Medicare

Medicare program revisions to pa3mient policies under the physician fee schedule for calendar year 2003 and inclusion of registered nurses in the personnel provision of the critical access hospital emergency services requirement for frontier areas and remote locations. Final rule with comment period. Fed Regist 2002 67 79965-80184. 

Over the next decade, seniors will spend 1.8 trillion on prescription medications. Medicare proposals to provide a drug benefit for seniors have been suggested to cost 400 billion over a 10-year period. Thus, the most elaborate of the current drug programs will pay only 22% of seniors drug costs. Enhanced use of pharmacoeconomic tenets to select appropriate therapy while considering cost and therapeutic benefits for seniors and others will become even more crucial for clinicians in the future. 

Total estimated direct and indirect costs for managing both chronic and acute HF in the United States for 2005 was approximately 27.9 billion. Medications account for approximately 10% of that cost.3 Heart failure is the most common hospital discharge diagnosis for Medicare patients and is the most costly diagnosis in this population. 

The patient has Medicare, but due to her fixed income, has difficulty paying for medications, leading to occasional periods of non-compliance. 

FIGURE 32-1. Projected increases in the population of patients with Alzheimer s disease, Medicare nursing home spending, and total Medicare spending. (Based on data from references 4 and 5.)... 

The Centers for Medicare and Medicaid Services has incorporated pneumococcal and influenza immunization rates into some of their quality standards. Patients admitted to a hospital for community-acquired pneumonia should be screened for, offered, and vaccinated with pneumococcal and influenza vaccines prior to discharge if not previously administered. In physicians office practice, all persons over 65 years of age who have been hospitalized in the past year should be screened for, offered, and vaccinated with pneumococcal and influenza vaccines if not previously administered. Both of these standards will affect payment if the standard is not met. The Joint Commission on Accreditation of Healthcare Organizations has also incorporated these standards into their accreditation reviews of health care facilities. 

HMO-PPO/Medicare-Medicaid Digest. Kansas City, MO Hoechst Marion Roussel, 1999. 

KN Lohr, ed. Institute of Medicine, Medicare A Strategy for Quality Assurance. Vol. 1. National Academy Press, 1990. 

Lillars, L.A. et al. (1999), Insurance coverage for prescription drugs effects on use and expenditures in the Medicare population , Medical Care, 37, 926-36. 

Centers for Medicare and Medicaid Services Guidelines for Monitoring Medication Use... 

From Center for Medicaid and Medicare Services Unnecessary Medication Use (Tag B29) 2007, http //mM.cms.hhs.gov/... 

A few studies have examined the impacts of Medicaid and non-Medicaid copayments on drug utilization and health care costs. In a 1993 study, Reeder et al. noted an 11% decrease in prescription use after South Carolina established a 50-cent per prescription copayment. This increase was significantly greater than in Tennessee, a comparison state with no copayments (Reeder et al., 1993). Another study using survey data from the 1992 Medicare Beneficiary Survey found that elderly and disabled Medicaid beneficiaries who live in states with prescription drug copayments have lower prescription drug utilization than their counterparts in states without copayment, and three-fourths of the difference was directly attributed to copayment policies. The study predicted that Medicaid copayments... 

Lohr, K., et al., "Use of Medical Care in the Rand Health Insurance Experiment Diagnosis and Service Specific Analyses in a Randomized Control Fill," Medicare, 24, S729-S801 (1986). 

D15. Do you currently have any type of health insurance coverage, including Medicare or Medicaid (DO NOT READ LIST) ... 

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