California Healthline Highlights Recent Developments Related to Medicare
California Healthline examines several news articles on recent developments related to Medicare. Summaries appear below.
AARP recommendations: Materials sent to Medicare beneficiaries to promote the new prescription drug benefit should use "clear and concise language at no higher than the sixth grade reading level," AARP Associate Executive Director Chris Hansen told CMS officials last week, CQ HealthBeat reports. In a letter to CMS, Hansen recommended that agency officials prohibit "cold calling and other inappropriate activities" and require health plans to submit their full marketing scripts, not "mere bullet points for in-home and telephone marketing endeavors." In addition, Hansen recommended that CMS test the draft language to explain prescription drug benefit subsidies for low-income Medicare beneficiaries in focus groups to "ensure that beneficiaries will understand that people with limited incomes and assets are eligible for extra help paying premiums and copays and what they must do to find out if they are eligible." A CMS spokesperson on Monday said that the agency will consider the recommendations (CQ HealthBeat , 7/11).
- Coverage gap: The new Medicare prescription drug benefit during the first three years will cover less than half the annual bills for beneficiaries who have high or catastrophic medication expenses, according to a study published on Tuesday in the July/August issue of Health Affairs, Scripps Howard/Detroit News reports. The study -- led by Bruce Stuart, director of the Peter Lamy Center for Drug Therapy and Aging at the University of Maryland-Baltimore -- found that Medicare beneficiaries who spend more than $2,250 on prescription drugs next year could have almost $11,000 in out-of-pocket costs between 2006 and 2008. Medicare beneficiaries who spend more than $5,100 on prescription drugs next year could have out-of-pocket costs of $12,300 over the same period, the study found. However, the study found that the prescription drug benefit will help an estimated nine million low-income Medicare beneficiaries who will receive subsidies and beneficiaries who spend only a few thousand dollars annually on prescription drugs (Bowman, Scripps Howard/Detroit News, 7/12). The study is available online.
- Chiropractors: The Washington Post on Tuesday examined a recent report released by the HHS Office of Inspector General that found chiropractors received an estimated $285 million in improper Medicare reimbursements in 2001, or about $2 of every $3 dollars the program paid to chiropractors. According to the report, maintenance treatments accounted for $186 million of the improper Medicare reimbursements. The American Chiropractic Association disputed the report and said that the results "do not represent a concerted effort by doctors of chiropractic to overbill the government" but indicate a "universal problem in physician documentation" of claims. Medicare currently only covers chiropractic care for cases in which a "reasonable chance of correcting a problem" exists, according to the Post (Graham, Washington Post, 7/12).
- Dual eligibles: The Los Angeles Times on Tuesday examined the effect that the new Medicare prescription drug benefit could have on beneficiaries eligible for both Medicare and Medicaid. According to the Times, the Medicare prescription drug benefit, which will provide coverage through private plans that might use generic medications and other measures to reduce costs, "was not created with the dual eligible in mind." Some health care advocates and experts maintain the Medicare prescription drug benefit offers "no guarantee" dual eligibles will continue to receive coverage for the same combinations of medications that they did under Medicaid. Health care advocates have asked the federal government to delay the transition of dual eligibles to the Medicare prescription drug benefit, and CMS has encouraged states to authorize a three-month supply of medications as a "bridge," the Times reports (Alonso-Zaldivar, Los Angeles Times, 7/12).
- Eligibility for subsidies: CMS, the Administration of Aging and the National Council on the Aging have launched an online service to help low-income Medicare beneficiaries determine their eligibility for subsidies included in the new Medicare prescription drug benefit, CQ HealthBeat reports. The service, a specialized version of BenefitsCheckUpRx, screens Medicare beneficiaries for eligibility and provides a link to allow them to apply for the subsidies online through the Social Security Administration Web site (CQ HealtBeat , 7/11).
- Health care IT: A majority of Medicare fee-for-service outpatient visits in 2001 were to physicians in practices that did not have significant health care information technology support, according to a recent study conducted by the Center for Studying Health System Change, CQ HealthBeat reports. According to the study -- conducted by Joy Grossman, HSC senior researcher, and Marie Reed, HSC data manager -- 57% of the visits were to physicians in practices that used health care IT for no more than one of five clinical functions. The study examined whether the physicians used health care IT to obtain treatment guidelines, exchange clinical data with other physicians, assess patient notes, establish preventive treatment reminders and write prescriptions (CQ HealthBeat , 7/8).
- Home health agencies: CMS on Friday proposed a 2.5% increase in Medicare reimbursement rates for home health agencies for 2006, CQ HealthBeat reports. According to CMS, the increase would increase Medicare reimbursements for home health agencies by $330 million next year. CMS officials said that they will accept comments on the proposal until close of business on Sept. 6 (CQ HealthBeat , 7/8).
- Pharmacists: Larry Kocot, CMS senior adviser, and Mark Hayes, senior health policy adviser for the Senate Finance Committee, on Friday at a meeting in Washington, D.C., told pharmacists that they have an important role in the implementation of the new Medicare prescription drug benefit, but some pharmacists said that they "remain wary of the law's effect on their profession," CongressDaily reports. Hayes said, "This is an incredible opportunity for the profession." Kocot added, "The key to success is enrollment, and that's where pharmacists are going to be important" (Heil, CongressDaily, 7/8). However, Tom Temple, executive director of the Iowa State Pharmacy Association, said that CMS should issue additional standards for contracts with and payments to pharmacists to regulate pharmacy benefit managers, which will help administer the Medicare prescription drug benefit. Some pharmacists maintain that PBMs "squeeze them too hard in negotiating less-costly benefits for their customers and hide large profits," CQ HealthBeat reports (CQ HealthBeat , 7/8).
Additional information on the Medicare drug benefit is available online.