Health Management Congress

Final Announcement: HMC is now part of Health Care – From Policy to Practice

noreply@blogger.com (Thiago) — Fri, 06 Feb 2009 18:24:00 +0000

The HMC blog is now part of Health Care – From Policy to Practice blog. We have more content, news and networking available to share with you on this new blog. Thanks for your continued readership and make sure to subscribe to the new feed.

http://healthcareinsights.blogspot.com/

Healthcare Insights To Launch in 2009!

noreply@blogger.com (Jennifer) — Tue, 23 Dec 2008 16:10:00 +0000

We're getting ready to launch a new blog that looks at the broader issues of Healthcare, providing breaking news, insights and strategies into Health Plan business and operations., update your RSS feed now as we get it ready for our official launch:

http://healthcareinsights.blogspot.com/

See you at MAC!

noreply@blogger.com (Priya) — Mon, 29 Sep 2008 12:31:00 +0000

For some time now you've probably noticed our linking to a new sister blog titled Medicare Advantage Congress. Our new blog will looks at the healthcare landscape from academic, industry, policy & provider view points on all issues related to Medicare Advantage.

Since we've established this corresponding blog we want to officially invite you to join us and subscribe to our feed: http://feeds.feedburner.com/MedicareAdvantageCongress

As you've already seen, we've been building up the Medicare Advantage Congress blog with the same quality content that you find here. Beginning today, this will be our last post on this blog but you can join us on the MAC blog, where we hope you'll continue to actively participate as you have here. Thank you and we look forward to seeing you!

Brand-Name Drugs are Favored by Medicare Beneficiaries

noreply@blogger.com (Thiago) — Thu, 25 Sep 2008 19:56:00 +0000

According to this article in EmaxHealth, brand-name medications account for almost two-thirds of all prescriptions filled by Medicare beneficiaries. Patients are asking for brand-name drugs when the program provides coverage and are asking pharmacists for generic drugs when they have to pay out of pocket.

When patients switch from brand-name to generic drugs, more than likely they’ve reached the coverage gap in which they must cover the full cost of the prescriptions. Woody Eisenberg, Medco Chief Medical Officer mentions that when Medicare beneficiaries become aware of the coverage gap they "become acutely aware of the cost difference between brand-name and generic drugs and most make the switch."

We're getting ready to launch a new blog that looks at the broader issues of Medicare, update your RSS feed now as we get it ready for our official launch: http://medicareadvantagecongress.blogspot.com.

Billions Paid in Medicare Suspect Claims

noreply@blogger.com (Thiago) — Wed, 24 Sep 2008 16:03:00 +0000

The National Center for Policy Analysis reports that billions of taxpayer dollars have gone to waste because Medicare has paid out claims with blank or invalid diagnosis codes over the past decade according to a new Senate report.

Claims for wheelchairs, drugs, and other medical supplies of Medicare patients were reviewed from 2001 to 2006. During these years, they found at least $1 billion of medical equipment which listed diagnosis codes that had little or no connection to the reimbursed medical items. Here are some findings from the report:

Medicare paid millions of dollars to medical suppliers for blood glucose test strips -- used exclusively for diabetics -- based on non-diabetic diagnoses.
Roughly $4.8 billion in payments were made from 1995 to 2006 despite invalid coding or nothing listed at all; about $23 million of that amount was paid after 2003, when federal rules made clear the codes were required.
Based on a sample of 2,000 of those invalid coding claims, investigators found more than 30 percent could not be verified as legitimate and "bore characteristics of fraudulent activity."
Federal regulations require that Centers for Medicare and Medicaid Services (CMS) pay only for items that are deemed "medically necessary," yet, CMS does not examine diagnosis codes to determine whether the equipment is actually necessary before making payment.
Only 3 percent of claims are reviewed after payment is made.

Sources:
http://hsgac.senate.gov/public/
http://townhall.com/news/us/2008/09/24/probe_medicare_paid_billions_in_suspect_claims

We're getting ready to launch a new blog that looks at the broader issues of Medicare, update your RSS feed now as we get it ready for our official launch: http://medicareadvantagecongress.blogspot.com.

Medicare Monthly Premium Costs Remain the Same for Elderly and Disabled in 2009

noreply@blogger.com (Thiago) — Mon, 22 Sep 2008 18:10:00 +0000

AHN reports that Medicare premiums for the disabled and elderly will remain constant at $96.40 next year, according to the U.S. Centers for Medicare & Medicaid Services.

The premium and deductible paid by consumers cover home health facilities, durable medical equipment, and cost of physicians. The Medicare Part B Program will also retain its costs at $135 this year. So far the only costs expected to rise is monthly premium payment for Part A coverage which will rise form $423 to $443 in 2009.

We're getting ready to launch a new blog that looks at the broader issues of Medicare, update your RSS feed now as we get it ready for our official launch: http://medicareadvantagecongress.blogspot.com.

Medicare rates to stay the same for 2009

noreply@blogger.com (Jennifer) — Fri, 19 Sep 2008 19:44:00 +0000

According to Elder Law Answer, it was announced recently that Medicare's monthly premium will stay the same for the first time in eight years. The monthly premium will remain the same, totaling $96.40 a month.

This fee covers portions of fees related to physicians services, outpatient hospital services, and other items.

We're getting ready to launch a new blog that looks at the broader issues of Medicare, update your RSS feed now as we get it ready for our official launch: http://medicareadvantagecongress.blogspot.com.

More advertising dollars going to Medicare Advantage

noreply@blogger.com (Jennifer) — Thu, 18 Sep 2008 19:41:00 +0000

In a recent study done by the Kaiser Family Foundation, detailed here at the Washington Post, they found that insurers spent three times more money promoting comprehensive Medicare plans rather than stand alone drug plans. The study was conducted between October 1 and December 31, 2007, with an increased effort looking at what's going on with Medicare marketing practices. For the most part, the commercials emphasized the benefits centered around preventative care, vision and hearing benefits.

We're getting ready to launch a new blog that looks at the broader issues of Medicare, update your RSS feed now as we get it ready for our official launch: http://medicareadvantagecongress.blogspot.com.

Restrictions placed on cold calls by insurance agents

noreply@blogger.com (Jennifer) — Wed, 17 Sep 2008 20:50:00 +0000

Effective October 1, insurance agents will no longer be able to cold call the elderly and disabled when trying to sell prescription drug plans. According to the AP, this new law will be enforced by an increased amount of surveillance on the agents as well as reviews of media and print ads published by those.

The new restrictions include:

- No unsolicited contacts with beneficiaries, such as visiting their home or calling them. The prospective customer must initiate the contact.

- No selling of other insurance products, such as annuities or life insurance, to beneficiaries.

- No free meals at promotional or sales events.

- New requirements for training or testing of agents.

Penalties for breaking these law could result in up to $25,000 worth of fines.

Medicare Hospice Protection Act

noreply@blogger.com (Jennifer) — Tue, 16 Sep 2008 19:27:00 +0000

Representative Maurice Hinchey has introduced a new bill to Congress to block a new bill from the Bush administration. According to The Ithaca Journal, a bill going into affect October 1 will begin reducing Medicare reimbursement rates by $2.2 billion over the next five years. This could result in hospice patients loosing their hospice care across the country, as it could cost certain hospices $50,000 next year across the country, and as much as $150,000 over the next three years. Hinchey is encouraging Congress to swift action due to the tight time frame they’re working with.

We're getting ready to launch a new blog that looks at the broader issues of Medicare, update your RSS feed now as we get it ready for our official launch: http://medicareadvantagecongress.blogspot.com.

Welcome to Doughnut Hole Season

noreply@blogger.com (Jennifer) — Mon, 15 Sep 2008 18:13:00 +0000

In a recent article at the Dallas Morning News, they discuss the current stress one in five seniors is now facing until the end of the calendar year. Doughnut Hole Season is the time of year when low co-payments reach their gap in the drug coverage provided by Medicare, and, as a result, they are faced with staggeringly high payments for their medication. In 2007, 3.4 million seniors faced this situation.

Through the current program, seniors are responsible for full costs once all of Medicare’s payments (co-pays and deductibles) have reached $2150. They do not pick up payments again until citizens spending exceed $5726. However, only one in five will reach this amount.

Senate Investigates Medicare Call Centers

noreply@blogger.com (Priya) — Fri, 12 Sep 2008 19:51:00 +0000

Yesterday's Wall Street Journal reported on Senator Gordon Smith (R-OR) and his investigation into the quality of Medicare's call center brought to Capitol Hill. The call centers, run by Vangent, are under investigation because "In 50 test calls placed last month, wait times ranged from zero to 45 minutes, and six calls were disconnected while on hold. Call centers have provided at least one piece of incorrect information or been unable to provide a response to at least one question in 90% of test calls placed in the past year," reported the WSJ article. Vangent denies the allegations citing their high customer satisfaction percentages. What do you think of Senator Smith's investigation?

We're getting ready to launch a new blog that looks at the broader issues of Medicare, update your RSS feed now as we get it ready for our official launch: http://medicareadvantagecongress.blogspot.com.

Humana looses some Medicare Enrollees

noreply@blogger.com (Jennifer) — Wed, 10 Sep 2008 19:27:00 +0000

As a result of premium bids that are higher than low income, government assigned members of Medicare, Humana expects to loose 10% of them at the beginning of 2009. However, according to the Wall Street Journal, they believe this could be positive for Humana due to the fact that higher prices would increase the bottom line, shares dropped 5% to $41.75 when it was announced that this could lead to a los of 380,000 eligible Medicare members. To ensure drug coverage for these dropped Medicare enrollees, the government will automatically re-enroll them in private drug care provider programs.

Medicare Made Easy

noreply@blogger.com (Priya) — Tue, 09 Sep 2008 20:34:00 +0000

In a latest release, Experion Systems has launched a new edition of their PlanPrescriber tool as reported by MarketWatch. Created by Glen Urban, a Professor at MIT, this new tool gives seniors access to “unbiased advice” for determining their Medicare Insurance plan. It is a free online tool designed to save seniors time, and money, and starts by simply entering a zip code. Those without access to Internet, can also call 877-900-4824. As Ross Blair, Experion Systems CEO, stated:

"The rising costs of prescription drugs is a real burden for seniors on a fixed income. PlanPrescriber allows seniors to switch to the optimal plan based on their individual needs. Seniors can typically save 25% to 50% of their annual prescription drug costs by joining the optimal insurance plan."

Marketing Documents for Medicare Prescription Drug Benefits is Confusing

noreply@blogger.com (Thiago) — Mon, 08 Sep 2008 13:34:00 +0000

The Wall Street Journal blog discusses how marketing brochures for Medicare prescription drug plans are doing a bad job of meeting guidelines set forth by the feds in this latest post.

A report published by the inspector general’s office in the Department of Health and Human Services found that 85% of marketing materials did not meet guidelines set out by the Center for Medicare and Medicaid Services. Some problems with the documents are that a lot of marketing documents that are produced in conjunction with an insurer and a pharmacy fail to mention that other pharmacies are available. This is required by law. Another problem is that some documents do not include required information on the subsidy that is available to beneficiaries with low incomes.

CDC and Columbia find no link between autism and MMR vaccine

noreply@blogger.com (Jennifer) — Fri, 05 Sep 2008 16:41:00 +0000

According to this post at the Wall Street Journal Health Blog, the Center for Disease Control and Prevention and Columbia University did a study that found that there is no connection between the Measles, Mumps and Rebella vaccine and autism.

The two researchers conducted a study based on:

The measles virus from the vaccine could reproduce in the intestinal tract, leading to inflammation and bowel permeability. That leaky bowel could permit the release of chemicals that would make their way to the nervous system, causing trouble.

When conducting the research, they looked at children with gastrointestinal problems who had autism and children with gastrointestinal problems with no autism. Studies showed there was no difference between the two sets of children.

Satisfied Medicare Providers

noreply@blogger.com (Priya) — Thu, 04 Sep 2008 20:36:00 +0000

In a survey conducted by CMS this year, which was administered to 35,000 randomly selected individuals and organizations including physicians, hospitals, and skilled nursing home facilities, Medicare health care providers are still satisfied with Medicare fee-for-service contractors. As indicated by this article, this shows that

Medicare health care providers continue to be satisfied by Medicare fee-for-service contractors showing a relatively smooth transition to the new Medicare Administrative Contractors (MACs).

This year the average score was 4.51 based on a scale from 1 to 6, which is very close to last years score of 4.56. How Medicare contractors dealt with “provider inquires” continued to be the leading sign of satisfaction. This is the third year in a row where this has been the case

Medicare and Medicaid Rise to the Top

noreply@blogger.com (Thiago) — Wed, 03 Sep 2008 19:56:00 +0000

The Wall Street Journal blog reports that while the share of Americans that got health insurance through work or bought it on the private market last year declined, the number of Americans insured through Medicaid and Medicare has increased. These are numbers based on the latest report from the US Census Bureau.

This change shows that there is an overall decline in the percentage of Americans who are uninsured, and this goes against recent trends of rising uninsurance rates. See the full report here.

“Billing balance” stirs up controversy

noreply@blogger.com (Jennifer) — Tue, 02 Sep 2008 21:23:00 +0000

Business Week recently collaborated with the CBS Evening News educate the nation on the nature of “billing balance.” When an insurance company covers less of the medical payments than doctors want them to, they turn to the customer for the rest of the payment. Since patients think that their unpaid bills will turn their credit bad, many automatically pay the bills. This has resulted in patients paying $1 billion more a year in medical bills than they’re supposed to. The California Association believes that 1.76 million policy holders paid $5.28 million more than they were suppose to, including 56% of those who were billed.

We're getting ready to launch a new blog that looks at the broader issues of Medicare, update your RSS feed now as we get it ready for our official launch: http://medicareadvantagecongress.blogspot.com.

Medicare Pays Too Much for New Generics

noreply@blogger.com (Thiago) — Thu, 28 Aug 2008 16:01:00 +0000

According to this article on The Wall Street Journal Blog when the price of generic drugs plunges, Medicare is slow to reflect that price change.

A report published by the Health and Human Services’ inspector general looks at irinotecan, which is a cancer that went generic in February of this year. The average price of the drug factoring in sales of the branded version was $52. During the current quarter, Medicare was paying about $75 for irinotecan, which is still far above the average price.

Read the full report here.

Numbers of uninsured dropped

noreply@blogger.com (Jennifer) — Wed, 27 Aug 2008 19:22:00 +0000

In a recent report released by the census bureau, they state that the number of uninsured has decreased 3.2% to 45.7 million, which is 15.3% of the population. According to this article here at Modern Healthcare, authorities state that the reasons why uninsured numbers have decreased is still unknown. The number of uninsured children has dropped as well to 8.1 million, down from 8.7 million in 2007 which is a 6.9% drop.

Oversight in Medicare Drug Fraud

noreply@blogger.com (Priya) — Tue, 26 Aug 2008 20:21:00 +0000

As reported in this Wall Street Journal article, the Government Accountability Office released a report stating that some insurers do not have “in place all the fraud controls they’re supposed to.” This means that some of them have not “met the requirements for employee training and internal monitoring and auditing. The GAO also stated that this oversight “risks significant misuse of funds in this $39 billion program.” Acting administrator for Medicare, Kerry Weems, has stated that he disagrees, however, has admitted the funding cap for the Medicare Integrity Program has, “seriously degraded [Medicare’s] ability to meet its responsibilities in combating fraud abuse.”A copy of the full report can be found here.

New Drug to Help Blood Clotting is Approved

noreply@blogger.com (Thiago) — Mon, 25 Aug 2008 17:16:00 +0000

The NY Times reports regulators have approved Amgen’s new drug called Nplate, which treats a rare blood clotting disorder that affects about 140,000 people. The disorder causes the body to attack platelets, which are tiny components that help with blood clotting. The drug will encourage platelet production by stimulating patient’s bone marrow.

There are some risks to taking the drug so regulators will require all patients to enroll in a long-term safety study. Some patients who have enrolled in the study have developed leukemia due to bone-marrow abnormalities. More studies will need to be done though to determine whether the development of leukemia may relate to the use of Nplate.

Measles outbreaks are at alarming levels

noreply@blogger.com (Jennifer) — Fri, 22 Aug 2008 18:36:00 +0000

According to a news report at ABC, measles infections are at their highest level in a decade. So far there have been 131 cases this year in the United States as opposed to 42 cases throughout the entire last year. Over half of those infected are children who did not receive the vaccine. Also alarming is the number of outbreaks, in a normal year there is one in the United States. This year, as of July 30, there have been seven outbreaks. The reason for the rising number of children not receiving the shots is because of the fear that the immunization leads to autism in some children.

Miracle Baby

noreply@blogger.com (Priya) — Thu, 21 Aug 2008 18:49:00 +0000

According to this Reuters report, a baby that was pronounced stillborn in an Israeli hospital, “came back to life” after spending about 5 hours in a refrigerated storage unit at the hospital. The mother had, had to have an emergency abortion because of internal bleeding. Upon birth, at 23 weeks, the baby weighed 600 grams which is approximately 1.32 pounds. Hospital deputy director Moshe Daniel had this to say:

"We don't know how to explain this, so when we don't know how to explain things in the medical world we call it a miracle, and this is probably what happened”

One explanation that was supplied, by Motti Ravid a professor of internal medicine, was that the lower temperatures slowed down the metabolism of the baby, which might have helped her to survive. Currently the baby is a neonatal intensive care unit. The doctors are still unsure of her prognosis, and do not know if she will be able to survive.