Medicare to Docs: Go Electronic in 2012

Medicare, the federal health insurance program for the elderly and disabled, will offer financial bonuses to doctors who prescribe drugs electronically rather than on paper. Doctors who do not will face penalties from Medicare starting in 2012. From Reuters. Medicare states that this is to improve efficiency between doctors and pharmacies and to avoid problems with handwriting, patients who lost prescription notes, etc. However, how much is this going to cost doctors--especially those who are serving low income areas or who are in private practice? I understand that Medicare is now offering monetary incentives to doctors who welcome this program but why bribe doctors into doing something that they will already ahave to do in a few years. Medicare should, if they are mandating that doctors adhere to this new policy, spend money to educate docs and their staff on the new inititative.

Just the Essentials: Deciding on Medicare Coverage

We stumbed across this very informative piece this morning by Allsup on MarketWatch that details the 10 most important things that indivudals/caretakers must ask themselves when figuring out appropriate Medicare coverage. The article stresses that knowing one's healthcare needs is the key to understanding what plans are solid for their needs. We highly recommend that you print out this list, available here.

U.S. Nursing Homes Get "Zagat" Rated by Feds

For a listing of the ratings by state, please click here. By offering ratings to each nursing home, it gives a clear rating of the quality of the home. Though a visit is always encouraged, soon people would be able to choose a nursing home much like choosing a place for vacation. What is particularly interesting about this report is that non-profit oranizations take better care of their clients than for profit organzations. This is probably because non-profits are so tied into keeping their non-profit status that a system of checks and balances in high order. An analysis of nearly 16,000 nursing homes reveals for-profit homes are more likely to provide inferior care than their non-profit rivals, according to a USA TODAY examination of the federal government's first ratings of the homes' performance. The new Zagat-like rating system, released today by the Centers for Medicare & Medicaid Services, assigns homes one to five stars for quality, staffing and health inspections, plus an overall score. What do you think of the rating system? How will it affect U.S. nursing homes?

Brand-Name Drugs are Favored by Medicare Beneficiaries

According to this article in EmaxHealth, brand-name medications account for almost two-thirds of all prescriptions filled by Medicare beneficiaries. Patients are asking for brand-name drugs when the program provides coverage and are asking pharmacists for generic drugs when they have to pay out of pocket.

When patients switch from brand-name to generic drugs, more than likely they’ve reached the coverage gap in which they must cover the full cost of the prescriptions. Woody Eisenberg, Medco Chief Medical Officer mentions that when Medicare beneficiaries become aware of the coverage gap they "become acutely aware of the cost difference between brand-name and generic drugs and most make the switch."

Texas Medicaid Fraud

Oops! More kickbacks for health officials have landed Texan health officials in some serious hot water. What is important about this case, as with all fraud cases, is that it affects the individuals who trusted in others to do their job and to do it well. People don't want to be seen as dollar signs, it grows contempt in the consumer which is just bad business. This case, with phony advocacy groups and false marketing materials is predatorial and wrong and these individuals deserve to be prosecuted by the full extent of the law. J&J’s Janssen Pharmaceutica funneled kickbacks to Texas health officials, distributed false marketing materials and deployed phony advocacy groups to get its Risperdal antipsychotic prescribed to low-income Texans, the state alleges in a new filing in an ongoing fraud lawsuit filed in 2006, according to The Dallas Morning News

Medicare assures patients about access to oxygen

From AP: Medicare officials tried on Monday to quell growing worry by the elderly that they could lose access to lifesaving oxygen supplies with the start of the new year. With a rise in phony marketing scams, which this blog has covered, many less than reputable companies are preying on the elderly for more money to offset their own losses during this economic climate. We must assure people that Medicare, though wacky and seemingly mismanaged will not keep individuals from life saving access to medical supplies. Any individual representing a company that claims to do so is wrong. Always do background checks on any company or individual who contacts you our someone you know about your personal Medicare status. For the rest of this article, please click here.

DaVita gets Department of Health subpoena for documents related to Medicare practices

From CNN/AP
Dialysis services company DaVita Inc. said Monday it is responding to a Department of Health and Human Services subpoena for documents related to Medicare claims for several drugs.
What do you think will come out of this government audit of DaVita? DaVita has willingly given up all of their documentation and files regarding Medicare claims, so perhaps they have nothing to hide. We'll keep you posted on any new developments. For the rest of this article, please click here.

First Spanish Medicare Educational Video for Seniors Released

From MarketWatch:
Award-winning journalist Maria Antonieta Collins has partnered with UnitedHealthcare to create the first-ever Spanish-language Medicare educational DVD for seniors and their caregivers.
What do you think of this outreach to the elderly Latin community?
For more information and for the video, please click here.

AP: Medicare insurers' profits exceed expectations

Health insurance companies that serve the elderly and disabled in Medicare are realizing significantly higher profits than they anticipated, resulting in the companies getting $1.3 billion more than projected, congressional auditors say.

This is likely due to an increase in payments to companies by the elderly, without an increase in services by the organizations. This money is now being seen as a profit that the companies in question must diligently work with the government to make sure that the clients served via Medicare are getting the best care that they deserve. We'll keep you posted on any new developments.

For the rest of this article, please click here.

AP: Retired players to get new Medicare benefit

The NFL and its union will pay a combined $100 a month toward the Medicare costs of retired players under a new plan announced Tuesday. Good for them! I love it when organizations take care of their retirees. Let's hope that more visable organzations follow suit! For a direct link to this article, please click here.

Indiana: Beware of Medicare scams

Everyone should be on the look out for Medicare fraudsters out to get money from unsuspecting seniors. Medicare does not contact seniors to go over their health care benefits and medicare does not schedule time to visit with seniors in their homes. If you or someone you know has been contact by a source claiming to help out with Medicare, let the authorities know immediately. For an example, please click here.

Economy likely to move up Medicare's insolvency

From WashingtonPost.com

Federal health officials estimate that the struggling economy will speed up by one to three years the exhaustion of the Medicare trust fund covering hospital and nursing home care.Trustees for the Social Security and Medicare programs warned last March that the trust fund for Medicare Part A would become insolvent in 2019. But the chief actuary for Medicare said Monday the economy will likely generate less revenue through payroll taxes than the trustees had projected.
Once the trust fund is exhausted, the federal government will continue to pay for hospital care and other services, but it initially would only have enough money coming in to cover 78 percent of estimated costs.
Trustees issue a once-a-year report on the financial conditions for Social Security and Medicare. In the fall, the trustees get an update that tells them what's happening versus what their latest projection indicated. In the latest update, Medicare's top actuary braced the trustees for a deterioration in Medicare's finances.

For the rest of this article, please click here.

Bayer to Pay $97.5 Million to Settle Kickback Claim

From Bloomberg.com:

A unit of Bayer AG agreed to pay $97.5 million to settle accusations that it paid kickbacks to diabetic-equipment suppliers, the U.S. Justice Department said.Bayer Healthcare LLC was accused of giving $2.5 million to Liberty Medical Supply Inc. to persuade Liberty to provide its patients with Bayer diabetic-testing equipment such as testing strips and glucose monitors, the Justice Department said in a statement.Bayer also was accused of paying $375,000 in kickbacks to 10 other diabetic suppliers and causing them to submit false claims to Medicare, the government said. From 1998 through 2007 the suppliers filed false claims on the sales to get Medicare reimbursements, the statement said.“Paying health care suppliers to place a particular brand of device with Medicare beneficiaries violates the law and will not be tolerated,” said Gregory G. Katsas, assistant attorney general for the Civil Division.Bayer spokeswoman Susan Yarin said the payment puts the matter behind the unit, based in Tarrytown, New York.

For more information, please click here.

Medicare Advantage Paid Too Much

Fierce Healthcare reports that studies form the Medicare Payment Advisory Commission suggest that private health care plans for Medicare beneficiaries may be a good place to start cutting. The studies also show that private insurance plans are driving up costs because they are paid on average 13 percent more than allocated for traditional Medicare. Do you think private health care plans should be cut?

Medicare drug benefits cause confusion

In a survey released by MedCo Health Solutions today, we find out that of the 1,000 Medicare beneficiaries selected, that 62% do not understand the doughnut hole when it comes to prescription drugs. More alarming is that 28% of those surveyed stated they weren't aware it existed.

For more information, read here.

Private Plans for Medicare that Cover Dental Care

This post on AMPSYS discusses how Medicare does not cover dental care, but there are ways around this. There are many private plans for Medicare that do offer such coverage for dental expenses. Some of these private plans include the basic Medicare coverage, and also offer savings in eyeglasses, hearing devices, and dental care as well. The post gives an example of how Humana pays for about 25 percent of fillings, 75 percent of the cost of examinations, cleanings and X-rays, and 50 percent of extractions.

Medicare Co-Pays and Premiums Expected to Rise

FierceHealthcare reports today that a recent study conducted by Avalere Health LLC found that for the largest 10 drug companies, premiums are expected to rise up an average of 31 percent next year. It is also speculated that this in term might cause insurers to increase drug co-payments 75 percent (about $7) for generic drugs and a 60% increase (about $40) for brand drugs.

A spokesperson from Humana, an insurer, mentions:

“Prices reflect the experience we've seen over the past three years, and our expectations around what will most interest our members and potential members going forward."

Billions Paid in Medicare Suspect Claims

The National Center for Policy Analysis reports that billions of taxpayer dollars have gone to waste because Medicare has paid out claims with blank or invalid diagnosis codes over the past decade according to a new Senate report.

Claims for wheelchairs, drugs, and other medical supplies of Medicare patients were reviewed from 2001 to 2006. During these years, they found at least $1 billion of medical equipment which listed diagnosis codes that had little or no connection to the reimbursed medical items. Here are some findings from the report:

• Medicare paid millions of dollars to medical suppliers for blood glucose test strips -- used exclusively for diabetics -- based on non-diabetic diagnoses.
  
• Roughly $4.8 billion in payments were made from 1995 to 2006 despite invalid coding or nothing listed at all; about $23 million of that amount was paid after 2003, when federal rules made clear the codes were required.
• Based on a sample of 2,000 of those invalid coding claims, investigators found more than 30 percent could not be verified as legitimate and "bore characteristics of fraudulent activity."
• Federal regulations require that Centers for Medicare and Medicaid Services (CMS) pay only for items that are deemed "medically necessary," yet, CMS does not examine diagnosis codes to determine whether the equipment is actually necessary before making payment.
• Only 3 percent of claims are reviewed after payment is made.
  

Sources:
http://hsgac.senate.gov/public/
http://townhall.com/news/us/2008/09/24/probe_medicare_paid_billions_in_suspect_claims

Medicare Monthly Premium Costs Remain the Same for Elderly and Disabled in 2009

AHN reports that Medicare premiums for the disabled and elderly will remain constant at $96.40 next year, according to the U.S. Centers for Medicare & Medicaid Services.

The premium and deductible paid by consumers cover home health facilities, durable medical equipment, and cost of physicians. The Medicare Part B Program will also retain its costs at $135 this year. So far the only costs expected to rise is monthly premium payment for Part A coverage which will rise form $423 to $443 in 2009.

Medicare rates to stay the same for 2009

According to Elder Law Answer, it was announced recently that Medicare's monthly premium will stay the same for the first time in eight years. The monthly premium will remain the same, totaling $96.40 a month.

This fee covers portions of fees related to physicians services, outpatient hospital services, and other items.

More advertising dollars going to Medicare Advantage

In a recent study done by the Kaiser Family Foundation, detailed here at the Washington Post, they found that insurers spent three times more money promoting comprehensive Medicare plans rather than stand alone drug plans. The study was conducted between October 1 and December 31, 2007, with an increased effort looking at what's going on with Medicare marketing practices. For the most part, the commercials emphasized the benefits centered around preventative care, vision and hearing benefits.

Restrictions placed on cold calls by insurance agents

Effective October 1, insurance agents will no longer be able to cold call the elderly and disabled when trying to sell prescription drug plans. According to the AP, this new law will be enforced by an increased amount of surveillance on the agents as well as reviews of media and print ads published by those.

The new restrictions include:

- No unsolicited contacts with beneficiaries, such as visiting their home or calling them. The prospective customer must initiate the contact.

- No selling of other insurance products, such as annuities or life insurance, to beneficiaries.

- No free meals at promotional or sales events.

- New requirements for training or testing of agents.

Penalties for breaking these law could result in up to $25,000 worth of fines.

Medicare Hospice Protection Act

US Representative Maurice Hinchey has introduced a new bill to Congress to block a new bill from the Bush administration. According to The Ithaca Journal, a bill going into affect October 1 will begin reducing Medicare reimbursement rates by $2.2 billion over the next five years. This could result in hospice patients loosing their hospice care across the country, as it could cost certain hospices $50,000 next year across the country, and as much as $150,000 over the next three years. Hinchey is encouraging Congress to swift action due to the tight time frame they’re working with.

Welcome to Doughnut Hole Season

In a recent article at the Dallas Morning News, they discuss the current stress one in five seniors is now facing until the end of the calendar year. Doughnut Hole Season is the time of year when low co-payments reach their gap in the drug coverage provided by Medicare, and, as a result, they are faced with staggeringly high payments for their medication. In 2007, 3.4 million seniors faced this situation.

Through the current program, seniors are responsible for full costs once all of Medicare’s payments (co-pays and deductibles) have reached $2150. They do not pick up payments again until citizens spending exceed $5726. However, only one in five will reach this amount.

Senate Investigates Medicare Call Centers

Yesterday's Wall Street Journal reported on Senator Gordon Smith (R-OR) and his investigation into the quality of Medicare's call center brought to Capitol Hill. The call centers, run by Vangent, are under investigation because "In 50 test calls placed last month, wait times ranged from zero to 45 minutes, and six calls were disconnected while on hold. Call centers have provided at least one piece of incorrect information or been unable to provide a response to at least one question in 90% of test calls placed in the past year," reported the WSJ article. Vangent denies the allegations citing their high customer satisfaction percentages. What do you think of Senator Smith's investigation?

Humana looses some Medicare Enrollees

As a result of premium bids that are higher than low income, government assigned members of Medicare, Humana expects to loose 10% of them at the beginning of 2009. However, according to the Wall Street Journal, they believe this could be positive for Humana due to the fact that higher prices would increase the bottom line, shares dropped 5% to $41.75 when it was announced that this could lead to a los of 380,000 eligible Medicare members. To ensure drug coverage for these dropped Medicare enrollees, the government will automatically re-enroll them in private drug care provider programs.

Medicare Made Easy

In a latest release, Experion Systems has launched a new edition of their PlanPrescriber tool as reported by MarketWatch. Created by Glen Urban, a Professor at MIT, this new tool gives seniors access to “unbiased advice” for determining their Medicare Insurance plan. It is a free online tool designed to save seniors time, and money, and starts by simply entering a zip code. Those without access to Internet, can also call 877-900-4824. As Ross Blair, Experion Systems CEO, stated:

"The rising costs of prescription drugs is a real burden for seniors on a fixed income. PlanPrescriber allows seniors to switch to the optimal plan based on their individual needs. Seniors can typically save 25% to 50% of their annual prescription drug costs by joining the optimal insurance plan."

Medicare Pays Too Much for New Generics

According to this article on The Wall Street Journal Blog when the price of generic drugs plunges, Medicare is slow to reflect that price change.

A report published by the Health and Human Services’ inspector general looks at irinotecan, which is a cancer that went generic in February of this year. The average price of the drug factoring in sales of the branded version was $52. During the current quarter, Medicare was paying about $75 for irinotecan, which is still far above the average price.

Read the full report here.

Marry For Health Reasons? Maybe Not Necessary

One common conception that scientists in the past have validated is that for your health, it is better to be married. A new study as reported in BusinessWeek, however, is suggesting otherwise.

Hui Liu, study’s lead author from Michigan State University stated

"One of the most-often documented facts is that married people are healthier than non-married people, but the difference between married and unmarried people has changed over the past few decades."

As the article further reports:

- the self-reported health status of never-married adults increased significantly over time

- self-reported health status of married women also increased

- the gap between married and never-married women's health stayed about the same

- never-married men narrowed the health gap between themselves and married men

Some of the speculated reasons for the results of the study include that with the mores in society changing, it is no longer imperative to have a spouse for social status and acceptance. In addition, currently there are more support systems in place for those who are unmarried that may help them to not experience the negative side effects that in the past have been associated with being single.

Living Near Highways Can Increase Risk of Low-Birth Weight

The NY Times reports that a recent Canadian study shows that mothers who live near highways are more likely to give birth to low-weight and preterm babies. The study, which was published in Journal of Epidemiology and Community Health, looked at medical records of nearly 100,000 births in Montreal from 1997 to 2001. Researchers measured distances to the nearest highways and determined socioeconomic and education levels from census data.

Researchers found that compared to wealthy neighborhoods, mothers who lived within 220 yards of a highway were linked to a 58 percent chance of preterm birth, and a 81 percent chance of increased risk of low-birth weight.

Dr. Mélissa Généreux, a resident physician at the University of Montreal mentions:

“Low-income mothers are exposed to more risk factors — smoking, poor nutrition, poor access to prenatal care, domestic violence. More advantaged mothers are protected from these risk factors, so they might be more affected by the addition of a single new risk factor, pollution from highways.”