Hospices to Improve Health Services

In a recent development, the Washington Post reports that CMS has issued an additional rule that requires hospice providers who are Medicare participants to put into effect a quality assessment and improvement system. This rule shall be implemented beginning December and involves patient participation in hospices to help settle upon treatment plans and the required improvement in areas of the hospice that seem deficient. Eventually the data shall be made public but for the beginning it shall be provided to Medicare and hospice organizers only. It will be akin to the way the federal government shares information on hospitals, home health agencies and nursing homes.

The number of Americans utilizing hospice services has increased by over two times since 1996 to an approximate count of 1.3 million in 2006.From $3 billion spent by Medicare on hospice care in 2000, the amount has increased to $10 billion in 2007.But experts say that hospice services are still not being utilized to the maximum. Malene Davis, the president and CEO of Capital Hospice attributed this underutilization to the popular misconception that hospices are for cancer patients only.

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Medicare Rules Introduced to Provide Health Care in Rural Areas

The Centre for Medicare & Medicaid Services (CMS) has proposed new rules under which Medical beneficiaries in rural areas will be able to access health care through Rural Health Clinics (RHCs) that have been designed to meet their specific needs.

Speaking on the issue, acting CMS administrator, Kerry Weems said that the changes that have been proposed to the rural health clinic program are meant to ensure good quality health services to Medicare beneficiaries in rural and previously underserved areas. Along with regular physicians, certain non physicians too shall aid in the program. The aim is to provide best value services from RHCs.

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Tough Times Ahead for Next President

Are the US Presidential candidates building castles in the air? If reports are to be believed, the countless promises they have made regarding health care and other issues are going to be really difficult to implement. The reason being that in present day US, the budget deficit is rising, tax collection is slowing down and the national debt is soon going to cross the $10 trillion mark.

Not just this but even the federal deficit is estimated to reach a record high of $400 billion by the end of this fiscal year. If nothing is done as regards policy changes, then the promised Medicaid and Medicare programs are likely to gulp down over 50 percent of federal spending till 2050.  Read more

House Agrees to War Appropriation Bill

As per the Washington Post reports, the $257.5 billion War Appropriations Bill (HR 2642) has been passed by the House. The bill has been passed along with a clause that allows for the delay of six Medicaid regulations that have been proposed by the Bush government. The approval was given via two votes- for war spending (268-115) and another for domestic programs and spending (416-12).

 The passage of this bill was no easy task. It took weeks of negotiations between the Democrats, the White House and the chambers. It is being heralded as a victory for many Republicans, Democrats and governors all over the country against the irresponsible Bush administration that has designed these rules to cut down on Medicare expenses.
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Mental Health Care for Kids Improves

A recent study published in the June issue of Medical Care says that with the expansion of the EPSDT Program (Early Periodic Screening, Diagnosis, and Treatment) in California, accessibility to mental health care for children has greatly improved. The principle author of this study is Lonnie R. Snowden, a PhD of University of California, and Berkley.

The biggest improvement is said to have been in the rural areas and communities where there is a higher percentage of children suffering from health problems and who are not given adequate care. These areas are known to have a history of poor state funding when it comes to medical health services. The study reflected on the changes that have influenced children’s access to mental health care which was the major aim of the EPSDT expansion.  

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Survey Shows Higher Funding Does Not Increase Perceived Quality of Care

According to a recently published study, higher levels of regional spending on medical care don’t actually impact Medicare beneficiaries’ perception of quality of care.  The survey, administered by researches from the University of Massachusetts, showed that although spending per capita varies depending on region, this difference in spending doesn’t seem to be reflected in care quality responses. 

The study, acknowledging that there is a disparity between region spending, was designed to see whether or not regions with low expenditures see themselves as receiving lower quality of care than those in high-expenditure regions.  Surveys were conducted by both mail and telephone in 2005.  The survey asked three questions about perceived unmet need for care, four about the perceived quality of ambulatory care, and three about ratings of overall quality of care.  2515 people responded to the survey.

The survey showed that higher per capital spending was related to receiving more medical care, such as more ambulatory visits to physicians and more cardiac tests.  But the questions that measured perceived quality of care – 7 of the ten measures -  showed that there really was no strong correlation between greater spending and increased perceived quality.  In fact, at times, perceived quality of care was actually higher in areas with lower-expenditures. 

For some, the study asks the question as to whether or not more spending actually improves the Medicare experience of beneficiaries.  For others, it also raises the question – if increased spending doesn’t work to increase the perception of care quality, what are some other solutions? 

 The study can be found published in the May 28 issue of the Journal of the American Medical Association. 

Isabella County Warned About Fraudulent Calls

In Michigan, an Isabella County Sheriff is warning people to be wary of a telephone scam under the guise of a Medicare validation.

Apparently, people have been receiving fraudulent calls from someone claiming to represent Medicare. The Sheriff is advising citizens, particularly seniors and individuals with disabilities, to be cautious if asked for certain personal information over the phone.

According to the Sheriff, the caller will allege that they are calling from Medicare, and that the recipient’s Medicare card needs to be updated in the next 30 days in order to remain valid. The caller will assure the recipient that updating the card is free, and all that is required is the individual’s bank account, Social Security, and Medicare numbers.

However, be aware that Medicare shouldn’t ask you this information via a telephone call, and they don’t ask for payments over the phone. The caller is counting on victims not knowing Medicare’s privacy procedures or their own rights, and on being easy targets for financial or identity theft. Identity theft is when people use someone else’s information (without their consent) to commit crimes, including fraud. It can happen when people have access to someone else’s personal information.

To protect yourself, whether you live in Michigan or any other State, don’t ever give out personal information to unknown callers. Your social security number, Medicare number, banking account numbers, and credit card numbers/expiry dates can all be used to steal from you or to commit crimes using your information.

If you live in the Isabella County area and have received a call from someone asking for your personal information, call the Sheriff Department at (989) 772-5911.

If you live anywhere in America and you suspect you may be a victim of identity theft, call the Fraud Hotline at 1-800-447-8477, or the Federal Trade Commission’s ID Theft Hotline at 1-877-438-4338.

Medtronic Inc. Settles Fraud Allegations for $75 million

 

Medtronic Inc.’s spinal unit has agreed to pay the government $75 million in order to settle false claim submission allegations.  The allegations were originally against Kyphon Inc., which was purchased by Medtronic Spine in November.  Medtronic Spine bought Kyphon Inc. for $4.2 billion, even after the allegations had been made.  They were aware of the lawsuit allegations before acquisition.

The allegations were brought forward by two former Kyphon employees.  According to one, when he realized they were involved in Medicare fraud, he spoke with the company’s vice president of reimbursement – to no avail.  Eventually, he accepted another job at a different company, for less money. 

The specific fraud allegations involved Kyphon’s submission of claims for a number of kyphoplasty procedures.  The Kyphoplasty procedure is a treatment for spine compression fractures.  This treatment is normally an outpatient procedure and only minimally invasive.  Kyphon Inc., however, was accused of marketing this procedure as a more expensive inpatient treatment, causing Medicare to pay more for some of these surgeries. 

The lawsuit, filed under the Federal False Claims Act, will also award two whisleblowers in the case $14.9 million.    It also required Medtronic Spin to agree to follow Medicare regulations in all future claims.  Although Medtronic Inc. agreed to pay a settlement, the company admitted no wrongdoing.  

New Sentinel Initiative to Improve Safety of Medical Products

The U.S. Food and Drug Administration is working with the Centers for Medicare & Medicaid Services to improve the safety of Prescription drugs, as well as other medical products.

The new initiative will make Medicare prescription drug data available in order to assist researchers and government agencies in ensuring and improving safety, quality, and care.  It will incorporate a new electronic system – the “Sentinel System” - that will allow the Food and Drug Administration to look at a wide variety of information in order to see potential concerns.  The system will utilize substantial databases – including information provided by Medicare – to carefully monitor effects of medical products and to provide prompt information about the performance of a drug or other medical product.

The use of Medicare claims information, like diagnoses, treatments, and hospitalizations is particularly helpful, since it is such a large database.  The Centers for Medicare & Medicaid Services has published a final rule which will allow them to use Medicare Part D claims data to aid research, care coordination, program oversight, and quality improvement and performance measurement initiatives. 

The Sentinel System will be good, in particular, for Medicare Part D beneficiaries.  A survey done by the Center for Medicare & Medicaid Services shows that Medicare beneficiaries use over twice the medications as other Americans.  Because this means that Medicare beneficiaries would therefore be at greater risk of negative medication effects, a system designed to protect people from these risks is of particular use to people enrolled in Medicare Plan D.

With the new Sentinel Initiative underway, we can look forward to both an improvement in safety and an increase of relevant, timely information. 

New to Medicare? Things to Think About

If you’re new to Medicare, you can look forward to a number of benefits.  However, there are a variety of things to consider as you start your program. 

The first thing you should do is, if you already have insurance, look into how it works with Medicare.  For instance, if you have veterans’ benefits, military benefits, federal employee health benefits, or employer or union health coverage, you should make yourself aware of how these will work with your Medicare plan. 

You will also need to choose the Medicare health plan you want, whether it is the Original Medicare Plan or a Medicare Advantage Plan, and if you want both parts A and B.  You’ll need to decide if you want part D as well, which is your prescription drug coverage.  If you do want prescription drug coverage, you’ll need to look at your various options and choose the prescription drug plan which will best meet your needs.  In addition to your hospital, medical, and prescription coverage, you’ll need to decide if you want a Medigap Policy. 

Another important thing to do within the first 6 months of joining Medicare is to go for your “Welcome to Medicare” physical exam.  You should also talk to your doctor about what other preventive services you may need. 

Finally, you’ll need to look at the basic information you need to make the most of your Medicare policy.  Make sure you’re aware of enrollment dates, and use the password and instructions mailed to you by Medicare in order to access your personalized information online.  If you need further assistance with your Medicare, contact your State Health Insurance Assistance Program.

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