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Physician Discusses The Confusing Aspects Of Medicare Part D

I have discussed Medicare Part B and Part F in recent blogs. A reader asked about Medicare Part D:

Dr. Feld

“Please discuss Medicare Part D, the drug benefit plan available to seniors. It is very complicated and completely confusing to me.

My physician gave me a prescription for Levequin 500 mg once a day for 10 days. The pharmacist told me it would cost me $330 dollars. Medicare Part D would pay an additional $110 dollars for a total of $440 dollars.

I asked the pharmacist if there was a generic equivalent. The answer was yes. It cost $10 dollars.

This is unconscionable. It is highway robbery.

Sincerely

a.g.”

Several issues are presented in this readers note. It is essential to understand these issues. The issues are an indictment against government “controlled” programs. Read more »

*This blog post was originally published at Repairing the Healthcare System*

Do-It-Yourself Health Care: A New Form Of Outsourcing?

Jessie GrumanThe outsourcing of work by businesses to the cheapest available workers has received a lot of attention in recent years.  It has largely escaped notice, however, that the new labor force isn’t necessarily located in Southeast Asia, but is often found here at home and is virtually free.  It is us, using our laptops and smart phones to perform more and more functions once carried out by knowledgeable salespeople and service reps.

This was particularly salient to me this week: I spent an hour online browsing, comparing prices, reading customer reviews and filling out the required billing and shipping information to get a great deal on a new lamp.  An airline would charge me 99 cents to talk to a person but provides information for free online.  Calls to Amtrak to make train reservations are routinely answered with a message that the wait to talk to an agent is 30 minutes, but that I can book travel myself – plus get better deals – if I do it online.  My bank has a small staff, limited hours and it charges extra for paper checks and mailed hard copy statements… but its Website is welcoming and useful, even at 3 a.m. Read more »

*This blog post was originally published at CFAH PPF Blog*

U.S. Pharmaceutical Sales: The Top 10 List

Misc drugsThe top moneymakers for the U.S. pharmaceutical industry might surprise you. These aren’t necessarily the most prescribed medications (although some of them are), but they’re the top products in terms of sales in 2009. The revenues were in billions:

1. Lipitor – used for high cholesterol: $7.5 billion

2. Nexium – a proton pump inhibitor for GERD: $6.3 billion

3. Plavix – a blood thinner: $5.6 billion

4. Advair Diskus – used for asthma and COPD: $4.7 billion Read more »

*This blog post was originally published at EverythingHealth*

Why Healthcare Reform Is Good For Medicare

You may have noticed, uncharacteristically for me, that I haven’t posted a blog in week. I thought it would be better to allow the readers to post their own reflections, and you did — with comments ranging for unabashed pride to skepticism to disdain for the law and the American College of Physician’s (ACP’s) role in bringing in about.

I respect the principled arguments made by those who believe that the legislation gives the government too much control or those who fear that it will add to the deficit and public debt, even though the Congressional Budget Office (CBO) says otherwise. But there is one claim made by some of the critics that sticks in my craw, which is that the legislation will result in “massive cuts” to Medicare. Here are the facts. Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

Highlights From The Medicare Policy Summit: What’s On The Mind Of The Congressional Budget Office (CBO)?

There is no doubt in anyone’s mind that the U.S. healthcare system, in its current form, is financially unsustainable. Many in Washington believe that 2009 will usher in more sweeping reform than we’ve seen in decades. I attended the Medicare Policy Summit (along with about 100+ industry insiders and one other physician, Dr. Nancy Nielsen) to try to read the “tea leaves” regarding Medicare’s likely reform – and how that will impact the healthcare system in general.

I took 49 pages of notes during the two-day conference, but will spare you the gory details and simply capture (in a series of blog posts) what I found to be the most interesting parts of the discussion. This post is devoted to highlights from Bruce Vavricheck’s lecture, “The President’s Budget and What It Means for Entitlements.”

Bruce Varvichek is the Assistant Director for Health and Human Resources, Congressional Budget Office.

Bruce explained that if we continue on our current healthcare spending path, over 50% of all federal spending will go towards funding Medicare, Medicaid, and Social Security entitlement programs by 2018.

What are the underlying causes for this rapid rate of growth in spending?

1.    Chronic Illness. The sickest, top 5% of Medicare beneficiaries account for 43% of all Medicare spending. Cost containment should focus on identifying these 5% early, and intervening so as to prevent advancement of disease where possible. Solution: The “medical home” model may help to identify people who are likely to become sick, and engage them in preventive health programs early.
2.    Obesity. Rises in obesity rates is directly related to increased heart disease, diabetes, cancer, and other chronic disease prevalence. The fastest growing segment of the population that is becoming obese is the high income bracket. Bruce concludes: “This can’t just be explained by McDonald’s.”
3.    Non outcomes-based spending. Medicare beneficiaries with the same medical conditions receive widely different medical services depending on where they are in the country. More services, however, do not correlate with improved outcomes.
Solution: Comparative Effectiveness Research

What changes in Medicare benefits is the Congressional Budget Office considering?

1.    Creating Medicare insurance buy-in for people ages 62-64.
2.    Reduce or eliminate 24 month waiting period for disabled people to become eligible for Medicare.
3.    Increase the age of eligibility of Medicare beneficiaries to 67. This encourages people to work longer since average lifespan has been steadily increasing.

CBO Strategies to improve quality and efficiency of care:

1.    Bundle Medicare payments so that hospital and post-acute care are linked. This will incentivize hospitals to do a better job of follow up once patients are discharged from the hospital.
2.    Reduce payments (after risk-adjustment) to hospitals with higher re-admission rates.
3.    Offer physicians performance-based payments for managing and coordinating care for their patients (the medical home model).
4.    Create incentives and penalties to promote adoption and use of HIT.

CBO strategies to streamline payment structure and benefits:

1.    Modify the Sustainable Growth Rate (SGR) formula used to determine payments to physicians. Put a cap on total spending.
2.    Change Medicare Advantage program to fee for service.
3.    Replace the current beneficiary cost-sharing structure with a unified deductible and uniform cost-sharing plan. Add catastrophic limit for out-of-pocket spending.
4.    Require drug manufacturers to pay a rebate to Medicare for drugs covered in Part D.
5.    Fill in the “donut hole” in Part D.

***

Next up: Grace Marie Turner and the free market gang debate the merits of a government-run healthcare system.

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