Doctors Ask Congress for Freedom, Not Bigger Reimbursements

/PRNewswire/ -- Once again, the American Medical Association is begging Congress to postpone a fee cut for doctors under Medicare's "sustained growth rate" (SGR) method. Unless Congress acts, doctors' Medicare payments will be slashed 23% on Dec 1, then another 6% on Jan 1. The formula automatically kicks in when Medicare spending exceeds a certain amount.

On what the AMA calls White Coat Wednesday, Nov 17, doctors are urged to call Congress. But the Association of American Physicians and Surgeons (AAPS) advises a different message.

"The AMA and Congress have been playing this game of 'chicken' for more than 8 years," says Dr. Jane Orient, executive director of AAPS. [See: http://www.aapsonline.org/newsoftheday/001097] The AMA threatens doctors will quit seeing Medicare patients unless Congress stops the cuts.

"Meanwhile, the AMA and the government collude on a dictatorial system of price controls."

The values for thousands of medical procedures are set by a secretive 29-member panel called the RUC, the Relative Value Scale Update Committee, convened by the AMA. [See Wall Street Journal, Oct 26, 2010. http://online.wsj.com/article/SB10001424052748704657304575540440173772102.html?KEYWORDS=Relative+Value+Scale+Update] Once the RUC determines the formula for divvying up $60 billion for physician fees, the government accepts most of the recommendations and applies a "conversion factor" to give each fee a dollar amount.

Doctors who charge a different amount are heavily fined or sent to prison. Because of the price controls or ban on "balance billing," if the Medicare-allowed fee doesn't cover the cost, doctors simply can't provide the service. Patients who are willing and able to pay are not permitted to make up the difference. It amounts to a form of covert rationing.

"In a free-market system, patients and doctors decide on the fee," states Dr. Orient. "That is not necessarily the same as the insurance reimbursement."

Doctors who opt out of Medicare set their own fees, but patients cannot collect Medicare reimbursement for their services.

Instead of asking for more taxpayer money, AAPS asks Congress to restore the freedom of patients and physicians to make their own decisions, including the amount of the fee. Without all the expensive Medicare hassles, fees are often lower.

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Medicare 'Competitive' Bidding Program for Home Medical Equipment Is Plagued by Myths; Economists Warn that the Bid System Will Fail

/PRNewswire/ -- While Medicare paints a glowing picture of the controversial "competitive" bidding program for home medical equipment and services (HME), economists and consumer groups have lined up to oppose the flawed system.

New restrictions and unsustainable prices based on this controversial bidding system are scheduled to take effect on January 1, 2011 in nine of the largest metropolitan areas including Charlotte, Cincinnati, Cleveland, Dallas-Ft. Worth, Kansas City, Miami, Orlando, Pittsburgh, and Riverside, Calif. Another 91 areas throughout the U.S. will be subjected to the bidding program starting later in 2011. The bidding system affects providers and users of home medical equipment and services such as oxygen therapy, respiratory devices, hospital beds, wheelchairs, and other medically required equipment and supplies needed by seniors and people with disabilities in Medicare.

Proponents of the bidding system have conveyed misleading information that exaggerate the benefits and ignore the severe shortcomings of the program.

MYTH #1: The bidding system improves the method setting reimbursement rates for providers of home medical equipment and services.

REALITY: 166 experts, including two Nobel laureates and numerous economics professors from leading universities, recently warned Congress and regulators that this bidding system will fail. The experts, who do not otherwise oppose competitive bidding to set Medicare prices, point out that the system has four fatal flaws:

* The bidders are not bound by their bids, which undermines the credibility of the process.
* Pricing rules encourage "low-ball bids" that will not allow for a sustainable process or a healthy pool of equipment suppliers.
* The bid design provides "strong incentives to distort bids away from costs."
* There is a lack of transparency in the bid program that is "unacceptable in a government auction and is in sharp contrast to well-run government auctions."


These concerns are not new. They have been shared with the federal Centers for Medicare and Medicaid Services (CMS), which designed the bidding system. But the agency has dismissed those concerns.

The 166 economists sent letters outlining the flaws in the bidding system to Senators Max Baucus (D-Mont.) and Charles Grassley (R-Iowa) and to Representatives Jason Altmire (D-Pa.) and Ralph Hall (R-Tex.) on October 15, 2010, and sent a letter to Rep. Pete Stark (D-Calif.) on September 26. See http://www.cramton.umd.edu/auction-papers.htm.

A September 30, 2010 New York Times' "Freakonomics" article by two of the 166 economists addresses the bidding issue. Yale University economist Ian Ayres and University of Maryland economist Peter Cramton, conclude: "The mystery is why the government has failed over a period of more than ten years to engage auction experts in the design and testing of the Medicare auctions…. We suspect the problem is that CMS initially did not realize that auction expertise was required, and once they spent millions of dollars developing the failed approach, they stuck with it rather than admit that mistakes were made." See: http://freakonomics.blogs.nytimes.com/2010/09/30/fix-medicares-bizarre-auction-program/

MYTH #2: Medicare overpays for home medical equipment, and the bidding system applies market forces to correct that.

REALITY: Proponents of the bidding system have used out-of-date reimbursement rates and false comparisons of retail costs versus Medicare costs to argue their case. For many years, CMS has set reimbursement rates for home medical equipment through a fee schedule. Over the past decade, those reimbursement rates have dropped nearly 50 percent because of cuts mandated by Congress or imposed by CMS.

The costs of delivering, setting up, maintaining, and servicing medically required equipment in the home are obviously greater than the cost of merely acquiring the equipment. But Medicare does not recognize the costs of these services. So comparing the cost of the equipment to the larger cost of furnishing the full array of required equipment, supplies, and services is false and misleading.

MYTH #3: The bidding program will make healthcare more cost-effective.

REALITY: The home is already the most cost-effective setting for post-acute care. For many years, home medical equipment providers have competed in Medicare on the basis of quality and service to facilitate in the hospital discharge process and enable patients to receive cost-effective, high-quality post-acute care at home. As more people receive quality equipment and services at home, patients and taxpayers will spend less on hospital stays, emergency room visits, and nursing home admissions. Home medical equipment is an important part of the solution to the nation's healthcare funding crisis. Home medical equipment represents less than two percent of total Medicare spending. So while this bidding program would make even more severe cuts to reimbursement rates for home medical equipment, that will ultimately result in much higher spending in Medicare and Medicaid for hospital and nursing home stays and for physician and emergency treatments.

MYTH #4: The bidding program will eliminate fraud in the home medical equipment sector.

REALITY: CMS continues to describe the bidding program as an anti-fraud tool. In reality, it is a price-setting mechanism that has nothing to do with fraud prevention. In fact, the exact opposite is true, according to the 166 market experts who warned Congress in their October 15 letters that the CMS bidding program "will lead to a 'race to the bottom' fostering fraud and corruption."

When explaining on October 14, 2010 why it has missed the deadline for announcing the bid winners, CMS raised concerns about fraud associated with the bidding program. Yet the agency said it will implement the new system on January 1, 2011. The economists' October 15 letter states, "This haste to implement results that raised many red flags with respect to program integrity seems contrary to the public interest and common sense."

The real solution to keeping criminals out of Medicare is better screening, real-time claims audits, and better enforcement mechanisms for Medicare. Two years ago, the American Association for Homecare proposed to Congress an aggressive, 13-point legislative action plan to combat fraud, and many of those provisions have been included in legislation passed in Congress. Moreover, two important anti-fraud requirements – accreditation and surety bonds – took effect more than one year ago, in October 2009.

MYTH #5: Only the home medical equipment sector opposes the bidding system.

REALITY: In addition to the 166 economists and bidding experts who have expressed grave concerns about the bidding program, many consumer and disability organizations have called for a halt to the bidding system. Those groups include the ALS Association, the American Association for Respiratory Care, the American Association of People with Disabilities, COPD/ALERT, the International Ventilator Users Network, the Muscular Dystrophy Association, the National Emphysema/COPD Association, the National Spinal Cord Injury Association, and Post-Polio Health International, among others.

These consumer groups support H.R. 3790, a bill in the U.S. House of Representatives that would eliminate the bidding program in a fiscally responsible manner. That legislation would lower reimbursement rates for durable medical equipment but would allow providers to continue competing to serve Medicare beneficiaries on the basis of service and quality. The bipartisan bill has 257 cosponsors, including more than half of the Democrats and more than half of the Republicans in the House.

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Reminding Healthcare Staff to Remove Catheters Reduces Infections by Half

/PRNewswire/ -- Urinary catheters are often left in place longer than needed, and new research shows that reminder systems that encourage hospital staff to remove catheters promptly can reduce the rate of catheter-associated urinary tract infections by 52 percent.

The review and meta-analysis was published July 30 in the journal, Clinical Infectious Diseases. The catheter-associated urinary tract infection (CAUTI) is the most common hospital acquired infection and was the first complication chosen for non-payment by Medicare, beginning in late 2008. Other insurers have now followed suit.

Lead author Jennifer Meddings, M.D., and her University of Michigan colleagues studied the effectiveness of reminder systems to decrease catheter use and reduce CAUTIs. They found that reminder systems that prompt hospital staff to assess and remove catheters on a routine basis reduced the rate of catheter-associated urinary tract infections by 52%.

"We are also excited about the potential for reminder systems to have a cascade of benefits to patients beyond prevention of CAUTI, because reducing catheter use can improve patient comfort, reduce bloodstream infections, reduce need for antibiotics, improve patient mobility and decrease length-of-stay," says Meddings, a clinical lecturer in U-M's Department of Internal Medicine.

Urinary catheters are commonly placed to drain bladders in hospitalized patients. Unfortunately, catheters are often left in place longer than needed because doctors forget the catheter is still being used or do not routinely assess if it is still needed. Having a catheter increases the patient's risk for catheter-associated urinary tract infections, bloodstream infections, and other risks associated with decreased patient mobility when catheters are in place, such as life-threatening blood clots. But prior research by VA/U-M's Patient Safety Enhancement Program indicated that only 1 in 10 hospitals use reminders to prompt removal of urinary catheters.

In most hospitals, four steps are needed to remove a urinary catheter: 1. the physician recognizes it is there; 2. the physician recognizes it is unnecessary; 3. the physician writes an order for removal; and 4. A nurse removes the catheter according to the order. Catheter reminder systems function by bypassing several of these steps.

The reminders can take many forms, such as stickers placed on charts or on catheter bags that remind nurses or physicians to remove the catheter. Some hospitals, like U-M, have used computer-generated reminders that appear when someone logs into a patient's chart online. Stop orders also can be directed at physicians, in which a catheter is discontinued unless a physician directly renews it.

Meddings and her colleagues note that hospitals should consider "nurse-empowered" catheter stop orders, which empower nurses to remove urinary catheters based upon criteria, without requiring the nurse to request an order from physicians. The researchers also found no evidence that reminder systems would lead to catheters being removed too early, as catheters did not need to be replaced at higher rates.

"Because catheter reminders and stop orders are beneficial regardless of the technology used -- from verbal bedside reminders to computer-generated stop orders -- these interventions appear to be low-cost strategies that could be implemented in any health care system," according to Meddings and her co-authors: Mary A.M. Rogers, Ph.D., research assistant professor in U-M's Department of Internal Medicine; Michelle Macy, M.D., MSc of U-M's Departments of Emergency Medicine and Pediatrics; and Sanjay Saint, M.D., MPH, Associate Chief of Medicine at Ann Arbor VA Medical Center and Professor of Medicine, Department of Internal Medicine, Division of General Medicine.

In related work, Meddings, Saint and Larry McMahon, M.D., chief of U-M's Division of General Medicine, also recently studied the implementation of new Medicare policies to encourage hospitals to prevent CAUTI by no longer paying hospitals to treat hospital-acquired conditions such as CAUTI. In a study published in the June issue of Infection Control and Hospital Epidemiology, the U-M researchers studied the potential of the new policy to encourage CAUTI prevention by financially penalizing hospitals when patients develop these complications.

This work revealed that the Medicare policy's requirements for documentation of hospital-acquired CAUTI is a complicated 3-step process for a hospital to correctly document a hospital-acquired CAUTI in order to not get paid extra. If any of the details are incorrectly documented, the hospital will mistakenly be paid extra. The researchers found that although hospital-acquired CAUTI was a common condition, most cases were not correctly identified in payment requests to insurers because a specific code to identify a UTI as "catheter-associated" was very rarely used. Rare use of this catheter code was found similarly at the hospital, state and national level.

"The bottom line is we are hopeful that policies such as non-payment for hospital-acquired complications such as CAUTI may motivate hospitals to invest in preventive strategies such as catheter reminder systems," says Meddings. "Yet, the anticipated financial impact of non-payment for hospital-acquired CAUTI may not be large due to complex implementation details that may require more evaluation and changes in documentation of patient care before these types of policies have the expected financial impact."

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ONC Issues Final Rule to Establish the Temporary Certification Program for Electronic Health Record Technology

The Office of the National Coordinator for Health Information Technology (ONC) on June 18 issued a final rule to establish a temporary certification program for electronic health record (EHR) technology. The temporary certification program establishes processes that organizations will need to follow in order to be authorized by the National Coordinator to test and certify EHR technology.

Use of “certified EHR technology” is a core requirement for providers who seek to qualify to receive incentive payments under the Medicare and Medicaid Electronic Health Record Incentive Programs provisions authorized in the Health Information Technology for Economic and Clinical Health (HITECH) Act. HITECH was enacted as part of the American Recovery and Reinvestment Act (ARRA) of 2009. The Centers for Medicare & Medicaid Services will soon issue final regulations to implement the EHR incentive programs.

Certification is used to provide assurance and confidence that a product or service will work as expected and will include the capabilities for which it was purchased. EHR technology certification does just that: It assures health care providers that the EHR technology they adopt has been tested and includes the required capabilities they need in order to use the technology in a meaningful way to improve the quality of care provided to their patients.

On March 10, 2010, the U.S. Department of Health and Human Services (HHS) issued a notice of proposed rulemaking (NPRM) entitled Proposed Establishment of Certification Programs for Health Information Technology. The NPRM proposed the establishment of two certification programs for purposes of testing and certifying EHRs —one temporary and one permanent. The temporary certification program final rule issued today will become effective upon publication in the Federal Register. The final rule for the permanent certification program is expected to be published this fall.

“By purchasing certified EHR technology, hospitals and eligible professionals and hospitals will be able to make EHR purchasing decisions knowing that the technology will allow them to become meaningful users of electronic health records, qualify for the payment incentives, and begin to use EHRs in a way that will improve quality and efficiency in our health care system,” said David Blumenthal, M.D., M.P.P., national coordinator for health information technology. “We hope that all HIT stakeholders view this rule as the federal government’s commitment to reduce uncertainty in the health IT marketplace and advance the successful implementation of EHR incentive programs.”

This final rule is issued under the authority provided to the National Coordinator for Health Information Technology in section 3001(c)(5) of the Public Health Service Act (PHSA) as added by the HITECH Act.

For more information about the temporary certification program and rule, please visit http://healthit.hhs.gov/certification.

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Medicare Meltdown Looming As Steep Medicare Cut Begins

/PRNewswire/ -- The U.S. Senate's failure to act before this week's 21 percent Medicare physician payment cut has put seniors' health care at grave risk. A new American Medical Association (AMA) physician survey shows that many physicians are already limiting the number of Medicare patients they treat. The AMA today launched a multi-million dollar national advertising campaign, with ads on TV and radio and in newspapers, including The New York Times, USAToday and The Wall Street Journal.

"The Senate has turned its back on our nation's seniors and the physicians who care for them by leaving for vacation and failing to stop a 21 percent Medicare cut before their self-imposed June 1 deadline," said AMA President J. James Rohack, M.D. "Today, the AMA is unveiling a new multi-million dollar ad campaign encouraging the public to contact their Senators and tell them to get back to work and fix Medicare now."

The 21 percent cut also hurts our nation's military families, as TRICARE rates are tied to Medicare. "It is sad and ironic that Senators raced home to celebrate Memorial Day without first voting to preserve health care for active duty military families," Dr. Rohack said.

Yesterday, the AMA received a call from Joan, a retired nurse, who was looking for a Maryland physician for her 72-year-old sister and could not find one who took Medicare. Both physician offices she called said that as of this June 1 they were no longer accepting new Medicare patients -- a real life example of how decisions made in Washington hurt real people.

Our new online survey of 9,000 physicians who care for Medicare patients confirms that seniors are already being hurt by Congress' mismanagement of the Medicare program. About one in five physicians (17%) say they have already been forced to limit the number of Medicare patients in their practice. Nearly one-third of primary care physicians (31%) have already been forced to take that action. The top two reasons physicians gave for these actions were the ongoing threat of future cuts and the fact that Medicare payment rates were already too low.

"Make no mistake: Physicians want to care for seniors and military families, but the chronic instability caused by the threat of future payment cuts has already taken its toll - and a 21 percent cut will make matters much worse," Dr. Rohack said.

"This is the third time this year that Congress has allowed a Medicare deadline to expire without action," Dr. Rohack said. "Each time Congress delays fixing the Medicare physician payment cut makes the problem worse and the price tag higher for the American taxpayer. Enough is enough. The Senate needs to fix the Medicare physician payment system for America's seniors once and for all."

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84% of Physicians Polled will have to Stop Seeing Medicare Patients if Reimbursement Cuts Pass

/PRNewswire/ -- Sermo (http://www.sermo.com/), the world's largest online community for physicians, today announced physician reaction to the Medicare cuts effective March 1st, 2010. Nearly 1,500 physicians participated in an online poll and discussion measuring how they will respond to the reimbursements cuts. Of the respondents, 84% said they will have to stop seeing new Medicare patients, stop seeing all Medicare patients or consider closing their practices altogether.

This cut in reimbursements will dramatically impact both the physicians providing care and the patients. As one Oncologist noted, "Ultimately, it's the patients who will suffer."

Many practices, private and group, will be opting out of Medicare as of March 1st. One Family Practice Physician said, "My primary care group (the largest in our county) will stop accepting new Medicare patients Monday, and if the cuts stick, terminate care for 25-50% of the existing patients and require all new patients with commercial plans to sign up for our retainer offering. We have a leaflet ready explaining the reasons why and how to contact our Congressman and Senators."

Many physicians explained they simply cannot make up for the declining payments by increasing volume of patients seen. For some practices, the bulk of the physician's patients are on Medicare/Medicaid. One Doctor of Osteopathy shares, "Medicare makes up about 50% of my practice. I cannot afford to stop seeing them all together right now. Either way I will have to significantly change my practice to reduce overhead to survive the cut."

Physicians are particularly disillusioned by what they believe is Congress' attempt to control the practice of medicine. One surgeon writes, "The government cannot be allowed to legislate that we take on unprofitable endeavors. It is time for all physicians to take a stand for a fare wage." A Dermatologist added, "Medicare needs to get out of the price-fixing business."

To view the full discussion and polling results, visit the Sermo Blog at http://sermo.com/blog. The Sermo Blog (www.sermo.com/blog) highlights the most vibrant discussions happening. Discussions on Sermo are physician-initiated and cover topics ranging from medical ethics & practice management to challenging clinical cases. All physicians on Sermo are verified as licensed in the US.

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CMS and ONC Issue Regulations Proposing a Definition of 'Meaningful Use' and Setting Standards for Electronic Health Record Incentive Program

The Centers for Medicare & Medicare Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) encourage public comment on two regulations issued today that lay a foundation for improving quality, efficiency and safety through meaningful use of certified electronic health record (EHR) technology. The regulations will help implement the EHR incentive programs enacted under the American Recovery and Reinvestment Act of 2009 (Recovery Act).

A proposed rule issued by CMS outlines proposed provisions governing the EHR incentive programs, including defining the central concept of "meaningful use" of EHR technology. An interim final regulation (IFR) issued by ONC sets initial standards, implementation specifications, and certification criteria for EHR technology. Both regulations are open to
public comment.

"Widespread adoption of electronic health records holds great promise for improving health care quality, efficiency, and patient safety," said, National Coordinator for Health Information Technology David Blumenthal, M.D., M.P.P. "The Recovery Act's financial incentives demonstrate Congress' and the Administration's commitment to help providers adopt and make meaningful use of EHR technology so they can give better care and their patients' experience of care will improve. Over time, we believe the EHR incentive program under Medicare and
Medicaid will accelerate and facilitate health information technology adoption by more individual providers and organizations throughout the health care system."

"These regulations are closely linked," said Charlene Frizzera, CMS acting administrator. "CMS's proposed regulation would define and specify how to demonstrate 'meaningful use' of EHR technology, which is a prerequisite for receiving the Medicare incentive payments. Our rule
also outlines the proposed payment methodologies for the Medicare and Medicaid EHR incentive programs. ONC's regulation sets forth the standards and specifications that will enhance the interoperability, functionality, utility and security of health information technology."

CMS and ONC worked closely to develop the two rules and received input from hundreds of technical subject matters experts, health care providers, and other key stakeholders. Numerous public meetings to solicit public comment were held by three Federal advisory committees:
the National Committee on Vital and Health Statistics (NCVHS), the Health IT Policy Committee (HITPC), and the Health IT Standards Committee (HITSC). HITSC presented its final recommendations to the National Coordinator in August 2009. These recommendations, along with all other input were considered to help inform the development of the regulations announced today.

The IFR issued by ONC describes the standards that must be met by certified EHR technology to exchange healthcare information among providers and between providers and patients. This initial set of standards begins to define a common language to ensure accurate and secure health information exchange across different EHR systems. The IFR describes standard formats for clinical summaries and prescriptions; standard terms to describe clinical problems, procedures, laboratory tests, medications and allergies; and standards for the secure transportation of this information using the Internet.

The IFR calls for the industry to standardize the way in which EHR information is exchanged between organizations, and sets forth criteria required for an EHR technology to be certified. These standards will support meaningful use and data exchange among providers who must use
certified EHR technology to qualify for the Medicare and Medicaid incentives.

Under the statute, HHS is required to adopt an initial set of standards for EHR technology by Dec. 31, 2009. The IFR will go into effect 30 days after publication, with an opportunity for public comment and refinement over the next 60 days. A final rule will be issued in 2010.
"We strongly encourage stakeholders to provide comments on these standards and specifications," Dr. Blumenthal said.

The Recovery Act established programs to provide incentive payments to eligible professionals and eligible hospitals participating in Medicare and Medicaid that adopt and make "meaningful use" of certified EHR technology. Incentive payments may begin as soon as October 2010 to
eligible hospitals. Incentive payments to other eligible providers may begin in January 2011.

The proposed rule would define the term "meaningful EHR user" as an eligible professional or eligible hospital that, during the specified reporting period, demonstrates meaningful use of certified EHR technology in a form and manner consistent with certain objectives and
measures presented in the regulation. These objectives and measures would include use of certified EHR technology in a manner that improves quality, safety, and efficiency of health care delivery, reduces health care disparities, engages patients and families, improves care
coordination, improves population and public health, and ensures adequate privacy and security protections for personal health information.

The proposed rule would define meaningful use for the Medicare EHR incentive programs. It proposes one definition that would apply to eligible professionals participating in the Medicare fee-for-service and the Medicare Advantage EHR incentive programs as well as a proposed
definition that would apply to eligible hospitals and critical access hospitals. These definitions also would serve as the minimum standard for eligible professionals and eligible hospitals participating in the Medicaid EHR incentive program. The rule proposes that states could
request CMS approval to implement additional meaningful use measures, as appropriate, but could not request approval of fewer or less rigorous meaningful use measures than required by the rule.

This rule proposes a phased approach to implement the proposed requirements for demonstrating meaningful use. This approach would initially establish reasonable criteria for meaningful use based on currently available technological capabilities and providers' practice
experience. CMS will establish stricter and more extensive criteria for demonstrating meaningful use over time, as anticipated developments in technology and providers' capabilities occur.

CMS provides a 60-day comment period on the proposed rule. "The definition and requirements for demonstrating meaningful use of EHR technology are proposals. CMS welcomes and will give serious consideration to comments that improve our proposal while achieving the
goals Congress established for the EHR incentive programs," Frizzera said.

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New Study Shows That American Public is Willing to Accept Major Reforms in Medicare Program

/PRNewswire/ -- Although Americans see Medicare as a key part of the country's social contract and want to preserve it in some recognizable form, they are willing to consider significant changes in the program to hold down its costs as the U.S. population ages.

In day-long "Choice-Dialogues" in which Americans from all walks of life considered the pros and cons of a range of choices for reforming Medicare, common ground was found in several key areas:

-- Allow Medicare to negotiate prices for prescription drugs (94 percent
support).
-- Encourage hospice care instead of heroic end-of-life measures (85
percent support).
-- Only cover treatments that are scientifically proven to be effective
(68 percent support).
-- Emphasize preventive care and personal responsibility (89 percent
consider preventive care very important or essential).
-- Gradually increase the Medicare eligibility age from 65 to 67 (68
percent support).


If additional money is needed to maintain Medicare in a way that is familiar in the future, Americans would rather see the government raise taxes than increase the federal debt.

These are among the central findings in a report released today by The Concord Coalition and Viewpoint Learning, Inc. The report is entitled "Medicare: It's Not Just Another Program."

The report, which was written by Viewpoint Learning, also underscores public dismay at the health care system in general. It comes as Congress and the Obama administration are working on massive changes in the entire system.

"Participants repeatedly expressed concerns over what they saw as a Byzantine and unaccountable health care system," the Medicare report says. "Most felt that the medical industry (especially the pharmaceutical companies) puts profits before people."

Robert L. Bixby, executive director of The Concord Coalition, says the report shows that Americans are prepared to accept significant changes in the program that plays a central role in the federal government's long-term fiscal problems.

"Medicare is on an unsustainable path and must be reformed," Bixby said. "According to conventional wisdom, however, the public is not ready to accept any change in the status quo. The good news from these Choice-Dialogues is that the conventional wisdom is wrong; the public is ready and willing to consider some very fundamental Medicare reforms so long as the program is preserved as a vital part of the social contract."

"Politicians who are truly interested in saving Medicare should stop the scare tactics and start engaging the public in a dialogue on the real trade-offs that must be confronted," Bixby added. "Changes will still be difficult, but the results will be more acceptable."

Viewpoint Learning conducted the dialogues with randomly selected representative samples of 35-40 citizens in Oak Brook, Illinois; Columbia Maryland; Phoenix and Houston. This project builds on the findings of a broader two-year project, "The America We Want," that examined public opinion on a broader range of federal programs and budget issues.

The new report found that many Americans lacked a strong understanding of the Medicare program, how it is funded, and the severity of the fiscal challenges facing the United States in the years ahead.

Yet most participants in the dialogues, after studying these issues in depth and spending much of a day discussing the problems and possible solutions with others, were able to agree on a set of Medicare changes.

But to win public support, the report cautions, "proposals for major reform to Medicare need to recognize the extent to which Americans see Medicare as an essential part of the social contract and not just as another government program."

Steven Rosell, president of Viewpoint Learning, said "The findings from these daylong dialogues with Americans from very different backgrounds and perspectives reveal deep disconnects between how Washington talks about Medicare and health care reform and how the public talks about them. In case after case, the report shows how leaders and the public are talking past each other, and how this deep disconnect and misunderstanding lead to the heat and the rancor that have made advancing real reform so difficult."

When most people talk about the "cost of health care," for example, they are focused on what they pay in premiums, co-pays and drug expenses. When health care experts talk about costs, however, they usually focus on the costs to businesses, government and other institutions.

Rosell also noted that many Americans do not realize that they are essentially paying for the cost of care for the uninsured already.

The new report, he said, provides insight for leaders about how best to bridge such disconnects and begin to create a learning curve that could lead to public support for significant Medicare reform.

Some elements in the new report also echo the findings of The Concord Coalition's fiscal advisory councils that met in early December in Washington. Working in six different parts of the country on Concord's Fiscal Stewardship Project, these advisory councils called for sweeping reforms in the health care system and some changes in Medicare to put the government on a more sustainable fiscal path. More information on the advisory councils' work is available at:

http://concordcoalition.org/fiscal-stewardship-project/fiscal-stewardship- project.

The full report, entitled "Medicare: It's Not Just Another Program," is available at: http://www.concordcoalition.org/files/uploaded-pdfs/Medicare_Report_Dec09_PRIN T.pdf

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Healthcare Bills Will Hamper Medicare Services for Seniors and the Disabled

/PRNewswire/ -- The following is news about the Medicare power mobility benefit from Support Mobility Now Volume 1 Issue 2:

Significant changes are needed in healthcare reform legislation to prevent senior citizens and the disabled from facing a difficult time obtaining homecare products through Medicare. The current legislation would likely prevent or delay many Medicare beneficiaries from receiving critical medical equipment that helps sustain their lives and allows them to live independently in their homes for longer periods of time.

Unfortunately, in piecing this historic legislation together, lawmakers may have overlooked the fact that some of the changes for medical equipment providers would adversely impact their ability to deliver timely and quality service to Medicare beneficiaries.

To be sure, America's healthcare system must be improved. But there should also be a responsibility to ensure that the changes don't place additional burdens upon Medicare beneficiaries, who are already some of the most vulnerable men and women in our society.

Medicare's power mobility benefit would be hit especially hard.

Currently, Medicare allows a beneficiary to purchase power wheelchair in the first month it is prescribed or rent the equipment for 13 months. The legislation eliminates a beneficiary's early purchase option. Seniors and people living with disabilities, who qualify for power wheelchairs, usually suffer from long-term, chronic conditions so they overwhelming chose the early purchase. Without the first month purchases, providers say they won't have the cash flow to pay the wheelchair manufacturers or provide other services required. Many equipment suppliers anticipate that they may go out of business or no longer offer power wheelchairs, a development that would make it more difficult for beneficiaries to find providers in their area.

Some in Congress recognize the potential danger from ending the early purchase.

Pennsylvania Sen. Arlen Specter proposed an amendment to preserve the first-month purchase option while obligating suppliers to pay back Medicare when equipment isn't used full term. The Congress, however, quickly showed how much financial concerns are out weighing practical ones: The Specter amendment essentially died when the Congressional Budget Office (CBO) contended that only $200 million would be saved over 10 years with his proposal, while lawmakers sought $800 million in savings. The industry maintains that the CBO was wrong, and that much more than $200 million would be saved with Specter's amendment.

Aware that the Congress is fixated on finding savings to pay for healthcare reform, providers are willing to accept further, yet agonizing, reductions in the reimbursement rates for power wheelchairs in exchange for keeping the purchase option and sustaining a process that would at least allow companies to stay in business.

The Senate legislation also accelerates the implementation of the competitive bidding program for Durable Medical Equipment (DME), which includes oxygen, power wheelchairs and other homecare products. Competitive bidding for these products was first implemented last year, but the program was flawed to the point that patients' lives were endangered because of confusion and delays in getting life-sustaining equipment to beneficiaries, hospitals and other institutions. Congress stepped in, and temporarily halted the program in July 2008. The Centers for Medicare and Medicaid Services (CMS) has re-launched the bidding program, but providers say that many of the original problems have not been corrected. The healthcare reform legislation makes matters worse by ordering a rapid expansion of the competitive bidding process before stakeholders can gauge whether the program can avoid putting some of the most vulnerable people in our society at risk.

Once again, some lawmakers recognize that the rush to pay for healthcare reform legislation could have a devastating impact on their constituents. Competitive bidding is projected to save millions of dollars. But Florida Rep. Kendrick Meek is more concerned about his constituents: he has sponsored legislation in the House that would end the competitive bidding experiment and obtain savings for the government by cutting the reimbursement rate for homecare products by 0.25% from 2010 to 2012 and an additional 0.5% in 2015. Moreover, the industry wants to work with CMS to establish a system that allows providers to deliver quality service and products to Medicare beneficiaries at a fair price to the government.

Comprehensive healthcare reform is long overdue, but we must ask our Representatives and Senators in Congress whether the cost of enacting this legislation should include placing new burdens on seniors and people with disabilities. One would hope that this population would benefit from reform, and not be its victims. It's clear that the current legislation delivers critical blows to the companies committed to providing medical equipment to Medicare beneficiaries.

What's unclear is whether enough lawmakers in Congress will recognize the consequences for their constituents back home when there are significant delays in providing medical equipment for Medicare beneficiaries, or only a few companies left to supply the products. There are ways to fix healthcare reform legislation so that the seniors, who built and protected our nation, can live with dignity and independence in their homes during their twilight years.

Let's hope Congress understands how much this means to them.

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Medicare Expands List of Covered Preventive Services to Include HIV Screening Tests

The Centers for Medicare & Medicaid Services (CMS) today announced its final decision to cover Human Immunodeficiency Virus (HIV) infection screening for Medicare beneficiaries who are at increased risk for the infection, including women who are pregnant and Medicare beneficiaries
of any age who voluntarily request the service. The decision is effective immediately.

Under the recently passed Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), CMS now has the flexibility of adding to Medicare's list of covered preventive services, if certain requirements are met. Prior to this law, Medicare could only cover additional preventive screening tests when Congress authorized it to do so.

"Today's decision marks an important milestone in the history of the Medicare program," said HHS Secretary Kathleen Sebelius. "Beginning with expanding coverage for HIV screening, we can now work proactively as a program to help keep Medicare beneficiaries healthy and take a more active role in evaluating the evidence for preventive services."

Under MIPPA, CMS can consider whether Medicare should cover preventive services that Congress has not already deemed as covered or non-covered by law. Among other requirements, the new services must have been "strongly recommended" or "recommended" by the U.S. Preventive Services Task Force. For instance, the Task Force graded HIV screening as "strongly recommended" for certain groups. More information about the Task Force is available online at
http://www.ahrq.gov/clinic/uspstfix.htm.

"Every adult should know their HIV status," said Dr. Howard K. Koh, HHS assistant secretary for health. "This decision by Medicare should help promote screening and save lives."

CMS uses the national coverage determination (NCD) process to make decisions on these types of preventive services. This process provides transparency about the evidence that CMS considers when making its decisions and allows opportunity for the public to comment on CMS'
proposals.

"Medicare's coverage of HIV screening tests is an important step forward in protecting beneficiaries from the potentially devastating and life-threatening complications of HIV and Acquired immunodeficiency Syndrome (AIDS)," said CMS Acting Administrator Charlene Frizzera.

AIDS is diagnosed when an HIV-infected person's immune system becomes severely compromised or a person becomes ill with an HIV-related infection. Of the more than one million estimated to have the HIV infection, the Centers for Disease Control and Prevention has estimated that about a quarter of them do not realize they are infected. Without treatment, AIDS develops within 8 to 10 years. While there is presently no cure for HIV, screening can help identify infected patients so that they can receive medical treatment that could help delay the onset of AIDS for years.

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AHIP Statement on Affordable Health Care for America Act

/PRNewswire/ -- Karen Ignagni, President and CEO of America's Health Insurance Plans (AHIP), released the following statement today in response to the Affordable Health Care for America Act:

"The promise of health care reform has been that if you like your current coverage, you can keep it. We are concerned that this proposal will break this promise by increasing health care costs for families and employers across the country and significantly disrupting the quality coverage on which millions of Americans rely today.

"The lack of system-wide cost containment is a missed opportunity. Without a greater focus on health care costs, families and employers will not be able to afford coverage and health care costs will rise at a rate much faster than the overall economy is able to sustain.

"We share the concerns that doctors, hospitals, employers, and patients have all raised about the significant disruption a new government-run plan would have on the current health care system. A new government-run plan would bankrupt hospitals, dismantle employer coverage, exacerbate cost-shifting from Medicare and Medicaid, and ultimately increase the federal deficit.

"Estimates show that a government-run plan would cause millions of people to lose their current coverage. Moreover, massive Medicare Advantage cuts would cause millions of seniors to lose their Medicare Advantage coverage altogether, while millions more would face benefit cuts and higher out-of-pocket costs.

"Health plans strongly support comprehensive, bipartisan health care reform and have proposed sweeping insurance market reforms and new consumer protections to ensure that every American has guaranteed access to affordable health care coverage. Experience in the states has shown that insurance market reforms must be paired with an effective personal coverage requirement for these reforms to work. While this legislation recognizes the key linkage of market reforms and a personal coverage requirement, more needs to be done to ensure coverage is affordable and our health care system is sustainable.

"As the process progresses, health plans will continue to work to advance bipartisan legislation this year that will cover all Americans, make coverage more affordable, and improve quality."

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'Doc Buy' Fails as Physician Support for Health Care Overhaul Wanes - Shadow Bill Concealing $247 Billion in Health Costs Defeated

'Doc Buy' Fails as Physician Support for Health Care Overhaul Wanes - Shadow Bill Concealing $247 Billion in Health Costs Defeated in Critical Senate Vote

/Standard Newswire/ -- Patients First, A Project of Americans for Prosperity(tm) is praising the U.S. Senate's bipartisan rejection of the $247 billion so-called "Doc Fix" bill (S.1776) by a 53-47 margin.

Senate Majority Leader Harry Reid had attempted to hastily force the bill through the Senate to
simultaneously purchase the support of doctors in the larger health care legislative battle, while concealing the full cost of the health overhaul in a shadow bill.

Leader Reid had abruptly scheduled today's failed cloture vote to increase Medicare payments to doctors by $247 billion. The tricky tactic, which would also have required a vote to waive Senate budget rules, raised criticism since it would conceal the total cost of the health care plan being considered in Congress by splitting the overhaul into two separate bills. The Senate Finance Committee recently voted for a $904 billion plan, but the addition of this $247 billion bill would have pushed the total cost of the overhaul to well over $1.1 trillion, violating the White House's
pledge to keep the health care plan deficit neutral.

"The 53 Senators that voted against this hastily-crafted backroom health care deal deserve credit," said Phil Kerpen, policy director of Patients First. "Leader Reid's attempt to use outright deception and trickery to conceal the true costs of the attempted Washington takeover of health care has failed. Americans have the right to know the details of how government-forced health care would impact their access to quality affordable health care. Transparency and open debate, not backroom deals and legislative gimmicks, offer us a way forward towards real health care
reform."

The "Doc Fix" bill's defeat spells further trouble for the Obama Administration and Congressional Democrats as they court critical support from doctors for the controversial health care overhaul. A recent IBD/TIPP Poll of nearly 1,400 doctors found that two-thirds of
physicians oppose the reforms proposed by Congress. 45 percent of doctors said that enactment
would force them to consider retiring or abandoning their practice, and 67 percent anticipated fewer medical school applicants. Meanwhile, 65 percent of doctors believed that the plan would lead to lower-quality care for seniors and 71 percent said that it was impossible for government to insure 47 million more Americans while cutting costs and providing better quality care.

"America's doctors cannot be bribed into supporting legislation that will restrict patient choice, increase bureaucracy, defund Medicare for seniors, and drive costs so high that middle class taxpayers suffer," said Phil Kerpen. "Our nation's physicians want to care for their patients, and government should not stand in the way of the sacred doctor-patient relationship."

Patients First, A Project of Americans for Prosperity(tm), is focused on real health care reform--reform that puts patients first. Patients First believes that Americans want and need more health insurance options--not just a costly, government-defined plan paid for by American taxpayers.

Patients First is a project of Americans for Prosperity® (AFP), a 501(c)(4) non-profit organization recognized by the IRS. AFP is the nation's premier grassroots organization committed to advancing every individual's right to economic freedom and opportunity. AFP has more than 700,000 members, including members in all 50 states, and 25 state chapters. Patients First is not affiliated in any way with Patient First health clinics. For more information on Patients First, go to www.JoinPatientsFirst.com (http://rs6.net/tn.jsp?et=1102780163328&s=13633e=001ZT5NIGsO3Sm71FnQxFM7c909urFNCe1BrHFUUxAchDovoi3PcvaYNpHK1T8
3srDskHtH9Wp_AWd5JxMhq2QGU6eumkYedekDD05_3N4yT1ANSouKAwNgOyU__ZtAVjIv).

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Secretary Sebelius Announces Medicare to Join State-Based Healthcare Delivery System Reform Initiatives

Health and Human Services Secretary Kathleen Sebelius, along with Vermont Governor Jim Douglas and Director of the White House Office of Health Reform Nancy-Ann DeParle today announced an initiative that will allow Medicare to join Medicaid, and private insurers in state-based efforts to improve the way health care is delivered. Innovative models of delivering primary care around the country are examples of the types of programs that will be part of the President's health reform plan. These are models that improve care for patients, give primary care providers better information about their patients and achieve greater value for the health dollars spent.

The new demonstration will build on a model being tested in Vermont. Under the Vermont model, private insurers work in cooperation with Medicaid to set uniform standards for "Advanced Primary Care (APC) models" also known as medical homes. These models provide incentives for doctors to spend more time with their patients and offer better coordinated higher-quality medical care.

"These demonstrations will strengthen our health care system and allow public and private providers to better work together," said Sebelius. "When Medicare, Medicaid and private insurance companies coordinate their efforts, we can improve the quality of care for Medicare
beneficiaries. As we have seen in Vermont, improved efficiencies in the system mean doctors can spend more time with their patients, provide high quality care and better coordinate that care with other medical professionals."

"The Medicare pilot program announced today will help states like Vermont achieve our vision of high quality, affordable health care for all our residents," said Douglas. "This is something we had been pushing for in Vermont for quite some time and I'm thrilled that Secretary Sebelius and her team have made it happen."

In Advanced Primary Care models, physicians are given supplemental payments for achieving nationally-recognized quality standards, coordinating care across a multidisciplinary team and monitoring patients' care outside the physician's office or hospital using health information technology.

This demonstration will mark the first time Medicare will be a full partner in these experiments and the practice model would, for the first time, align compensation offered by all insurers to primary care physicians. Instead of each third party payer and public program adopting different approaches, using different ways of measuring performance and creating different payment incentives, multi-payer programs will join together to work toward common goals to improve the delivery of care.

States wishing to participate in the new demonstration must:
* certify they have already established similar cooperative agreements
between private payers and their Medicaid program;
* demonstrate a commitment from a majority of their primary care doctors
to join the program;
* meet a stringent set of qualifications for doctors who participate;
* integrate public health services to emphasize wellness and prevention
strategies.

The demonstration's design will include mechanisms to assure it generates savings for the Medicare trust funds and the federal government overall.

The Centers for Medicare & Medicaid Services will develop application materials later this fall with the expectation that the demonstration programs begin next year.

"This is a jump start on health insurance reform," said DeParle. "These demonstration projects will foster innovation, support change at the local level and help us build a better 21st century health care system."

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HIV Screening Tests Proposed to Be Added to Medicare's List of Covered Preventive Services

The Department of Health and Human Services (HHS) today announced a new proposal that would cover Human Immunodeficiency Virus (HIV) infection screening for Medicare beneficiaries who are at increased risk for the infection, including women who are pregnant and Medicare beneficiaries of any age who voluntarily request the service.

"The President has set clear priorities for an improved national response to ending the HIV epidemic," said HHS Secretary Kathleen Sebelius. "Today's action by HHS' Centers for Medicare & Medicaid Services (CMS) sends a strong signal that this Administration takes prevention very seriously, especially when it comes to HIV and AIDS."

"While younger age groups account for most cases of HIV infection in the United States, the Centers for Disease Control and Prevention (CDC) estimates that in 2006, approximately 19 percent of all U.S. residents with AIDS were age 50 years or older when the disease was diagnosed, " she added. "Knowing about their HIV status can help patients live longer, fuller lives as well as avoid unintentional transmission of the virus to others."

CMS' efforts mark the first time that Medicare has proposed to expand its list of covered preventive services under a new authority established by Congress. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) gave CMS the ability to consider whether
Medicare should cover "additional preventive services," if certain requirements are met.

Acquired immunodeficiency syndrome (AIDS) is diagnosed when an HIV-infected person's immune system becomes severely compromised or a person becomes ill with an HIV-related infection. Of the more than one million Americans estimated to have the HIV infection, the CDC has estimated that about a quarter of them do not realize they are infected. Without treatment, the HIV infection usually develops into AIDS within 8 to 10 years. While there is presently no cure for HIV, screening can help identify infected patients so that they can receive medical
treatment that could help delay the onset of AIDS for years.

"This proposal to cover HIV screening for our Medicare population has great potential in terms of saving lives and improving the quality of life for many seniors, as well as beneficiaries under age 65," said Acting CMS Administrator Charlene Frizzera.

The White House's top HIV/AIDS official saluted the move by HHS, calling it a critical step in helping HIV and AIDS patients to get the treatment they need.

"The President is committed to re-focusing national attention on the domestic HIV epidemic and salutes this decision as an important step in our overall strategy," said Jeffrey S. Crowley, the Director of the White House Office of National AIDS Policy. "We are working with agencies across the government to achieve the President's goals of reducing HIV incidence, getting all people living with HIV/AIDS into care and improving health outcomes, and reducing HIV-related health disparities. The actions taken by the HHS today are an important part of
our efforts."

Under MIPPA, CMS can consider whether Medicare should cover preventive services that Congress has not already deemed as covered or non-covered by law, as long as they have been "strongly recommended" or "recommended" by the U.S. Preventive Services Task Force.. For
instance, the Task Force graded HIV screening as "strongly recommended." More information about the Task Force is available online at http://www.ahrq.gov/clinic.

CMS uses the national coverage determination process to make decisions on these types of preventive services. This process provides transparency about the evidence that CMS considers when making itsdecisions and allows opportunity for the public to comment on CMS'
proposals.

"We are pleased to be able to propose an expansion to Medicare's portfolio of preventive services," said Barry M. Straube, M.D., CMS Chief Medical Officer and Director of the Agency's Office of Clinical Standards & Quality. "Before the MIPPA law, CMS had not been able to
expand preventive services without Congressional action. Now we can take more active steps to evaluate the evidence about which services are reasonable and necessary to help keep Medicare beneficiaries healthy."

CMS will accept public comments on the proposed decision through Oct. 9, 2009, and will issue a final coverage decision by Dec. 8, 2009.

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As August Congressional Recess Concludes, Polls Show Seniors, General Public Strongly Opposed to Medicare Cuts in Congressional Health Reform Plan

As August Congressional Recess Concludes, Polls Show Seniors, General Public Strongly Opposed to Medicare Cuts in Congressional Health Reform Plan, Says AHCA

/PRNewswire/ -- As Congress prepares to reconvene next week following an August recess replete with wide-ranging local discussion of how to fund health care reform, new polling finds both seniors and the public at large are strongly opposed to slashing Medicare-funded nursing home care to pay for the plan. Meanwhile, at events in Florida and Pennsylvania - states with large concentrations of Medicare beneficiaries - seniors and caregivers are urging their respective state congressional delegations to help preserve, protect and defend quality nursing home care as the legislative debate resumes Tuesday on Capitol Hill.

According to a new national poll (1000 RVs, 8/21-24, +/- 3%) and analysis from the Mellman Group (D), "78% of voters nationwide predict that if Congress cuts $32 billion in Medicare payments to nursing homes, the quality of care delivered to seniors will decline. Seniors are equally concerned, as 78% of those over 65 believe nursing home care will get worse because of such cuts, and a majority believes care will get 'much worse' (58%). Those approaching retirement age (55-64) express even more concern. 83% believe care will worsen." The Mellman Group data also finds a full 66% of voters are less likely to support their local member of Congress for re-election if he or she votes for cuts to Medicare-financed nursing home care. The poll analysis is available in its entirety at www.ahca.org.

Additionally, A new CNN poll (1010 Adults, 8/28-31, +/- 3%) released 9/2) finds that by a 43% to 26% margin, Americans believe senior citizens will be "worse off," not "better off," from the health care reform proposals now being advanced. 30% said "about the same"; 1% expressed no opinion.

The 9/2 Florida Times Union, in a story entitled, "Proposed Medicare Cuts Have Nursing Homes Worried," reports on a Jacksonville-area event in which seniors' advocates and nursing home staff warned Florida's Medicare funded nursing home care benefits will be cut $3.5 billion over ten years to finance health care reform. Lisa Cantrell, President of the National Association of Health Care Assistants, spoke at the Southlake Nursing and Rehabilitation Center in Mandarin, FL. "To Cantrell's side, propped against a wall, was a large, scroll-like petition urging Florida's congressional delegation to rethink the cuts. . . Patricia Johnson, 68, signed the petition with her left hand, as her dominant right hand remains paralyzed from a recent stroke. 'If they have to cut staff here,' her husband, Artie, said, 'it would be down to what I would call the bare minimum.' He added his name, too."

The 9/4 Wilkes-Barre Times-Leader, in a story entitled, "Residents Petition Against Any Medicare Cuts," reports that "Caregivers, residents and family members gathered at the Riverstreet Manor Nursing Home Thursday to sign a petition to members of Pennsylvania's congressional delegation asking that any health care reform bill does not include crippling cuts in Medicare funding." The story notes "Representatives of The Coalition to Protect Senior Care are touring the country's nursing homes asking them to urge their respective members of Congress not to support the currently proposed health care reform measure as long as it includes Medicare funding cuts for seniors in nursing homes by more than $32 billion over 10 years. In Pennsylvania, which would be the seventh hardest hit state, the cuts would total $2.1 billion. In the 11th Congressional District alone, where Riverstreet Manor is, the loss over the next decade would be about $142 million."

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Cancer Community Alarmed at CMS Policy Lumping Life-Saving Cancer Therapy With Diagnostic Testing For Major Funding Cuts

/PRNewswire/ -- The following is being released by US Oncology:

Concerned members of the cancer community, including physicians, patient organizations and other care advocates, spoke out today in opposition to a proposed federal policy under consideration by the Centers for Medicare and Medicaid Services (CMS) that would lump life-saving radiation therapy in with diagnostic testing services in receiving major Medicare funding cuts. In support of their cause, a bipartisan letter led by Reps. Parker Griffith (D-AL), Sue Myrick (R-NC), Lois Capps (D-CA) and Mike Rogers (R-MI), was sent to Health and Human Services Secretary Kathleen Sebelius urging a reversal of this proposal.

"I am very alarmed at the prospect of these dangerous funding cuts being made to radiation therapy, which is a safe and effective treatment proven as a trusted tool in the fight against cancer," said Bernard W. Taylor, M.D., a radiation oncologist at Texas Oncology-Longview Cancer Center in Longview, Texas. "For vulnerable cancer patients like mine, this proposed policy would limit their access to vital radiation treatment through longer wait times and less time spent with their doctors. We must educate policymakers on the radical difference between life-saving, therapeutic radiation therapy and diagnostic testing, and the critical need to spare radiation therapy from these cuts."

At issue is a 19 percent funding cut in Medicare reimbursement to the radiation oncology specialty contained within the CY 2010 Physician Fee Schedule Proposed Rule, equating to cuts of up to 44 percent for certain codes critical to the provision of radiation therapy treatments. Of particular concern in the rule is a proposed policy that raises the utilization rate for medical equipment costing over one million dollars from 50 to 90 percent. The lawmakers and other experts in the industry warn that cuts of this size will result in the closing of many freestanding and community-based cancer centers, particularly in rural areas, harming patient access to care.

"As a radiation oncologist who practiced in the community setting, I am aware of how these severe cuts would limit access to life-saving radiation therapy for cancer patients," said Rep. Griffith. "I am proud to be working on healthcare reform to expand access to high quality, effective care for cancer patients and all Americans, and I look forward to working with both parties as well as the administration to find a solution that averts these cuts and protects patient access to care."

The Congressional letter submitted to Secretary Sebelius, signed by more than 60 Members of Congress, asked CMS to refrain from finalizing the proposed reductions in Medicare payment for radiation oncology services, and to refrain from applying a higher assumed equipment utilization rate to radiation oncology equipment. The letter states:

"We are writing you today to emphasize a clear distinction: Radiation therapy is not diagnostic imaging. . . The therapeutic use of radiation to treat cancer should not be the target of those concerned with volume growth in the area of diagnostic imaging."

The proposal to reduce rates for diagnostic imaging was made by the Medicare Payment Advisory Commission (MedPAC) in their March 2009 report. MedPAC has subsequently stated that it never intended to include radiation therapy in any Medicare reimbursement cuts and yet CMS proposed to extend the cuts to radiation oncology anyway.

According to the National Cancer Institute (NCI), radiation therapy has been found to be under-utilized, with a variety of barriers, including travel time to care, cited as standing between patients and treatment. Following a review of relevant literature, the Agency for Health Care Research and Quality (AHRQ) found evidence of disparities in radiation therapy use among older patients; women; and African Americans, with the exception of care provided in the Veterans' Administration system. In another study of more than 11,000 women in Florida who had undergone breast conserving surgery, the odds of receiving post-surgical radiation therapy decreased by 3 percent for every 5-mile increase in the distance to the nearest radiation therapy facility.

"We support using data to ensure that payment rates for medical procedure are appropriate," said Leonard Kalman, M.D., Chairman of US Oncology's Public Policy Steering Committee. "However, making cuts of this size to radiation therapy - a treatment modality that more than 1 million cancer patients rely upon each year for both curative intent and palliative treatment - without an expressed rationale backed by supporting data is unsound and frankly quite frightening. On behalf of our country's cancer patients, many of whom will rely on radiation therapy at some point in their illness, we must ensure that these cuts are not applied."

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New National Poll Finds Americans Strongly Opposed to Cutting Medicare Payments for Nursing Home Care as a Means of Financing Health Care Reform

/PRNewswire/ -- As federal lawmakers continue to sound out constituents over the August recess on health care reform, and how best to finance a broad-based overhaul, a new Mellman Group (D) national survey (1000 Registered Voters, 8/21-24, +/- 3%) finds Americans, by significant margins, strongly oppose cutting Medicare-funded nursing home care over other funding options. Underscoring the unpopularity of cutting Medicare-financed nursing home care - now proposed by Congress - the data finds a full 66% of voters less likely to support their local member of Congress for reelection if they voted to cut seniors' Medicare-funded care to finance health care reform, believing that cutting such payments would reduce quality of care.

Says the new Mellman Group poll analysis:

"Voters overwhelmingly oppose cutting Medicare payments to nursing homes as a means of financing healthcare reform, expressing their distaste for this approach in several ways during our brief survey.

First, it is the least popular of the funding options being considered.

Second, cutting Medicare payments to nursing homes is far and away the least acceptable method of financing reform.

Finally, a large majority of voters would feel less favorable toward a Member of Congress who supported such an approach. Voters say they will take out their anger on Members who vote for such nursing home cuts at the ballot box. The reason is straightforward--most Americans believe that cutting such payments will reduce the quality of care seniors receive in nursing homes. While healthcare reform is important to many Americans, Medicare funds for nursing homes are considered off limits as a way to finance reform."

When asked "If Congress cut $32 billion in Medicare payments to nursing homes to care for seniors, do you think the quality of care seniors receive in nursing homes would get better, stay about the same or get worse?" the analysis indicates that, "Seniors are equally concerned, as 78% of those over 65 believe nursing home care will get worse because of such cuts and a majority believe care will get much worse (58%)."

The following are the poll questions and results:

1. Congress is now considering ways to pay for healthcare reform. Which one of the following do you think is the most acceptable way to pay for healthcare reform?

Cutting Medicare payments to nursing homes to care for seniors 3%
Raising taxes on people who make over $250,000 per year 45%

Requiring people to pay taxes on generous healthcare benefits they receive from their employers 6%

Taxing health insurance companies 14%
None 26%
Don't know 6%


2. And which one of the following do you think is the least acceptable way to pay for healthcare reform?

Cutting Medicare payments to nursing homes to care for seniors 49%
Raising taxes on people who make over $250,000 per year 8%

Requiring people to pay taxes on generous healthcare benefits they receive from their employers 14%

Taxing health insurance companies 9%
None 14%
Don't know 6%


3. If Congress cut $32 billion in Medicare payments to nursing homes to care for seniors, do you think the quality of care seniors receive in nursing homes would get better, stay about the same or get worse? [IF BETTER/WORSE ASK]. And is that much [BETTER/WORSE] or only somewhat [BETTER/WORSE]?

Much better 4% 7%
Somewhat better 3%
Stay about the same 11%
Somewhat worse 19%
Much worse 59% 78%
Don't know 4%


4. If your Member of Congress voted to fund healthcare reform in part by cutting $32 billion in Medicare payments to nursing homes to care for seniors would you be __more likely to vote to reelect them, __less likely to vote to reelect them or would it not make much difference to your vote? [IF MORE/ LESS LIKELY ASK:] Is that much [MORE/LESS] or somewhat [MORE/LESS] likely?

Much more likely 5% 7%
Somewhat more likely 2%
No difference 20%
Somewhat less likely 17%
Much less likely 49% 66%
Don't know 6%


"From the results of this objective, timely and highly significant national survey, it is abundantly clear the public, to its credit, harbors strong antipathy to slashing Medicare beneficiaries' nursing home benefits to finance any broader reform package," stated Bruce Yarwood, President and CEO of AHCA. "We strongly support the laudable objective of the Obama Administration and Congress to expand Americans' access to care, and help bring down health care costs. However, we will continue to warn both on Capitol Hill and at the local level how and why the $32 billion Medicare cuts now under consideration will not only harm seniors' ongoing access to quality nursing home care, but also jeopardize the jobs of the key frontline caregivers who make a significant difference in patients' care outcomes."

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Congress Must Recognize Homecare as Cost-Effective Part of Health Care Reform

/PRNewswire/ -- In their effort to find savings in the healthcare system, the Obama administration and Members of Congress have been eyeing Medicare's home medical equipment (HME) sector for cuts. This sector provides medical oxygen, respiratory therapy, hospital beds, wheelchairs, walkers and other equipment and services that allow people to get the care they need at home instead of in a hospital or nursing home.

Already in 2009, Medicare payments for the most commonly prescribed home medical equipment categories have been cut by 9.5 percent. Medical oxygen reimbursement has been cut by 27 percent so far this year. Another measure aimed at cutting HME costs further is so-called "competitive" bidding.

"The American Association for Homecare urges Congress to recognize that home care is a cost-effective alternative to more expensive forms of care, and should therefore be a critical component -- not a casualty -- of American health care reform. Current and proposed cuts to Medicare's home medical equipment sector are not an effective way to reduce overall Medicare spending. These cuts are likely to increase Medicare costs over time by forcing more seniors into nursing homes and hospitals, blocking preventative care, and causing more frequent visits to emergency rooms.

"Quality home medical equipment and services facilitate hospital discharges, reduce hospital readmissions and emergency room visits, and help to keep seniors and people with disabilities out of more expensive institutional settings. As Congress debates health care reforms, it is important that it keeps these facts in mind and recognizes home care as a partner in improving the quality of American health care and reducing overall health care costs.

"Most home medical equipment costs just dollars a day. The cost of providing the equipment and service for home oxygen, for example, is less than $7 per day under Medicare. Compare that to the average daily cost of about $200 for a nursing facility and more than $5,000 per day for a hospital stay under Medicare.

"According to a recent study in the New England Journal of Medicine, up to one-fifth of all Medicare patients are readmitted to hospitals within one month of being discharged. These unplanned visits cost Medicare an estimated $17 billion in 2004. One reason for the high readmission rates is the lack of continued interaction and guidance once patients are dismissed. Home medical equipment providers help to fill this gap by smoothing the transition from hospital to home with the equipment and services patients need.

"This year, Medicare payments for the most commonly prescribed home medical equipment categories have been cut by 9.5 percent, including complex rehabilitative power wheelchairs. Medical oxygen reimbursement has also been cut by 27 percent so far this year. Home oxygen is a critical, life-sustaining medical treatment prescribed to nearly 1.5 million Medicare patients each year who suffer from respiratory illnesses such as chronic obstructive pulmonary disease.

"Another measure aimed at cutting HME costs further has been labeled 'competitive' acquisition. A regulation enacted in the final hours of the Bush administration would selectively contract with a small number of home care providers based on a race to bid the lowest payment. Even among those who agree to new bid-determined payment rates, Medicare only allows a select few to provide the items, which will have the long-term result of reducing the number of companies competing to offer home care products.

"These cuts in reimbursement are having a negative impact on the quality of equipment and the level of services that providers are able to furnish to consumers who have severe disabilities and who are in greatest need of mobility products and services.

"Home medical equipment and service is already the most cost-effective slowest-growing portion of Medicare spending, increasing only 0.75 percent per year, according to the latest National Health Expenditures data from Medicare. That compares to more than 6 percent annual growth for Medicare spending overall. Moreover, home medical equipment represents only 1.6 percent of the Medicare budget.

"As Congress deliberates cuts to Medicare, they would do well to recognize that cuts to home medical equipment will increase long-term Medicare costs. The home medical equipment sector should be seen as a key element in reducing overall Medicare costs."

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Hospice Community Urges President Obama to Stop Funding Cuts

/PRNewswire/ -- Today, 3,524 hospice providers from across the country sent a letter to President Barack Obama urging him to stop cuts to the Medicare hospice benefit beginning on October 1, 2009.

The cuts threaten to jeopardize availability of the compassionate and high-quality care that 1.5 million patients and their family caregivers receive from hospice providers each year.

In addition to the letter, more than 500 providers of the hospice community submitted comments to the Centers for Medicare and Medicaid Services (CMS) on how the cuts will cause them to decrease services, reduce staffing, and in some cases, close their programs.

This follows two Congressional letters sent to President Obama by 45 U.S. Senators and 171 U.S. Representatives, demonstrating that he has strong, bipartisan support to stop the cuts in hospice funding.

The cuts come from a 2008 federal rule that eliminates a component of the Medicare hospice benefit known as the budget neutrality adjustment factor (BNAF). Members of the hospice community have been calling and emailing the Administration requesting that implementation of this rule be stopped.

"The sheer number of hospice programs represented by this letter and those recently sent by Members of Congress should send a strong message to the White House about the urgency in stopping these cuts," said J. Donald Schumacher, NHPCO president/CEO.

Earlier this year, President Obama and Congress approved a moratorium on the hospice funding cuts that expires on September 30, 2009. Without further action, hospice reimbursements will drop by 3.1 percent, leaving hospice programs, particularly smaller and rural ones, facing cutbacks in services and possible closure.

Hospice is a proven Medicare cost saver. In 2007, an independent, Robert Wood Johnson Foundation-funded study by Duke University found that hospice reduced Medicare costs by $2,300 per patient, saving more than $2 billion per year.

Hospice is considered to be the model of high-quality care at the end of life. Research from NHPCO shows that 98 percent of families served by hospice are willing to recommend its care and services to others.

For more information about NHPCO's efforts to protect hospice funding, please visit NHPCO's Advocacy Web page at: www.nhpco.org/advocacy (the letter sent to President Obama is available online).

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City Leaders Launch Medicare Diabetes Screening Project in Augusta

/PRNewswire/ -- Senator Ed Tarver (D - District 22), Jeanette Cummings, Director, Central Savannah River Area Regional Development Center (CSRA RDC) Area Agency on Aging (AAA), and other city and community leaders today urged all Augusta area seniors to learn more about their personal risk for diabetes, as they launched the Medicare Diabetes Screening Project (MDSP) in Augusta before a crowd gathered at the Henry H. Brigham Senior Center on Golden Camp Road. On a national level, the MDSP is co-chaired by the American Diabetes Association, the Health Care Leadership Council, and Novo Nordisk, and is supported by more than 20 organizations representing the interests of seniors and health care providers.

"Today, I am proud to announce the start of the Medicare Diabetes Screening Project in Augusta," said Sen. Tarver. "When diabetes is undiagnosed and untreated, it can be devastating, and new government statistics show that our senior citizens are especially vulnerable."

According to a study in the February 2009 issue of Diabetes Care, 32% of adults ages 65 and older have diabetes. What's more, almost half (46%) of those seniors with diabetes don't know they have it - they have not been diagnosed. In addition to those with diabetes, another 40% of adults ages 65 and older have pre-diabetes, putting them at very high risk of developing diabetes and heart disease, and it is likely that most of them are unaware of their status. When these statistics are applied to Richmond County, it is estimated that approximately 3,400 seniors ages 65 and older have undiagnosed diabetes, and an additional 9,300 seniors ages 65 and older have pre-diabetes.

"These statistics show why it is crucial that we create awareness of the benefits that Medicare offers for diabetes screening, and motivate our seniors to ask their health care providers about being tested for diabetes," said CSRA AAA Director, Jeanette Cummings.

Since 2005, Medicare has offered benefits for diabetes screening, but usage of these benefits has been minimal. For people who are ages 65 and older and have one risk factor for diabetes, Medicare offers a free diabetes-screening test in a health care provider's office, with no deductible and no co-pay. If seniors are found to have pre-diabetes, they are eligible for another free screening in six months.

To encourage use of these benefits, the Medicare Diabetes Screening Project was conceived and launched in 2007 in Columbus, Georgia. City and community leaders in Columbus developed a model for public awareness and outreach, and that model is being adapted for implementation here in Augusta.

"Augusta elected officials and other leaders from the community immediately saw the need for the Project," said Commissioner Jerry Brigham, "and they have quickly developed ideas and networks for reaching out to seniors and their health care providers with messages of what Medicare offers for diabetes screening. This type of collaboration represents the best of Augusta."

The MDSP will reach out to Augusta-area primary care physicians and their office managers via a letter signed by diabetes specialist Dr. Charles Shaefer of University Primary Care. "To complement public awareness activities, it is important that we directly inform physicians and their staff about the MDSP and the screening benefits that Medicare offers their patients," said Dr. Shaefer.

Also planned are a series of educational seminars at local senior centers, to be coordinated and implemented by the CSRA Area Agency on Aging. And according to Rev. Robert Ramsey, Pastor of the Gospel Water Branch Baptist Church, seniors and their family members will also hear about the MDSP and Medicare diabetes screening via the faith-based community. "Communicating health information to our congregants is not only possible, it's been proven successful," said Rev. Ramsey, who recently participated in a diabetes prevention faith-based program as part of a research study funded by the National Institutes of Health (NIH).

The most currently-available estimates from the Centers for Disease Control and Prevention (CDC) show that the prevalence of diabetes is 25% higher in the state of Georgia as compared to the national average (10% versus 8%, respectively). The CDC also estimates that 10.3% of all adults ages 20 and older in Richmond County have diabetes.

The Medicare Diabetes Screening Project in Augusta is a community-based effort to reach and motivate seniors who have undiagnosed diabetes or pre-diabetes, and encourage them to see their doctors or other health care providers, and take advantage of the free diabetes screening benefits offered by Medicare. To learn more, visit www.screenfordiabetes.org.

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