as likely to receive long-term care in a nursing home, according to newly published research in The Milbank Quartly. Researchers from various institutions, including the University of Rochester Medical Center Department of Public Health Sciences and the University of Chicago, examined data from 1,000 seniors participating in a Medicare demonstration project. Based on a self-report questionnaire, these seniors were classified under five personality traits: neuroticism, extraversion, openness to experience, agreeableness and conscientiousness. These are traits commonly used as a conceptual framework by psychologists. Based on participants' healthcare use over…
Medicare is currently undergoing its second round in the penalty program. The campaign works toward reducing the numbers of patients readmitted within a month and hospitals will have their reimbursements reduced for poor performance. The majority of hospitals with high readmission rates serve low-income patients. Kaiser Health News discovered that 1,371 hospitals are receiving a lower fine than before. Learn more in the Washington Post.
Starting October 1, 2013, people who lack health insurance can start signing up for coverage through the new Internet-based health insurance marketplaces set up under the Affordable Care Act (aka Obamacare). Most of those who don’t already have insurance will have to buy coverage by March 31, 2014 or pay a penalty. But if you already have Medicare, you have nothing to worry about. You have coverage that will continue as before (better than before, in fact) and you don’t need to do anything. Any stranger who tries to tell you otherwise is likely trying to steal your personal information. …
The federal government shutdown furloughed as many as 800,000 of the nation’s 2.1 million federal workers as it hit early Tuesday after a bitterly divided Congress failed to approve a temporary spending bill to keep the government running. The shutdown will have far-reaching consequences for some, but minimal impact on others. Mail will be delivered. Social Security and Medicare benefits should continue to flow. But vacationers will be turned away from national parks and Smithsonian museums. Low-to-moderate income borrowers and first-time home buyers seeking government-backed mortgages could face delays. Veterans appealing a denial of benefits will have to wait for…
A U.S. district court has ruled that a group of Medicare beneficiaries who were denied coverage of nursing home care because they were not admitted to a hospital for three days prior to moving a nursing home, but rather were placed on “observation status” for the duration of their stay, cannot compel the government to change the rules governing how hospitals admit patients. Bagnall, et al v. Sebelius (D. Conn., No. 3:11cv1703 (MPS), Sept. 23, 2013). Under current Medicare rules, a patient must be admitted to a hospital for at least three days in order for Medicare to pay for…
But something unusual happened just before Congress left for its summer break. The House Energy and Commerce Committee voted 51-0 for a bill that would overhaul the way Medicare pays doctors. The bill would, among other things, repeal something called the sustainable growth rate formula (SGR) and eventually replace it with a system that would pay doctors based on how healthy they keep their patients. The current formula has threatened to cut physician pay, often by double-digit rates, for each of the past dozen years. "Since its passage in 1997, SGR has bred uncertainty and frustration," said Energy and Commerce…
September 12, 2013SERVICE DELIVERY VISION: A more responsive, integrated, person-centered, and fiscally sustainable LTSS delivery system that ensures people can access quality services in settings they choose.Rebalancing – A Balanced Array of LTSS:Recommendation: Promote services for persons with functional limitations in the least restrictive setting appropriate to their needs– building a system, including Medicaid, with options for people who would prefer to live in the community.Integration:Recommendation 1: Establish a single point of contact for LTSS on the care team.Recommendation 2: Align incentives to improve the integration of LTSS with health care services in a person- and family-centered approach.Recommendation 3: Use…
The government estimates that it loses some $60 billion a year to Medicare fraud and waste, and as it gears up to launch its giant health care reform program to provide affordable coverage for every American, putting a stop to this is at the top of the agenda. One of the ways Medicare officials hope to do this is by turning the 50 million beneficiaries of the senior health insurance program into fraud fighters. This summer, Medicare redoubled its efforts to get them involved by redesigning a claims statement, known as the Medicare Summary Notice, with larger print and a…
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