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Identifying widely covered drugs and drug coverage variation among Medicare part D formularies.

 Medicare News, Syndicated  Comments Off
Aug 042007
 
JAMA, Vol. 297, No. 23. (20 June 2007), pp. 2596-2602.

CONTEXT: Clinicians can find it difficult to know which drugs are covered for their Medicare patients because formularies vary widely among Medicare Part D plans and many states have 50 or more such plans. OBJECTIVE: To determine whether Part D formularies in California (the state with the most Medicare beneficiaries) and Hawaii have at least 1 drug within each of 8 treatment classes for hypertension, hyperlipidemia, and depression that can be identified for clinicians as "widely covered" by the vast majority of Part D plans. DESIGN AND SETTING: Use of the medicare.gov Web site (March 1-April 15, 2006) to examine 72 California and 43 Hawaii Part D formularies' coverage of 8 treatment classes (angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, beta-blockers, calcium channel blockers, loop diuretics, selective serotonin reuptake inhibitors, statins, and thiazide diuretics), with evaluation of how often drugs were widely covered (defined as inclusion in >or=90% of formularies at co-payments of <or=$35 without prior authorization). MAIN OUTCOME MEASURE: Identification of treatment classes with at least 1 widely covered drug. RESULTS: For California, coverage for the 75 drugs examined ranged from 7% to 100%. Despite this variation, 7 of 8 classes (excluding angiotensin II receptor blockers) had at least 1 widely covered drug. Of the 34 widely covered drugs (45%), all but 2 were generic. Restricting widely covered to include 95% or more of formularies at co-payments of $15 or less still resulted in 7 of 8 classes with at least 1 widely covered drug. Overall, 73% of generic drugs and 6% of brand-name drugs were widely covered. Findings were similar for Hawaii. CONCLUSIONS: Formularies varied substantially; however, all but 1 treatment class examined had 1 or more widely covered drugs at low co-payments. Knowing which drugs are widely covered would assist clinicians in prescribing, since not all generic drugs were widely covered. Clinicians should know that few brand-name drugs are widely covered and check coverage before prescribing.
CW Tseng, CM Mangione, RH Brook, E Keeler, RA Dudley

Impact of managed care on the treatment, costs, and outcomes of fee-for-service Medicare patients with acute myocardial infarction.

 Medicare News, Syndicated  Comments Off
Apr 232007
 
Health Serv Res, Vol. 39, No. 1. (February 2004), pp. 131-152.

OBJECTIVE: To examine the effects of market-level managed care activity on the treatment, cost, and outcomes of care for Medicare fee-for-service acute myocardial infarction (AMI) patients. DATA SOURCES/STUDY SETTING: Patients from the Cooperative Cardiovascular Project (CCP), a sample of Medicare beneficiaries discharged from nonfederal acute-care hospitals with a primary discharge diagnosis of AMI from January 1994 to February 1996. STUDY DESIGN: We estimated models of patient treatment, costs, and outcomes using ordinary least squares and logistic regression. The independent variables of primary interest were market-area managed care penetration and competition. The models included controls for patient, hospital, and other market area characteristics. DATA COLLECTION/EXTRACTION METHODS: We merged the CCP data with Medicare claims and other data sources. The study sample included CCP patients aged 65 and older who were admitted during 1994 and 1995 with a confirmed AMI to a nonrural hospital. PRINCIPAL FINDINGS: Rates of revascularization and cardiac catheterization for Medicare fee-for-service patients with AMI are lower in high-HMO penetration markets than in low-penetration ones. Patients admitted in high-HMO-competition markets, in contrast, are more likely to receive cardiac catheterization for treatment of their AMI and had higher treatment costs than those admitted in low-competition markets. CONCLUSIONS: The level of managed care activity in the health care market affects the process of care for Medicare fee-for-service AMI patients. Spillovers from managed care activity to patients with other types of insurance are more likely when managed care organizations have greater market power.
MK Bundorf, KA Schulman, JA Stafford, D Gaskin, JG Jollis, JJ Escarce

Impact of managed care on the treatment, costs, and outcomes of fee-for-service Medicare patients with acute myocardial infarction.

 Medicare News, Syndicated  Comments Off
Apr 232007
 
Health Serv Res, Vol. 39, No. 1. (February 2004), pp. 131-152.

OBJECTIVE: To examine the effects of market-level managed care activity on the treatment, cost, and outcomes of care for Medicare fee-for-service acute myocardial infarction (AMI) patients. DATA SOURCES/STUDY SETTING: Patients from the Cooperative Cardiovascular Project (CCP), a sample of Medicare beneficiaries discharged from nonfederal acute-care hospitals with a primary discharge diagnosis of AMI from January 1994 to February 1996. STUDY DESIGN: We estimated models of patient treatment, costs, and outcomes using ordinary least squares and logistic regression. The independent variables of primary interest were market-area managed care penetration and competition. The models included controls for patient, hospital, and other market area characteristics. DATA COLLECTION/EXTRACTION METHODS: We merged the CCP data with Medicare claims and other data sources. The study sample included CCP patients aged 65 and older who were admitted during 1994 and 1995 with a confirmed AMI to a nonrural hospital. PRINCIPAL FINDINGS: Rates of revascularization and cardiac catheterization for Medicare fee-for-service patients with AMI are lower in high-HMO penetration markets than in low-penetration ones. Patients admitted in high-HMO-competition markets, in contrast, are more likely to receive cardiac catheterization for treatment of their AMI and had higher treatment costs than those admitted in low-competition markets. CONCLUSIONS: The level of managed care activity in the health care market affects the process of care for Medicare fee-for-service AMI patients. Spillovers from managed care activity to patients with other types of insurance are more likely when managed care organizations have greater market power.
MK Bundorf, KA Schulman, JA Stafford, D Gaskin, JG Jollis, JJ Escarce

Medicare cuts cripple access to cardio care

 Medicare News, Syndicated  Comments Off
Dec 311969
 
Beginning Jan. 1, 2010, Medicare patients throughout New Jersey will find it more difficult to receive potentially life-saving heart tests and treatments. The cause: a cut in the federal reimbursement system that compensates private cardiovascular clinics for serving Medicare patients.

Mayo Clinic in Arizona to Stop Treating Some Medicare Patients

 Medicare News, Syndicated  Comments Off
Dec 311969
 
Dec. 31 (Bloomberg) -- The Mayo Clinic , praised by President Barack Obama as a national model for efficient health care, will stop accepting Medicare patients as of tomorrow at one of its primary-care clinics in Arizona, saying the U.S. government pays too little.

Rants & Raves: Mayo under Obamacare: Good luck, Medicare

 Medicare News, Syndicated  Comments Off
Dec 311969
 
The Mayo Clinic, praised by President Barack Obama as a national model for efficient health care, has stopped accepting Medicare patients at one of its primary-care clinics in Arizona, saying the government pays too little. More than 3,000 patients eligible for Medicare will be forced to pay cash if they want to continue seeing their doctors at the Mayo family clinic in Glendale. Medical ...

Mayo location in Arizona stops accepting Medicare: MedCity Morning Read, Jan. 4, 2010

 Medicare News, Syndicated  Comments Off
Dec 311969
 
Highlights of the important and the interesting from the world of health care: Mayo Clinic in Arizona stops accepting Medicare patients: In what millions of Americans no doubt hope isn't the start of a long-term trend, one primary care clinic in Arizona that's affiliated with Minnesota's highly acclaimed Mayo Clinic says it will stop seeing Medicare patients . The move at Mayo's Glendale ...

Mayo Clinic in Arizona to Stop Treating Some Medicare Patients

 Medicare News, Syndicated  Comments Off
Dec 311969
 
The Mayo Clinic, praised by President Barack Obama as a national model for efficient health care, will stop accepting Medicare patients as of tomorrow at one of its primary-care clinics in Arizona, saying the U.S. government pays too little.

Mayo in full damage control mode over Medicare decision

 Medicare News, Syndicated  Comments Off
Dec 311969
 
ROCHESTER, MINNESOTA-- Mayo Clinic scrambled to blunt criticism over its decision to stop accepting Medicare patients at a facility in Glendale, Arizona. A post on Mayo's Health Policy blog said some media reports incorrectly reported the organization was not seeing any Medicare patients in the state. Instead, Mayo's decision impacts patients who see "only primary care office visits for the five ...
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