Home > Medicare Monitor > Archives > 2008 > May
May 2008
The killer sofa and chronic disease
I’d just come from a news conference on the medical and economic impact of chronic health care conditions, many of them caused by our lifestyles, when I stepped into a Metrorail car and came face-to-face with the poster.
It showed an overweight teenager sprawled on a couch, clutching a video game controller — a giant bag of potato chips and a liter bottle of soda at his feet. Big black letters dubbed the couch the “killer sofa.”
The message under the picture was clear: “Lack of exercise and a poor diet puts kids at serious risk for Heart Disease, Diabetes, Asthma, Joint Pain and more.”
The poster was sponsored by the HSC Foundation, a Washington-based organization that grew out of the former Hospital for Sick Children.
The HSC Foundation is not a part of the Partnership to Fight Chronic Disease, but their message is the same: If Americans want to get serious about controlling health care spending, they need to control their lifestyles.
Diet, exercise and no smoking, could prevent the onset of chronic conditions and dramatically lower the amount spent on health care. And it could save huge amounts of money for Medicare, said Kenneth E. Thorpe, the partnership’s executive director and chairman of Emory University’s Department of Health Policy and Management.
He pointed to a recent study by Zhou Yang and Allyson Hall at the University of Florida that found that health care spending on 65-year-old men of proper weight was 6 percent to 13 percent less over the remainder of their lifetime than those who were overweight or obese. A similar finding for women showed an 11 percent to 17 percent savings for women who were proper weight at age 65.
To get an idea of the dimensions of the issue, the partnership released an almanac on the extent of chronic conditions, how they have grown and are likely to grow over the next 15 years, and their medical and economic costs.
The bad news is pretty bleak:
- Nearly half of all Americans, 45 percent, have one or more chronic diseases such as hypertension, diabetes, cancer, pulmonary conditions and mental disorders.
- Chronic diseases are the leading cause of death in the U.S., accounting for seven out of 10 deaths each year.
- Three-fourths of all dollars spent on health care are for patients with one or more chronic conditions.
- More than 96 cents of every Medicare dollar spent — and 83 cents for every Medicaid dollar spent — are for patients with chronic diseases.
- Chronic conditions are most prevalent among the elderly — no surprise there — but have nearly quadrupled since 1960 among children: from 1.8 percent in 1960 to 7 percent in 2004.
- Obesity is a key risk factor for chronic illness, and the rate of obesity among children has roughly tripled in the past two decades. For kids 6 to 11, the rate has jumped from 6.5 percent to nearly 19 percent; for those 12 to 19 it’s gone from 5 percent to more than 17 percent.
- The chronic disease problem is expected to get much worse with the aging of the baby boom generation and today’s obese children. In 15 years, the number of cancer cases is expected to increase 62 percent; mental disorders, 54 percent; diabetes 53 percent; and heart disease and hypertension around 40 percent.
- The direct and indirect economic cost of chronic diseases (including lost productivity and absenteeism) is nearly $1.3 trillion now and is expected to be $4.1 trillion in 15 years.
Yikes! So what’s the good news?
Well, it turns out much of the chronic disease suffered by Americans could be prevented, or at least significantly delayed, by following Thorpe’s prescription: good diet, plenty of exercise and no smoking.
The almanac reports that 80 percent of type 2 diabetes, heart disease and stroke, and 40 percent of cancer cases could be prevented by those three lifestyle changes.
Other changes could also improve the quality of life and reduce the onset of illness. For example, an estimated 100,000 lives annually could be saved if:
- The percentage of adults taking a daily dose of aspirin increased from 50 percent to 90 percent.
- The percentage of smokers urged by their doctor to quit who were also offered medication or other assistance increased from 28 percent to 90 percent.
- The percentage of adults 50 and older who are up-to-date with recommended colorectal screenings increased from 50 percent to 90 percent.
- The percentage of adults 65 and older who received flu immunizations increased from 37 percent to 90 percent.
- The percentage of women 40 and older who received appropriate breast cancer screening increased from 67 percent to 90 percent.
Got a question about Medicare? Send me your Medicare-related questions at medicaremailbag@coxnews.com and I’ll try to answer as many as possible.
Permalink | Comments (0) | Post your comment |
Nursing homes say Florida could lose $62 million
Florida nursing homes would lose an estimated $62 million next year under proposed rules designed to recoup “forecasting errors” in Medicare payments, according to a study released today by the American Health Care Association and the Alliance for Quality Nursing Home Care.
The nursing home groups have been slugging away at the proposed rules, which they say will trim $770 million nationwide from nursing homes.
“Florida seniors are facing the second-highest Medicare funding reduction in the nation (behind New York) on top of the state Medicaid cuts passed into state law in recent weeks,” Tony Marshall, senior vice president and chief operating officer of the Florida Health Care Association, said in a statement.
“Medicare and Medicaid funding are inextricably linked,” Marshall said. “The combination of cuts to both programs squeezes facilities in a manner harmful to older residents’ rising care needs, as well as to our local economy and caregiver jobs base.”
Permalink | Comments (1) | Post your comment |
Medicare announces new protections
Medicare announced a series of new changes to crack down on high-pressure Medicare Advantage sales techniques and to make it easier for low-income beneficiaries to obtain benefits.
“The Medicare Advantage program is a valuable source of enhanced benefits and coordinated care for beneficiaries, and it should not be undermined by the actions of a limited number of unscrupulous sales agents,” said Kerry Weems, acting administrator of the Center for Medicare and Medicaid Services.
According to Medicare, the proposed marketing standards for Medicare Advantage (MA) plans would:
- Prohibit cold-calling and expand the current prohibition on door-to-door solicitation to cover other unsolicited circumstances. Any appointment with a beneficiary to market health care-related products would have to be limited to the scope that the beneficiary agreed to in advance. Cross-selling of non-health care-related products to a prospective MA or Part D enrollee would also be prohibited.
- Prohibit sales activities at educational events such as health information fairs and community meetings or in areas such as waiting rooms where patients primarily intend to receive health care-related services, as well as limit the value and type of promotional items offered to potential enrollees.
- Require that MA organizations that use independent agents to market MA and Part D plans use state-licensed agents for such marketing, and require that MA organizations report to States, in a manner consistent with State appointment laws, that they are using those agents.
- Require MA organizations to establish commission structures for sales agents and brokers that are level across all years and across all MA plan product types (for example, HMOs, PPOs, and private fee-for-service plans). Commission structures for prescription drug plans would have to be level across the sponsors’ plans as well. These requirements are designed to discourage “churning” of beneficiaries from plan to plan each year in a manner that earns agents and brokers the highest commissions and would ensure that beneficiaries are receiving the information and counseling necessary to select the best plan based on their needs.
To make it easier to qualify for low income drug assistance, Medicare would use a more lenient “best available evidence” process.
Medicare also would forbid Part D plans from disenrolling beneficiaries who had chosen to have their premiums withheld but, for whatever reason, those premiums were not deducted.
The proposals also give Medicare stronger authority to levy fines of up to $25,000 per enrollee against Medicare Advantage plans to violate Medicare rules.
Permalink | Comments (1) | Post your comment |
AARP: Don’t raise doctor pay on backs of beneficiaries
AARP is launching a major advertising and lobbying blitz on the Senate aimed at averting a huge jump in Medicare Part B premiums next year.
“Taking money out of the pockets of older Americans to pay for skyrocketing health care costs just isn’t fair,” the ad says, while the green line on a medical monitor climbs higher and higher.
Well, it’s not precisely accurate. Congress isn’t considering raising premiums. What Congress is thinking about is how to avert a scheduled 10 percent cut in physician payments scheduled to kick in July 1. Doctors have warned that such a cut would mean a reduction in services to Medicare beneficiaries — meaning more docs would refuse to accept new Medicare patients.
AARP doesn’t have a quarrel with the docs getting paid more. But what happens in the Medicare premium formula is that those increased payments are figured into the cost of Medicare — and beneficiaries pay 25 percent of those costs through their Part B premiums.
Higher doctor payments means higher Medicare premiums — and higher copayments for the increased rates.
AARP says it has gotten out of hand. They want Congress to give the docs more, but not take it out of beneficiaries’ pocketbooks.
To avoid the higher premiums, AARP suggests raiding some funds set up by Medicare that haven’t gotten much use. Whether that will be enough to avert the higher premiums may depend on how much of a boost Congress gives the doctors.
In addition to the television ads, AARP will launch a series of print ads in selected areas around the country and step up its efforts to have people call and e-mail their senators. AARP also is collecting signatures on a petition aimed at averting the premium\ increases. The petition can be found at: KeepMedicareFair.org.
Permalink | Comments (0) | Post your comment |
Medicare to cover artificial heart tests
“Our decision revises a long-standing non-coverage policy and allows beneficiary access to this advanced technology,” said Kerry Weems, Medicare’s acting administrator. “Our decision also encourages the completion of FDA post-approval studies.”
Coverage of artificial hearts has been blocked by a policy in place since 1986. According to a Centers for Medciare and Medicaid Services news release, the agency now “believes there is now sufficient scientific evidence on the use of artificial hearts to allow coverage of these devices for beneficiaries in the carefully controlled clinical environment of an FDA-approved study.”
Weems said: “Our policy will allow beneficiaries to access artificial heart technology while also stimulating the research community to develop further evidence about the impact of this technology on improving patient outcomes.”
Permalink | Comments (0) | Post your comment |
Nursing home industry predicts cuts could jeopardize jobs, wages and tax revenues
Touting an analysis from the Lewin Group, the nursing home industry warns that an anticipated $720 million cut in Medicare nursing home payments would have a huge economic ripple effect on the economy.
Bruce Yarwood, the American Health Care Association president and CEO, said a projected Medicare rule would “not only threaten seniors’ access to quality care nationwide, but will also negatively impact the economy and employment base.
“From our perspective, and as the data confirms, the CMS-driven ‘Forecast Error’ Medicare cuts represent a ‘lose-lose’ proposition for seniors’ care needs as well as the U.S. and local economies,” Yarwood said. Medicare annually adjusts payment rates to reflect what it calls forecast errors.
According to the Lewin Group’s report, the proposed rule could have an economic impact of $4.2 billion in the first year, result in the loss of more than 40,000 jobs nationwide, cut wages by $1.6 billion and trim $618 million from already sluggish state and federal tax revenue.
“On every level, the CMS actions cutting Medicare funding are conceptually flawed,” Yarwood said.
