Tag Archives: preventive care

Medicare

Medicare Pays for Prevention – Finally!

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man-in-wheelchairThe Centers for Medicare & Medicare Services has announced Medicare (that is, taxpayers) will pay for lifestyle-intervention program that prevents type 2 diabetes:

In 2011, through funding provided by the Affordable Care Act, CMS awarded the National Council of Young Men’s Christian Associations of the United States of America (Y-USA) more than $11.8 million to enroll eligible Medicare beneficiaries at high risk for diabetes in a program that could decrease their risk for developing serious diabetes-related illnesses. Beneficiaries in the program attended weekly meetings with a lifestyle coach who trained participants in strategies for long-term dietary change, increased physical activity, and behavior changes to control their weight and decrease their risk of type 2 diabetes. After the initial weekly training sessions, participants could attend monthly follow-up meetings to help maintain healthy behaviors. The main goal of the program was to improve participants’ health through improved nutrition and physical activity, targeting at least a five percent weight loss for each individual.

The results of the Diabetes Prevention Program model are striking:

  • Medicare beneficiaries enrolled in the program lost about five percent of their body weight, which is enough to substantially reduce the risk of future diabetes. Average weight loss was 4.73 percent of body weight for participants attending at least four weekly sessions.  Participants who attended at least nine weekly sessions lost an average of 5.17 percent of their body weight.
  • Over 80 percent of participants recruited attended at least four weekly sessions.
  • When compared with similar beneficiaries not it the program, Medicare estimated savings of $2,650 for each enrollee in the Diabetes Prevention Program over a 15-month period, more than enough to cover the cost of the program.

After years and years of jawboning about preventing disease and reducing health spending by catching health problems early, the federal government has finally approved one intervention that actually appears to achieve this goal! Continue reading Medicare Pays for Prevention – Finally! →

Health Care Access

Preventive Care Does Not Want To Be “Free”

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One conceit behind Obamacare is that if the government mandates preventive care be “free”, people will use it. The notion should appeal to free-market types, too: As the price of a service drops, the quantity demanded should increase.

However, it is not that simple in health care. Let’s take another dive into the always heated and controversial discussions about preventive care for women (such as our recent entry about mammography).

New research shows that women under 65 are over screened for osteoporosis, and women aged 65 and over are under screened, although older women get screened for “free”: Continue reading Preventive Care Does Not Want To Be “Free” →

Health Care Costs

Confirmed Again: Preventive Care Does Not Save Money

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As reported by the Washington Post:

Using data from long-standing clinical trials, researchers projected the cost of caring for people with Type 2 diabetes as they progress from diagnosis to various complications and death. Enrolling federally-insured patients in a simple but aggressive program to control the disease would cost the government $1,024 per person per year — money that largely would be recovered after 25 years through lower spending on dialysis, kidney transplants, amputations and other forms of treatment, the study found.

However, except for the youngest diabetics, the additional services would add to overall health spending, not decrease it, the study shows.

Health Care Costs

New Report From the Actuaries

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A May 2009 report form the American Academy of Actuaries, summarizes the latest data on the performance of Consumer-Drive Health Plans (CDHPs). The authors conclude that CDHPs cut expenditures 4 to 15 percent in their first year. After the first year, the expenditure growth rate is 3 to 5 percent lower than in comparable PPO plans. Continue reading New Report From the Actuaries →

Health Care Costs

The Patient as a Billing Opportunity

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Imagine going in for a free medical screening and then being hit with a big bill. It's happening a lot these days.

Company health plans increasingly are offering to pay the full cost of preventive services such as physicals, colonoscopies and mammograms to help employees stay healthy. But some patients then find they owe money for such screenings, sometimes hundreds or thousands of dollars.

So, what can go wrong? (1) The doctor's office miscodes the service. (2) Something happens, say, during a preventive exam which allows the doctor to code the episode as another service. For example, the patient mentions he has allergies or some other problem and the session gets coded as a treatment rather than a physical. (3) Or, during the exams:

Doctors sometimes order more views of suspicious masses they spot as they are doing a screening mammogram. This then gets billed as a diagnostic mammogram, which deals with existing symptoms, rather than a screening, which is for people without any specific signs of risk. For patients, that shift could mean new fees.

Warning: Once it gets coded wrong, it's like pulling teeth to get it fixed.

Science and Other News

Another Blow for Preventive Medicine

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This is from an article by Gina Kolata of the New York Times:

The P.S.A. blood test, the popular screening test for prostate cancer, saves few if any lives and exposes large numbers of men to risky and unnecessary treatment…..

The European….. studies found that screening was associated with a 20 percent relative reduction in the prostate cancer death rate. [link; gated, but with abstract.] But the number of lives saved was small: 7 fewer prostate cancer deaths for every 10,000 men screened and followed for nine years…..

The American study….. found no reduction in deaths from prostate cancer after most of the men had been followed for 10 years. [link; gated, but with abstract.]

The reason screening saved so few lives, cancer experts say, is that prostate cancers often grow very slowly, if at all, and most never endanger a man if left alone…..

Mammography has about the same effect as the P.S.A. test.

Health Alerts

CIGNA Announces New Study Results

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CIGNA reports that its consumer driven plans "reduced medical cost trend by 13 percent relative to HMO and PPO plans, even as individuals enrolled in CDHPs use more preventive services and comply with their medical treatments."  The study covered medical claims for 440,000, including 22,000 individuals who have either hypertension or diabetes.

  • Cost trend was reduced by 20% for people with diabetes and 18% for people with hypertension, compared to people with the same conditions in non-CDHP plans.
  • Overall medical trend was down by 3.3%, compared to an increase of 10.6% for HMO and PPO enrollees.
  • Pharmacy costs for new enrollees were 10% lower;
  • Yet preventive care visits were 8% higher for CDHP enrollees and 15% higher for renewing CDHP enrollees.