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Medicare’s national coverage decisions for technologies, 1999-2007

Medicare News, Syndicated Comments Off

Oct 112010

In Health Affairs, Vol. 27, No. 6. (2008), 1620-31.

An analysis of Medicare national coverage decisions (NCDs) from 1999 through 2007 reveals that the Centers for Medicare and Medicaid Services (CMS) considers the available evidence as no better than fair for most of the technologies considered. Still, the CMS issues favorable decisions in 60 percent of the cases it takes on, although almost always with conditions placed on coverage. Since enactment of the 2003 Medicare Modernization Act, which legislated maximum review times for NCDs, the CMS has eliminated "long duration" decisions (more than one year) and has issued several "coverage with evidence development" decisions, which promise flexibility but also carry implementation challenges.
PJ Neumann, MS Kamae, JA Palmer

How The Center For Medicare And Medicaid Innovation Should Test Accountable Care Organizations

Medicare News, Syndicated Comments Off

Jul 312010

Health Aff, Vol. 29, No. 7. (1 July 2010), pp. 1293-1298.

The Patient Protection and Affordable Care Act establishes a national voluntary program for accountable care organizations (ACOs) by January 2012 under the auspices of the Centers for Medicare and Medicaid Services (CMS). The act also creates a Center for Medicare and Medicaid Innovation in the CMS. We propose that the CMS allow flexibility and tiers in ACOs based on their specific circumstances, such as the degree to which they are or are not fully integrated systems. Further, we propose that the CMS assume responsibility for ACO provisions and develop an ordered system for learning how to create and sustain ACOs. Key steps would include setting specific performance goals, developing skills and tools that facilitate change, establishing measurement and accountability mechanisms, and supporting leadership development. 10.1377/hlthaff.2010.0453
Stephen Shortell, Lawrence Casalino, Elliott Fisher

Unequal access to cadaveric kidney transplantation in California based on insurance status.

Medicare News, Syndicated Comments Off

Jul 192010

OBJECTIVE: To assess the impact of insurance status on access to kidney transplantation among California dialysis patients. STUDY SETTING: California Medicare and Medicaid dialysis populations. STUDY DESIGN: All California ESRD dialysis patients under age 65 eligible for Medicare or Medicaid in 1991 (n = 9,102) took part in this cohort analytic study. DATA COLLECTION: Medicare and California Medicaid Program data were matched to the Organ Procurement and Transplantation Network Kidney Wait List files. PRINCIPAL FINDINGS: Only 31.4 percent of California Medicaid dialysis patients were placed on the kidney transplant waiting list compared to 38.8 percent and 45.0 percent of dually eligible Medicate/Medicaid and Medicare patients, respectively. Compared to the Medicaid population, Medicare enrollees were more likely to be placed on the kidney transplant waiting list (adjusted Relative Risk [RR] = 2.10, Confidence Interval [CI] 1.68, 2.62) as were dually eligible patients (RR = 1.54, CI 1.24, 1.91). Once on the waiting list, however, Medicare enrollment did not influence the adjusted median waiting time to acquire a first cadaveric transplant (p > .05). CONCLUSIONS: California dialysis patients excluded from Medicare coverage, who are disproportionately minority, female, and poor, are much less likely to enter the U.S. transplant system. We hypothesize that patient concerns with potential subsequent loss of insurance coverage as well as cultural and educational barriers are possible explanatory factors. Once in the system, however, insurance status does not influence receipt of a cadaveric renal transplant.
M Thamer, SC Henderson, NF Ray, CS Rinehart, JW Greer, GM Danovitch

Social Security, Medicare & Government Pensions: Get the Most Out of Your Retirement & Medical Pensions (Paperback)

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Jan 022010

Review

“Anyone who can write a readable guide to Medicare should get a medal…. Why can’t the system be as straightforward as this book?” — Pasadena Star-News

“Guide[s] you through the maze of Social Security and Medicare in simple English…” — The Wall Street Journal

“Offers clear explanations of what to expect from a remarkable safety net that has withstood the test of time…” — Contra Costa Times

Get the most out of the new Medicare drug coverage! Everyone wants to get the highest possible retirement and pension income –not to mention the best medical coverage. This book is your guide to finding retirement benefits, figuring out the best time to claim them, and then doing so quickly and easily. Social Security benefits Find all the latest information and instructions you need to get your retirement and disability benefits, dependents and survivors benefits, and Supplemental Security Income (SSI). Medicare & Medicaid Learn the nuts (more…)

Medicare Explained 2009 (Paperback)

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Jan 022010

This new edition of Medicare Explained provides a detailed explanation of Hospital Insurance Benefits for the Aged and Disabled (Part A) and Supplementary Medical Insurance Benefits Program for the Aged and Disabled (Part B), as well as explanations of the Medicare Advantage program (Part C) and the prescription drug benefit (Part D).

In addition, this book provides legislative and regulatory analysis on the Medicare Advantage Program, Exclusions from Medicare, Miscellaneous provisions (e.g. role of state agencies and fiscal intermediaries, role of Medicaid, Peer Review Program, Medigap Insurance, Fraud and Abuse Penalties, etc). Also, analysis of payment rules and claims and appeals is covered.

This book provides 2008 legislative and regulatory changes that impact Medicare Part A, B and the Medicare Advantage programs as well as the Prescription Drug Benefit. Guidance issued by the Centers for Medicare and Medicaid Service (CMS) used to administer these programs is also used.

John McCain Sarah Palin want to cut Medicare & Medicaid

Medicare News, Video Comments Off

Oct 072008

	John McCain Sarah Palin want to cut Medicare & Medicaid The McCain campaign has lost their minds. They want to cut the programs that millions of Americans rely on Medicare & Medicaid. Rachel Maddow Show.	From: style6919 Views: 934 12 ratings
	Time: 04:14	More in News & Politics

Medicare Physician Fee Cuts: Can Small Practices Survive?-2

Medicare News, Video Comments Off

May 082008

	Medicare Physician Fee Cuts: Can Small Practices Survive?-2 Panel I Hon. Herb B. Kuhn Deputy Administrator Centers for Medicare and Medicaid Services	From: HouseSmallBizDems Views: 195 0 ratings
	Time: 04:57	More in News & Politics

Per-patient-per-month drug costs in Medicare Part D protected classes.

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Aug 042007

Pharmacoeconomics, Vol. 24 Suppl 3 (2006), pp. 79-84.

OBJECTIVE: The objective of this study was to estimate the per-patient-per-month (PPPM) costs of medications in the six Medicare Part D protected classes based on findings among Medicare and dual eligible beneficiaries with drug coverage before the enactment of the benefit. DESIGN: Data were from the Thomson Medstat MarketScan Medicare and Medicaid claims databases. The study sample was constructed by identifying patients who were enrolled either in Medicare or dually in Medicare and Medicaid. PPPM costs were calculated for each protected class. Drugs covered under Part B were excluded. OUTCOMES MEASURE: PPPM aggregated costs within each class. RESULTS: The classes in which generic formulations are available (antidepressants and anticonvulsants) show low PPPM costs ($ US 45.31 and $ US 50.97, respectively). The most expensive class is the antiretrovirals ($ US 829.73). This class is the costliest for all dual eligible patients including those aged 64 years and under. Among the dual eligible aged 65 years and older, the immunosuppressants are the most expensive class. The same result is seen qualitatively in the Medicare group. CONCLUSIONS: PPPM costs are not uniformly high among the protected classes. The claims data in this study allowed a 'real world' check of how much the protected classes may impact the finances of Part D. There are differences within the classes between the dual eligible and Medicare patients, and also within the dual eligible by age. This is an important message to policy makers that a change to the structure of the protected classes in Part D may have differential effects across classes and also within classes.
L Mucha, NA Masia, KJ Axelsen

Per-patient-per-month drug costs in Medicare Part D protected classes.

Medicare News, Syndicated Comments Off

Aug 042007

Medicare Part D: selected issues for pharmacists and beneficiaries in 2007.

Medicare News, Syndicated Comments Off

Aug 042007

J Manag Care Pharm, Vol. 13, No. 1. (b 2007), pp. 59-65.

BACKGROUND: Upon signing the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) on December 8, 2003, President Bush set in motion the greatest change in the Medicare program since its inception in 1965. MMA was implemented on January 1, 2006, and established the Medicare prescription drug benefit, also known as Medicare Part D. Community and managed care pharmacists were essential to the success in 2006 of this new benefit program with 33 million beneficiaries. Pharmacists will continue to be an essential and integral part of the continued success of the Medicare prescription drug benefit in 2007, in part by being informed about the policies and regulations. OBJECTIVE: To review policy statements released by the Centers for Medicare & Medicaid Services (CMS) for the Medicare prescription drug benefit in 2006 and to compile an abridged version of the highlights from the policy statements that may affect pharmacists and their interaction with Medicare beneficiaries. METHODS: We reviewed all policy statements that were released publicly via the CMS Web site (www.cms.gov) policy guidance section between January 1, 2006, and September 30, 2006. We read through approximately 100 guidance statements and summarized approximately 50 that were determined to be relevant to beneficiaries and pharmacists in various practice settings. RESULTS: Policy statements that may impact beneficiaries of the Medicare prescription drug benefit in 2007 include the timeline for the annual coordinated election period, managed care open enrollment period, and distribution of annual notices of change to beneficiaries. Changes have also occurred in the standard benefit and cost sharing for low-income subsidy (LIS) or extra help that some beneficiaries are eligible to receive based on their current financial status. Discontinuation of coverage of erectile dysfunction drugs is a noteworthy coverage change. For all health care providers, the National Provider Identification (NPI) number will be used beginning May 23, 2007. Once the system using NPI numbers is required, no other provider identification number will be valid for billing Medicare and Medicaid. CONCLUSION: Important policy updates to the Medicare prescription drug benefit in 2007 include the subject areas of: (1) beneficiary enrollment, (2) transition medication fills, (3) standard benefit, (4) cost sharing, particularly for those who qualify for LIS, (5) enhancement of the Medicare Prescription Drug Plan Finder, (6) beneficiary complaints, (7) discontinuation of coverage for erectile dysfunction drugs, (8) vaccine coverage by the Medicare prescription drug benefit, (9) syringes in long-term care, (10) donation of unused medications by beneficiaries, (11) implementation of the NPI, and (12) preventive services covered by the Medicare program.
J Kilian, J Stubbings

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