Medicare Update

Advancing Advance Directives

Healthcare coverage has historically focused on providing acute life-sustaining services, but there has been growing attention paid to improving end-of-life care. This attention has been increasing as of late in healthcare reform, with other recommended changes being proposed. Of course, end-of-life care is critical from a cost perspective—both emotional and financial.

This issue is especially keen at this time given the concern by many over healthcare costs, specifically concerns with ineffective treatment at the end of life. Studies have shown that approximately one-third of Medicare e

The Effect of the Obama Stimulus Plan on Geriatric Healthcare

Change is coming—in the form of the Stimulus Package, as well as President Obama’s healthcare reform plan. Actually, change is clearly upon us. The elements of this change have been happening slowly over the last several years, of course. Much occurred well before President Obama’s Stimulus Bill, the American Recovery and Reinvestment Act of 2009, was signed into law.

In 1993, key members of Congress led by Senators Max Baucus (D-MT) and Edward Kennedy (D-MA) agreed on four principles that appear to remain as the foundation for our current round of reform. These principles are:

What Is Medicare Going to Do to Survive?

Author Affiliations: Dr. Stefanacci served as a CMS Health Policy Scholar for 2003-2004. He is Director of the Center for Medicare Medication Management and the Geriatric Health Program at the Mayes College of Healthcare Business & Policy, University of the Sciences, Philadelphia, PA.
Dr. Spivack is Associate Physician Editor of Clinical Geriatrics.

When Medicare was created in 1965, the average lifespan for those 65 years of age was four years, and this was being paid for by ten taxpayers for each Medicare beneficiary. The number of Medicare beneficiaries a

Working Together to Assure the “Right” Medication for the “Right” Patient

Think of the world of accessing medications as a big bull’s eye. In Medicare’s perception, that is exactly the way that the market for pharmaceuticals should be viewed. Medicare believes it must play a very active role, as it believes that many key players will aim poorly, completely missing their desired target. And in the worst-case scenarios, prescribers’ aim will be so poor that they may actually wind up hitting patients who have adverse events because of access to an inappropriately prescribed medication. Rofecoxib is an example of “poor shooting” be

Medicare Medication Management: Updating Issues with Parts A, B, C, and D

Presidential election aside, medication management under Medicare promises to see some major changes that will affect access to medications in the coming year. This at a time—or perhaps because we are in a time—of increasing demand for access to innovative medications by an ever-expanding group of Medicare beneficiaries.

In a question-and-answer format, this article will highlight the major areas of change that are occurring to medication management within all parts of the Medicare program:

•Medicare Part A, which covers hospitalization, subacute services, and hospice
•Medicare

Medicare Update: Medicare Part B's BIG Changes

The “B” in the Medicare Part B program may come to be known as “BIG,” as in big changes; both the physician reimbursement component of Medicare Part B, as well as the coverage of outpatient medications, are undergoing major changes. Medicare Part B, also known as medical insurance, covers physician services. Physician and other providers, such as nurse practitioners, are paid for by Medicare under a fee schedule dictated by Medicare. In addition to physician services, Medicare Part B also covers supplies such as durable medical services and medications provided within a physician offic

Team Building

Healthcare professionals are generally trained in isolation and continue their practice in much the same way. Geriatrics has historically embraced an interdisciplinary team approach to training and practice. The importance of a well-balanced interdisciplinary team has been shown to be beneficial in the care of the elderly; however, payers and government regulators are attempting to lower one aspect of healthcare cost by making decisions that will directly affect the balance of the care team. Our current geriatric care system is under increasing pressure to find efficient and effective systems

Overtaxing Healthcare Providers

It’s never been more taxing to be a geriatric healthcare provider than now, what with the aging of the baby boomers demanding more services. At the same time, a greater number of innovative products are becoming available—all in the face of limited available funding.

Not surprisingly, the American College of Physicians Executives’ Physician Morale Survey found physicians suffering from low reimbursement, loss of autonomy, bureaucratic red tape, patient overload, and diminished respect.1 Even more telling was the fact that nearly 60% of physicians who participated in the survey stated

Reimbursement Politics

Unlike the rest of the U.S. economy, reimbursement for healthcare is not a simple matter of supply and demand. Reimbursement decisions are based to an increasing extent on politics. Not surprisingly, this nonmarket approach has resulted in quality concerns in healthcare. Less-than-optimum healthcare outcomes are in part due to the lack of capital and incentives available from the current reimbursement system—a reimbursement system that unfortunately has become a matter of politics, forcing physicians and other providers to manipulate or “game” the system in order to obtain more appropria

Prescribed Guidance

Oversight of long-term care (LTC) prescribing is getting a little more difficult because, on top of the restrictions on access imposed on prescribers as a result of Medicare Part D, there are now additional pressures being applied by LTC state surveyors. These new surveyor pressures are the results of the revised survey guidelines concerning pharmacy services and unnecessary medications that were introduced on December 18, 2006. In addition to these factors, it appears likely that legislative changes planned for Medicare Part D may place even greater restrictions on prescribing.

The Need fo