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Medicare News
Medicare Issues Getting Much Attention in Closing
Days of Congress
Diabetes treatment, review of anemia medication
rules top list
December 6, 2006 – The final days of this Congress
are seeing considerable focus on Medicare issues. A group of senators
have asked Health & Human Services to make diabetes screening and
prevention a "top priority" for Medicare. Tomorrow, the House Ways and
Means Committee will consider Medicare's coverage of anemia medication
used to treat patients with end-stage renal disease. And, outside
Congress, a meeting of advocates expressed their desire to see
"patient-centered care" linked to Medicare reimbursements with
pay-for-performance measures.
 Senators Ask
HHS To Focus on Diabetes Screening, Prevention for Medicare
Beneficiaries
Nineteen senators in a letter sent on Monday to
HHS
Secretary Mike Leavitt requested that he "make diabetes screening and
prevention for Medicare beneficiaries a top priority,"
CQ HealthBeat
reports.
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Lame-Duck Congress Still Wrestling with How to
Reverse Medicare's Proposed Pay Cut for Doctors
December 6, 2006 – The long and costly battle over
Medicare proposed cut in pay to physicians was expected to be settled in
this lame-duck session of Congress but it has hit a snag – how to make
up for the lost funds if the 5.1% pay cut is reversed. Leaders in the
House and Senate seem unable to find common ground. The doctors argue
that cutting Medicare reimbursements will make it more difficult for
senior citizens to find a doctor that will accept Medicare patients.
Other studies disagree. Read
more...
Senior Citizens' Political Hot Buttons Not High with
Most Americans
Social Security, Medicare rank low in polls by
Harris, Gallup
 November 30, 2006 – As the new year approaches and
the new Democrat Congress considers their agenda, the hot button issues
for senior citizens and older baby boomers are far down the list of
importance for most Americans. Two recent polls – Harris and Gallup –
show Social Security and Medicare are not among the most important
issues. Read
more...
Medicare Making Changes, Expanding Preventive Care
Services to Fight Diabetes
Expanding access in
rural areas, encouraging physician discussion
December 4, 2006 – Medicare has announced expanded
preventive services and other changes beginning January 1, that will
affect millions of senior citizens battling diabetes. Diabetes screening
was first added to preventive services in 2005, but the agency says it
is making additions and changes that can help seniors with the disease
or even those at risk of diabetes. Below are the highlights.
Read more...
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According to the letter, findings from a recent
study in the journal Diabetes Care show that 61% of Medicare
beneficiaries -- 21 million of an estimated 32 million seniors -- have
either diabetes or prediabetes. Of those, 14 million beneficiaries are
believed to have undiagnosed prediabetes.
"Please include in your FY 2008 budget proposal an
aggressive collaborative effort between the
CDC, [CMS],
and other key agencies to find and screen" those beneficiaries who have
not yet been diagnosed, the letter states.
The senators, including John Cornyn (R-Texas) and
Charles Schumer (D-N.Y.), noted that a clinical trial conducted by
NIH
found that "modest" changes to diet and exercise prevented diabetes in
58% of participants considered to be at high risk of contracting
diabetes.
The trial also found that such changes prevented
the onset of diabetes in participants over age 60 by 71%. The trial
"shows that such an initiative will save lives and money" the letter
states (CQ HealthBeat, 12/4).
House Committee Hearing To Address Medicare
Reimbursements for Anemia Medications
The
House Ways and
Means Committee on Thursday plans to hold a hearing to
discuss the cost and safety of anemia medication used to treat patients
with end-stage renal disease and Medicare reimbursements for such
treatments,
The Hill
reports.
According to an analysis published in October by
the journal Health Affairs, Medicare in 2005 spent $1.75 billion on
anemia treatments, which represent the largest medication expense for
the program.
The anemia medications Epogen and Aranesp,
manufactured
Amgen,
and Procrit, manufactured by
Johnson & Johnson
-- all of which have the same active ingredient epoetin -- have no
generic competition. T
he lack of generic competition for anemia
medications limits "the power of market forces to moderate price,"
according to a recent
Government
Accountability Office report. In addition, according to the
Health Affairs analysis, "liberalization" of the Medicare coverage
"benefit for epoetin therapy over the years has created a financial
incentive for its increased use."
Lawmaker Concerns
In a recent
letter
to acting
CMS
Administrator Leslie Norwalk, committee Chair Bill Thomas (R-Calif.) and
ranking member Rep. Pete Stark (D-Calif.) criticized a policy under
which Medicare reimburses for the administration of doses of anemia
medications that exceed the level recommended by
FDA.
The lawmakers wrote, "We are deeply concerned that
the current CMS policy is not aggressive enough to stem the systemic
abuse of Epogen, resulting in costs to taxpayers and potential health
dangers to patients."
Thomas and other lawmakers have proposed reforms to
the Medicare reimbursement system that would combine services,
medications and other expenses related to kidney dialysis treatment.
Thomas and Stark also cited a recent study published in the New England
Journal of Medicine as evidence against the CMS policy.
The study, conducted by researchers at Harvard
Medical School and sponsored by J&J, found that kidney disease patients
treated with high doses of the anemia medications epoetin and
darbepoetin had a 34% higher risk for heart attack, congestive heart
failure, stroke and death than those treated with lower doses of the
medications (Young, Hill, 12/6).
Implications
According to the
Los Angeles Times,
in the event that "lawmakers signal that they want to curtail the amount
of anemia drugs doctors prescribe, ... it would clearly pose a
significant threat to Amgen's bottom line" because "the company's anemia
lineup makes up almost half of its sales and 60% of its profit"
(Costello, Los Angeles Times, 12/6).
In a statement, Amgen officials raised concerns
that implementation of the proposed reforms to the Medicare
reimbursement system would combine expenses related to kidney dialysis
treatment "without appropriate case-mix adjusters."
Officials in the statement said that "quality
safeguards could introduce financial incentives to underutilize services
and could decrease the quality of care." Amgen officials wrote, "A
bundled system prior to the completion of a CMS demonstration project,
if implemented poorly, could result in harm to patients and cost
Medicare more money" (CQ HealthBeat, 12/5)
'Patient-Centered Care' Important in Efforts
To Measure Health Care Quality, Forum Speakers Say
Speakers at a forum hosted by the
Alliance for Health
Reform and the
Commonwealth Fund
on Monday said that "patient-centered care" is important in efforts to
measure health care quality,
CQ HealthBeat
reports.
At the forum, speakers said that patient-centered
care measures can include the level of patient involvement in their
health care, the effectiveness of coordination of care among different
providers, routine feedback to hospitals, clinical information systems
that support high-quality care and publicly available information on
patient-centered care.
A report recently published in the Joint Commission
Journal on Quality Improvement found that patients who received
patient-centered care were less likely to experience complications and
death than other patients, according to Commonwealth Fund President
Karen Davis.
Davis recommended that
CMS
include patient-centered care in efforts to link Medicare reimbursements
with pay-for-performance measures. She said, "We need to make
patient-centered care a central part of pay-for-performance" (Hopkins,
CQ HealthBeat, 12/4).
>> A webcast of the forum is available
online
at
kaisernetwork.org.
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