Tag Archives: medicare

Affordable Care Act Saves Medicare Recipients Billions On Prescription Drugs

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Main Category: Medicare / Medicaid / SCHIP
Also Included In: Seniors / Aging
Article Date: 04 Dec 2012 – 10:00 PST

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Affordable Care Act Saves Medicare Recipients Billions On Prescription Drugs

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As the last week of Medicare Open Enrollment gets closer, Health and Human Services Secretary Kathleen Sebelius declared yesterday that savings on prescription drugs have topped $5 billion thanks to the Affordable Care Act.

Over 5.8 million people using Medicare have benefited from the help the health care law gives with the Medicare prescription drug coverage gap referred to as the “donut hole”.

In the initial 10 months of 2012, close to 2.8 million people have saved an average of $677 on drug prescriptions alone. At the same time, around 23.4 million people with regular medicare had one or more preventive services for free, with 2.5 million of them getting an Annual Wellness Visit.

Secretary Sebelius said:

“The health care law is saving money for people with Medicare. Everyone with Medicare should look at their health and drug plan options for additional value before the Medicare open enrollment period ends this week.”



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Terminating Medicare Consults Linked To A Rise In Total Spending

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Main Category: Medicare / Medicaid / SCHIP
Also Included In: Health Insurance / Medical Insurance
Article Date: 27 Nov 2012 – 10:00 PST

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Terminating Medicare Consults Linked To A Rise In Total Spending

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Getting rid of payments for Medicare consultations frequently billed by specialists was seen to be connected with a new increase in spending during visits to specialists as well as primary care doctors, suggests a new study examining medicare data published in Archives of Internal Medicine.

Preceding 2010, Medicare costs for consultations were significantly greater than for office visits that were almost identical in terms of difficulty, and were frequently charged by primary care physicians (PCPs). In January of 2010, Medicare got rid of consultation payments from the Part B Physician Fee Schedule and simultaneously increased costs for office visits.

Regarding the budget, these changes would leave it unaffected since it would reduce payments to specialists but increase payments to PCPs.

A research team led by Zirui Song, Ph.D., of Harvard Medical School, Boston, analyzed the relationship of this policy with spending, capacity and coding for office visits during the initial year of the plan going into effect. Zirui and his colleagues investigated outpatient claims from 2007 to 2010 for over 2.2 million Medicare beneficiaries with Medicare Supplemental coverage via sizable employers.

The authors explained:



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Most Medicare Patients Wait Weeks Before Breast Cancer Surgery

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Main Category: Breast Cancer
Also Included In: Medicare / Medicaid / SCHIP
Article Date: 21 Nov 2012 – 1:00 PST

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Most Medicare Patients Wait Weeks Before Breast Cancer Surgery

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Although patients may feel anxious waiting weeks from the time of their first doctor visit to evaluate their breast until they have breast cancer surgery, new findings from Fox Chase Cancer Center show that these waits are typical in the United States. Results were published in the Journal of Clinical Oncology. Looking at data collected from more than 72,000 Medicare patients diagnosed with non-metastatic breast cancer, researchers – led by Richard J. Bleicher, M.D., attending surgeon and director of the Breast Fellowship Program at Fox Chase – found that, in 2005, half of the breast cancer patients underwent breast cancer surgery at least 32 days after first consulting their doctor about their breast problem. This is an increase from 1992, when half of the patients waited no more than 21 days.

“For many Medicare patients, it can take a month or more from the time they first see their doctor to evaluate their breast concern, make a diagnosis, and get them to the operating room,” says Bleicher. “So if a woman learns that her surgery date is weeks after her evaluation, where she was found to have a breast cancer, she should know this length of time is typical, and should not be concerned.”



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Medicare Barrier To Hospice Increases Hospitalization

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Main Category: Palliative Care / Hospice Care
Also Included In: Medicare / Medicaid / SCHIP;  Alzheimer’s / Dementia
Article Date: 02 Nov 2012 – 1:00 PDT

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Medicare Barrier To Hospice Increases Hospitalization

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A Medicare rule that blocks thousands of nursing home residents from receiving simultaneous reimbursement for hospice and skilled nursing facility (SNF) care at the end of life may result in those residents receiving more aggressive treatment and hospitalization, according a new analysis.

“This study is the first, to the knowledge of the authors, to attempt to understand how treatments and outcomes vary for nursing home residents with advanced dementia who use Medicare SNF care near the end of life and who do or do not enroll in Medicare hospice,” wrote researchers, including lead author Susan Miller, research professor of health services policy and practice at Brown University, in the Journal of the American Geriatrics Society.

Miller said the outcomes are often unwanted treatments.

“Unfortunately, given the high use of Medicare skilled care near the end of life and policy that prevents simultaneous Medicare reimbursement for skilled nursing and hospice care, aggressive treatments that may not be the preference of families or their loved ones are common,” she said.

The federal government will investigate this issue under the Medicare Hospice Concurrent Care demonstration project mandated by the Affordable Care Act.



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Medicare Regional Analysis Masks Substantial Local Variation In Health Care Spending

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Main Category: Medicare / Medicaid / SCHIP
Also Included In: Public Health
Article Date: 02 Nov 2012 – 0:00 PDT

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Medicare Regional Analysis Masks Substantial Local Variation In Health Care Spending

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Reforming Medicare payments based on large geographic regions may be too bluntly targeted to promote the best use of health care resources, a new analysis from the University of Pittsburgh Graduate School of Public Health suggests. The analysis will be published in the Nov. 1 issue of the New England Journal of Medicine.

“Much policy attention has been drawn to the large geographic variation in health care spending across regions, and for good reason – because regional variation points to inefficient use of resources,” said lead author Yuting Zhang, Ph.D., associate professor of health economics at Pitt Public Health. “But it is important to effectively target these policies to reduce overutilization while maintaining access to high-quality care.”

Policies that are too widely focused, such as at the larger regional level, could leave many high-spending locales untouched while inadvertently penalizing some low-spending locales. However, policies that are too finely focused, such as at the physician-level, could miss system-level factors that account for high utilization in some areas, Dr. Zhang said.

Previous geographic variation analyses primarily focused on regional areas, such as the hospital referral regions (HRRs) described in the Dartmouth Atlas of Health Care. The United States can be divided into 306 HRRs, which are areas served by large tertiary hospitals where patients are referred for major cardiovascular surgical procedures and for neurosurgery.



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