Smoking Cessation Counseling Benefit in Medicare To Begin in March

Medicare will pay for smoking cessation counseling for beneficiaries who smoke and have smoking-related diseases -- such as heart disease, stroke, lung cancer, emphysema, weak bones, blood clots and cataracts -- or take certain medicines whose effectiveness can be compromised by smoking, the Bush administration announced Dec. 24, the New York Times reports.

CMS Administrator Mark McClellan said, "Millions of our beneficiaries have smoked for many years and are now experiencing heart problems, lung problems and other diseases that smoking can cause. Just about all of them will be eligible for the new coverage. You're never too old to quit smoking and to get benefits of quitting."

Under the program, which will be available by March 31, Medicare will pay for up to eight counseling sessions in a 12-month period. Partnership for Prevention estimates that several million beneficiaries will be eligible for the benefit and that it will cost about $50 million annually (Pear, New York Times, 12/24). The government has estimated that about 10% of Medicare's budget, or $14.2 billion, is spent on health problems related to smoking (Wall Street Journal, 12/24).

CMS officials on Wednesday said that they will wait for the New England Journal of Medicine to publish study results on implantable cardiac defibrillators before expanding coverage, Bloomberg/Minneapolis Star Tribune reports. Medtronic, one of the biggest manufacturers of the defibrillators, said that unpublished research showed the device lowered the death rate of sudden cardiac arrest by 23% (Hallam, Bloomberg/Minneapolis Star Tribune, 12/30/04).

In September, CMS issued the proposed rule to expand Medicare coverage for ICDs, a move that would increase the number of eligible beneficiaries by one-third, to about 500,000 (California Healthline, 9/29/04). "We will reconsider expansion of ICD coverage immediately following publication of the trial results," a memorandum posted on the Medicare Web site said (Bloomberg/Minneapolis Star Tribune, 12/30/04).

When the federal government begins offering physical examinations for new beneficiaries as part of the new Medicare law, the program for the first time will begin screening beneficiaries for alcoholism, the Los Angeles Times reports. The physical exams are part of a new emphasis on preventive care and will screen for conditions such as depression, high blood pressure and diabetes in addition to alcoholism. According to the American Medical Association, alcohol abuse among the elderly is a "hidden epidemic," with an estimated three million Medicare beneficiaries having drinking problems, many of which are undiagnosed.

A study by researchers at the Veterans Administration in Wisconsin found that in 1989, Medicare spent at least $234 million on alcohol-related hospitalizations for such conditions as liver disease. Adjusting for inflation, the current cost would be $300 million to $400 million, compared with the $20 million to $60 million cost of the new preventive benefits in 2005. The VA study, published in 1993, also found that hospitalization rates for alcohol-related illnesses were comparable to those for heart attacks.

Lead author Joseph Barboriak said the findings are "still applicable because I don't think there has been a drastic change in human metabolism." Diagnosing "problem drinking may be one of the toughest preventive challenges," the Times reports. Signs of a problem with alcohol, including falls, can be mistaken for symptoms of an aging-related illness, and many patients are secretive about their drinking habits. "A lot of times, it's closet-type drinking that has crept up on them over the years," Edward Hill, president-elect of AMA, said.

CMS Administrator Mark McClellan said, "The initial physical is intended to make Medicare into a prevention-oriented program." He added, "Prevention-oriented medicine is not the way Medicare has worked in the past. What we need to do now is close the gap in prevention as a result of people not taking advantage of all the new benefits. This is about the biggest deal we are undertaking."

Marilyn Moon, a health economist at the American Institutes for Research, said the introductory exams are a "step in the right direction," but she added that Medicare also should cover preventive physical exams for current beneficiaries. James Firman, head of the National Council on Aging, said, "There are two pieces to the puzzle. One is providing the coverage. The other is getting people to act on it. Prevention is an uphill battle" (Alonso-Zaldivar, Los Angeles Times, 1/2).