Tag: "Medicare"

Wrong Way to Reform the Malpractice System

We’re 10 years into the future and you have terminal cancer. Still, all is not lost.

Doctors in other countries are reporting successful remission of your type of cancer, using a drug originally approved in the United States for some other purpose. There are several journal articles that appear to back up these claims and there is additional positive information on the Internet.

Here’s the problem. The FDA has not approved this drug for cancer treatment; so its use for that purpose is “off-label.” Also, there have not been the clinical trials required by the “comparative effectiveness” board; so it’s not considered a “best practice.” Ever since the Affordable Care Act (ACA) passed a decade earlier, that has meant that Medicare won’t pay for it. And since Medicare isn’t paying, private insurers won’t pay either. Fortunately, you’ve accumulated some savings through the years. Even though the drug is quite expensive, your doctor knows you can pay for it yourself.

So what does your doctor do about this promising new treatment?

He doesn’t tell you about it.

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Oct 27, 2010 | 19 comments | by

Grading Hospitals

A promising method that researchers hope will boost quality is the “check list” approach, similar to the way airline pilots review a pre-flight list of steps prior to take-off. Note that this approach grades plans on inputs (process) rather than outputs (survival). However, researchers at the University of Michigan studied six types of surgeries with a high risk of death. They found little correlation between death rates and how well hospitals followed process measures.

Oct 21, 2010 | 7 comments | by

Giving a New Meaning to Evidence-Based Care

David Leonhardt in The New York Times discusses a cost-cutting idea proposed in the latest issue of Health Affairs: Give expensive new treatments three years to prove that they work better than cheaper treatments; barring proof, cut their reimbursement rates to that of the cheapest treatment. Here’s how it would work for prostate cancer:

The options for treating prostate cancer include three forms of radiation. One of them, three-dimensional radiation, costs Medicare about $10,000. Another treatment, a targeted form of radiation known as I.M.R.T., came along a decade ago and initially cost about $42,000. Lately, Medicare has also started covering a third, proton radiation therapy, for which it pays $50,000.

No solid research has shown I.M.R.T. to be more effective at keeping people alive, with minimum side effects, than three-dimensional radiation.

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Oct 20, 2010 | 4 comments | by

Cheating Medicare: It’s Easy

 A pregnant woman who gets an ultrasound exam — from an ear, nose and throat doctor. A forensic pathologist whose patients walked into his office, rather than being rolled in with toe tags. A dermatologist who conducted heart tests. A psychiatrist who performed M.R.I.’s. But none of the far-fetched procedures ever took place, according to federal prosecutors.

Full article on the gangsters who stole $35 million in a Medicare scheme.

Oct 15, 2010 | 5 comments | by

Dialysis at Home, New Fiscal Year’s Resolution, and Online E-Visits Reduce Face-to-Face Visits by Almost Half

Why isn’t all dialysis done at home where it’s more convenient and cheaper? Answer: Medicare.

Kids are getting 40 percent of their calories from junk food. No wonder childhood obesity is such a problem.

Steuerle: Here’s the fiscal gap you can expect: annual federal spending of about $30,000 per household and taxes of about $20,000.

Oct 14, 2010 | 5 comments | by

CMS to Reward Providers that Ration Care

The Patient Protection and Affordable Care Act (ACA) requires the Centers for Medicare and Medicaid Services (CMS) to move to a system that pays health care providers based on the cost and quality of the care they provide. At a Sept 24th meeting at the CMS headquarters in Baltimore, agency staff told stakeholders it had little choice but to base its value indicator on claims data because it has yet to develop a better metric for value. Representatives of doctors and hospitals expressed concerns that CMS would use claims data as an excuse to reduce reimbursements. The implication is that CMS could penalize high volume providers and cut their payments while rewarding doctors and hospitals that ration care.

Oct 14, 2010 | 12 comments | by

NPR Misses the Boat

What’s wrong with this video? Crossroads GPS, an organization affiliated with Republican strategist Karl Rove, recently began airing a political ad critical of California Senator Barbara Boxer with this message: 

California seniors are worried. Barbara Boxer voted to cut Medicare by $500 billion dollars. Cuts so costly to hospitals and nursing homes that they could stop taking Medicare altogether. Boxer’s cuts would sharply reduce benefits for some and could jeopardize access to care for millions of others. And millions of Americans will not be able to keep the plan or doctor they already have. Check the facts and take action. Call Boxer. Stop the Medicare cuts.

National Public Radio reporter Peter Overby has teamed up with Bill Adair of PolitiFact.com to fact-check the accuracy of advertisements aired by interest groups. One of their criticisms: the music was scary! Their final conclusion: the ad was “barely true.”

Yet the ad is fair and it reflects precisely the point of view of the Office of the Medicare Actuary as well as  independent, non-Republican, Harvard University health economist Joe Newhouse, who wrote in Health Affairs that we will have a two-tiered health system, with seniors being relegated to community health centers and safety-net hospitals. (See our summary of both judgments in “What Does Health Reform Mean for You? A Consumer’s Guide.”)

Oct 13, 2010 | 11 comments | by

Bending the Cost Curve

In the national debate leading up to the passage of the Patient Protection and Affordable Care Act (PPACA), President Obama said on several occasions that he would veto any bill that did not lower the growth rate of health care spending. So now that the Act is law, you would expect to find a lot of people focused on how that is going to work.

Yet an informal scan of news stories, opinion pieces, journal articles and even conference agendas reveals that “cost control” is probably the least talked about feature of the new law. An exception is a Health Affairs study produced by analysts at the Office of the Medicare Actuary — concluding that costs will go up, not down, as a result of the new legislation. Other exceptions are all the members of Congress who voted for PPACA who are now campaigning for reelection by claiming, “If we had not passed this law, health care costs would have…”                                                                                                                                                                                                                                                        

Okay, so how does the new law promise to control costs? I’m going to skip over efforts to control fraud, waste and abuse, electronic medical records, managed care, coordinated care, teamwork care, medical home care, cost effectiveness research, etc., as ideas that, however meritorious, have not been shown to control costs and probably won’t control costs. As I explained at the Health Affairs Blog the other day, that leaves us with three cost-control initiatives that are new, unique to PPACA and worth discussing.

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Oct 11, 2010 | 18 comments | by

3M to Dump Its Retirees on the Individual Market

Starting in 2015, 3M retirees too young to qualify for Medicare will receive financial support through what the company called a “health reimbursement arrangement” and won’t be able to enroll in the company’s group insurance plan. The company described that as an account retirees can use to purchase individual insurance through exchanges that the health law will create in 2014.

Full article on how 3M is dropping health insurance coverage for its retirees.

Oct 04, 2010 | 11 comments | by

What’s Worse Than Being on Medicare?

Being on Medicaid as well. “Dual eligibles” have twice the rate of potentially avoidable hospitalizations, according to the Agency for Healthcare Research and Quality:

  • Dual eligible patients accounted for roughly one of every three Medicare hospital stays primarily involving bed sores, asthma and diabetes, and one of every four stays for urinary tract infection, chronic obstructive pulmonary disease and bacterial pneumonia.
  • Dual eligible patients ages 65 to 74 years were two to four times more likely than other Medicare patients the same age to have potentially preventable hospitalizations for most of the conditions studied.
Oct 01, 2010 | 5 comments | by
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