For at least several decades, telling the elderly to get an annual flu shot seemed like a no brainer. After all, seniors are often in more fragile health, and a bout of influenza can be debilitating. Moreover, it can lead to pneumonia and other serious conditions.
But new data suggests that the flu shot doesn’t actually reduce deaths among the elderly. This contradicts a study published in 2007 that suggested that influenza immunization can actually reduce deaths in community dwelling elders. If the flu shot doesn’t save lives, is it still “worth it” to spend on promotion and delivery of the …read more

Dr. Peter Bach, who practices at Memorial Sloan-Kettering Cancer Center in New York and who advised Medicare and Medicaid (CMS) from 2005 to 2006, penned an editorial with this same title – “Paying Doctors to Ignore Patients” – in today’s New York Times. As bad as is sounds, Bach is right.
Physicians who are paid on a fee-for-service (FFS) basis are paid per service they provide, whether this service is a surgical procedure , a PET/CT scan, or an office visit. The more expensive services are reimbursed more handsomely. (This scheme does not apply to physicians who are reimbursed by capitation …read more

As reported by the Washington Post, CMS is attempting to jump-start the adoption of electronic health records/electronic medical records (EHR/EMR) and e-prescribing with a new program that will pay physicians and practices a bonus for using electronic prescribing tools. Practices that move to electronic prescribing methods will receive bonuses of 2% in 2009 and 2010, bonuses of 1% in 2011 and 2012, and bonuses of 1/2 % in 2013.
At the same time, the New York Times is reporting on Philadelphia area insurers that are offering bonus payments or increased payments to physicians for using tools such as telephone visits, e-mail “visits,” …read more

The NYT editorial board has written a fantastic op-ed on the recent Medicare Bill and, by corollary, Medicare Advantage plans. As they say, Medicare Advantage plans (they do not mention them by name right away, but refer to them as “private plans that participate” in Medicare) are draining the resources we have available in this country to pay for senior citizens’ health care needs.
According to the op-ed, private plans now cover more than 20% of all Medicare beneficiaries. The editorial supports the move made by Congress to cut back on the subsidies private insurers make on these plans because they …read more

Led by Senator Ted Kennedy (recently returned to the Senate floor), the Democrats were able this week to pass a Medicare bill by a veto-proof majority. (President Bush had promised to veto the bill, so the larger margin of majority was an essential to keep the bill alive — the final vote was 69 to 30 in favor.)
Passage of this piece of legislation will be a victory for the AMA and others who vehemently sought to prevent the 10.6% cut in Medicare payments to physicians that would have fallen into place otherwise. Still, the bill does little to fix some …read more

The American Medical Association isn’t too thrilled by the planned expansion of Medicare’s “No-Pay” List. Starting in October 2008, CMS will no longer reimburse for care for the following: pressure ulcers, catheter-associated urinary tract infections, Stephylococcus aureus septicemia, air embolism, blood incompatibility, and an object left behind in a surgical patient.
I agree with the first one (pressure ulcers) for the most part, and definitely with the last three — these three items are sometimes called “never events” because they should never, ever happen (and rarely happen when a hospital has good procedures for staff communication and safety double-checks). However, denying …read more

The executive branch (Dept. of Health and Human Services) stepped in yesterday to stop a 10.6% cut in Medicare reimbursement to physicians from going through because Congress left for a recess before finishing deliberations on a bill. DHS is freezing current reimbursement levels for up to 10 days. After that, physicians and other health care practitioners might get the money back retrospectively if Congress can find a way to keep reimbursement at its current levels.
So, what is the danger to cutting what doctor’s are paid for treating Medicare patients? The American Medical Association is claiming that physicians will drop out …read more

[In a sarcastic voice:] Thank you, Heritage Foundation, for helping to confuse seniors and encourage them to choose health care plans that both cost more to taxpayers and offer less coverage at a higher price. That’s very noble of you.
Apparently, the definition of “success” is now “spending more, getting less, and ripping off taxpayers and the elderly at the same time.”
I especially love this part:
“Seniors enjoy an unprecedented level of personal freedom in choosing health care options that they think are best for them.”
Note the use of “that they think are best for them.” (emphasis mine) That’s probably because the …read more

Can we please re-name these privately administrated plans for the elderly “Medicare Disadvantage”?
If you thought that Medicare Part D was a hand out to private payors, you should be reading about Medicare Advantage plans. These plans basically entice seniors to forego coverage in traditional Medicare (Part A) and “MediGap” supplemental insurance (Part B) for a privately-run HMO-type plan that may have a lower premium, but can end up costing far more in the long run because of coverage restrictions, high co-payments, and benefit maximums and ceilings. Stranger still, these plans are subsidized by the government, but Medicare Advantage plans cost …read more

For anyone whose working in oncology these days, it should come as little surprise that Medicare payments for cancer are exploding. The study compared 2002 data to 1991 data — which means that the prescription drug benefit is not even factored in to these numbers. (Most cancer drugs would have been covered anyway prior to Medicare Part D because they were infusion drugs delivered in hospital or clinic settings. The new benefit would apply to some of the expensive, newer oral chemotherapy drugs and expensive anti-nausea drugs, however.)
Exactly how much did costs rise over approximately 11 years?