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Medicare Update

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

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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 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 of...

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 syste...

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...

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 approp...

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 ...

Medicare Gets Tough

Medicare is getting a little tougher in 2007 in several ways. This new 2007 Medicare will be likely to make a difficult situation worse for geriatric care providers and older persons alike. This year may not be an isolated rough patch; rather, it may be the beginning of a much longer period of increasing cost sharing, as well as pressure being applied to both older persons and to their providers in the form of higher premiums and deductibles for individuals—and lower reimbursement for providers. These issues could come together to force both older persons and their providers into a market...

Filling the Donut Hole

Before the new plan year starts on January 1, marking once again the beginning of the prescription drug benefit cycle, many Medicare beneficiaries will find themselves having a difficult time obtaining their medications because of the gap in coverage. This gap in coverage, commonly referred to as the “donut hole,” is the period in the Medicare Part D benefit when the beneficiaries are completely responsible for the cost of their medications.

While many long-term care (LTC) residents are not subject to the donut hole, a fair number of them unfortunately are. The Kaiser Family Fou...

Preventing Medication Errors

More than 1.5 million Americans are injured every year by drug errors in various settings, including nursing homes. The Institute of Medicine (IOM), in its most recent report, evaluated medication errors in a broad range of settings, and finding tremendous room for improvement.1 In the report, the IOM states that at least one-quarter of all medication-related injuries are preventable. Gurwitz et al2,3estimated that 800,000 preventable medication-related injuries occur annually in nursing homes across the country.

Most of the “medication errors” in long-term care (

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