Bundled payments, DMEPOS, regulatory reform, and ESRD

By Jonathan Blum, Acting Principal Deputy Administrator and Director, Center for Medicare 

In the past few days, the Centers for Medicare and Medicaid (CMS) announced four critical initiatives that are designed to enhance health care delivery for millions of Medicare beneficiaries by improving care or lowering costs, or both.  Taken together the announcements illustrate the breadth and diversity of efforts underway to ensure a better, stronger, more patient-centered Medicare program.

Last week, we announced a new health care delivery system reform, made possible by the Affordable Care Act, to test how bundling of payments for episodes of care, for example a heart attack or stroke, instead of paying for each test or procedure or physician’s visit, can result in more coordinated, higher quality care for beneficiaries.  By bundling payments for services that beneficiaries receive during an episode of care, CMS hopes to encourage doctors, hospitals, and others  to work together to improve care and health outcomes, while also lowering Medicare costs.  Over 500 organizations, nationwide, have already signed-on to participate.

We also announced a major expansion of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.  In its first year of operation, competitive bidding, where prices are based on suppliers’ bids, saved the Medicare program, and taxpayers, over $202 million, while maintaining access to quality products for Medicare beneficiaries in the nine areas of the country where the program launched.   It’s a great example of the Administration’s determination to put the brakes on runaway healthcare costs.  With this expansion in the program, Medicare beneficiaries in 91 major metropolitan areas will save an average of 45 percent on certain DMEPOS items beginning in July.  Between 2013 and 2022, we estimate that the expansion of the DMEPOS program will save Medicare $25.7 billion, while saving beneficiaries, who pay a percentage for medical equipment and supplies, $17.1 billion through lower prices.

This week, we issued a proposed rule which will help health care providers and hospitals to operate more efficiently by getting rid of regulations that are outdated, obsolete, or excessively burdensome.  Many of the rule’s provisions streamline requirements that health care providers must meet in order to participate in the Medicare and Medicaid programs, without jeopardizing patient safety, and they will save providers nearly $676 million annually.  Just as important, by eliminating burdensome requirements, health care providers can improve the quality of health care delivery for Medicare beneficiaries by spending more time focusing on patient care and less time filling out forms.

Finally this week, we announced the Comprehensive End-Stage Renal Disease (ESRD) Care Initiative.  It will help identify, test and evaluate new ways to improve care for Medicare beneficiaries living with ESRD.  We’ll be working with the health care provider community to care for a population that significant and complex health care needs.  Through better care coordination, beneficiaries can more easily navigate the multiple providers involved in their care, ultimately improving their health outcomes.

These four initiatives demonstrate that CMS is employing new and novel tools and programs, thinking outside the box and beyond the usual way of doing things, in order to improve health care delivery for people with Medicare and, in the process, strengthen the Medicare program for current and future beneficiaries.

Making a Heart Healthy Resolution

Richard Gilfillan, Director, CMS Center for Medicare and Medicaid Innovation

It’s the New Year, which means it’s time for those annual resolutions, whether it’s eating right or tackling a new skill.  But none may be more important than making the resolution to get heart healthy in 2013.

Did you know heart attacks and strokes are the first and fourth leading cause of death in the U.S.? The Million Hearts™ initiative, launched in 2012, is aiming to prevent 1 million heart attacks and strokes by 2017. CMS and the Centers for Disease Control and Prevention are working with other federal agencies, communities, health systems, non-profit organizations and private-sector partners to help educate Americans on how to make a long-lasting impact against cardiovascular disease.

If you’re at risk for, or are already suffering from, heart disease, now’s the time to practice the “Million Hearts ABCS”:

• Aspirin for people at risk
• Blood pressure control
• Cholesterol management and
• Smoking cessation

Medicare can help you take control of many of the major risk factors for heart disease. People with Medicare can get cardiovascular screenings, counseling to stop smoking, and blood pressure and weight checks during their yearly wellness visit with their doctor.

Make a New Year’s resolution and give your loved ones one more gift they’ll be sure to treasure—a healthier you in 2013. Help prevent a heart attack or stroke by joining the Million Hearts™ initiative.

Protect yourself – Get screened for cervical cancer

Cervical cancer and human papilloma virus (HPV) affect thousands of women each year. Regular screening tests like pap tests and pelvic exams can help find cancer and other health problems early and improve recovery and survival rates. Talk to your doctor about scheduling your next test!

Find out more about Medicare’s pap test and pelvic exam coverage.

For more information about HPV, check out the American Cancer Society’s HPV Frequently Asked Questions.

To learn more about Cervical Cancer, go to the American Cancer Society’s Web site for Cervical Cancer Information.

At risk for glaucoma? Find out before it’s too late

At risk for glaucoma? Find out before it’s too late

Do you have diabetes, a family history of glaucoma, or are you African American and age 50 or older? If so, your risk of getting glaucoma may be higher. With the start of a new year, it’s the perfect time to schedule a regular eye exam to check for glaucoma. You can prevent vision loss by finding and treating problems early.

Find out more about Medicare’s glaucoma screening coverage.

Medicare is ready to help you quit smoking

Every year, more people die from lung cancer than any other type of cancer and smoking is the leading cause. Don’t become a statistic – Medicare is ready to help you quit smoking. Talk to your doctor today and cross one thing off your list.

Besides being famous for Thanksgiving, November is also Lung Cancer Awareness Month. While you’re making lists for the upcoming holiday season, make a note to talk with your doctor about quitting if you smoke. Medicare covers 8 face-to-face smoking cessation counseling sessions during a 12-month period. If you haven’t been diagnosed with an illness caused or complicated by tobacco use, you pay nothing for these counseling sessions, as long as you get them from a qualified doctor or another Medicare provider.

Get smart: know when antibiotics work

By: Patrick Conway, M.D., Director and Chief Medical Officer, CMS Center for Clinical Standards and Quality

As we enter flu season, you may seek fast relief when illness strikes, but think twice before asking your doctor for antibiotics. Did you know that if you have a cold or flu, antibiotics won’t work for you? That’s because antibiotics cure bacterial infections, not viral infections. Every time someone takes antibiotics, sensitive bacteria are killed, but resistant germs may survive to grow and multiply.

Antibiotic resistance, caused by overuse and misuse of antibiotics, is one of the world’s most pressing public health problems. These drug-resistant bacteria—which were once easily treatable—can now cause significant harm and suffering. When antibiotics fail to work, we get longer-lasting illnesses, need more doctor visits or extended hospital stays, and more expensive medications.

If you or a loved one lives in a nursing home, pay close attention to when antibiotics are prescribed. Roughly  2 out of 3 nursing home residents get at least one course of antibiotics each year, yet nearly 27,000 residents end up with antibiotic-resistant infections each year. These infections are often severe, difficult to treat, and lead to more hospitalizations and deaths among people over 65.  If you have questions, please ask your health care provider.

The CDC has marked November 12—18 as Get Smart About Antibiotics Week. You can take several steps to make certain you’re using antibiotics properly:

• Take antibiotics only to treat a true bacterial infection. It should be for only as long as your doctor prescribed to treat the infection, to reduce your risk of getting the infection again, or to reduce the risk to those around you.
• Always talk to your doctor before taking an antibiotic to be sure it will treat the infection you have.
• Never take antibiotics for a viral infection, such as a cold, cough, or the flu. Antibiotics won’t cure your virus, they won’t keep those around you from getting the illness, and they won’t help you feel better. In fact, taking antibiotics when you have a virus may do you more harm than good, because you increase your risk of getting an antibiotic-resistant infection later.
• Not sure if you have a virus, which can’t be treated by antibiotics? Get smart—read this chart!

Antibiotics won’t help you recover from the flu, but keep yourself from catching the major flu viruses in the first place by getting your flu shot! It’s free for people with Medicare, once per flu season in the fall or winter, when given by doctors or other health care providers (such as senior centers and pharmacies) that take Medicare.

Medicare resources for your loved ones

More than 66 million Americans care for loved ones who have a chronic illness, disability, or frailties that come naturally with old age. Nobody is in a better position than family caregivers to help loved ones manage their health and health care, like medicines, treatments, diets, and exercise. Only you know what’s most important to you and your loved ones – that’s why we want to be sure you have all the information you need to make the best decisions.

During Open Enrollment – which ends on December 7th – it’s worth your time to review and compare your loved one’s coverage choices. Only you can decide what mix of benefits and costs will work best with your loved one’s needs and budget. Now is the time to look at all of the health and drug plan options in your area. If you still need help comparing plans, call 1‑800‑MEDICARE. 

Looking for more information and support? Our caregiver resources have tip sheets, videos, and practical information for caregivers, including tips on what Medicare covers, planning for the future, and taking care of yourself. You can also sign up for our caregiver e-newsletter, so you’re always informed about Medicare issues that affect you and your loved one. We know you’re juggling a lot, so we put it all in one place to save you time.

For even more information, check out the Administration on Aging’s Eldercare Locator and the National Family Caregivers Association.

Keep your loved ones healthy – take them to the doctor

Who doesn’t want another reason to celebrate? This year add a new holiday to your family’s calendar – Take Your Loved One to the Doctor Day on September 20^th. After all, what’s a better reason to celebrate than the good health of the people you love?

The best way to stay healthy is to live a healthy lifestyle. Your loved one can live a healthy lifestyle and prevent disease by exercising, eating well, keeping a healthy weight, not smoking, and taking advantage of Medicare’s preventive services.

Preventive services can find health problems early, when treatment works best, and can keep your loved one from getting certain diseases. The first “Welcome to Medicare” preventive visit and yearly “Wellness” visit are a key part of a healthy lifestyle. 

Schedule a doctor’s appointment today, and as long as the doctor accepts assignment there’s no cost. Now that’s something to celebrate! 

“Medicare & You” goes paperless

Love your red, white, and blue “Medicare & You” handbook? Did you ever think it would be nice to get the same information online? Knowing that the number of people 65 and over using the web has tripled in the past 10 years, we thought it would be a good idea too. And, now we’ve got some great news!

As part of the new Medicare.gov, you can go on the web and access all the same information found in your printed handbook. You can learn what’s new for the year, how Medicare works with your other insurance, get Medicare costs, and find out what Medicare covers. Even better, the handbook information on the web is updated regularly, so you can instantly find the most up-to-date Medicare information.

You can also do a lot of things on your own like replace your Medicare card, change your address, sign up or make changes to your Medicare coverage, and find out important date. All this in time for October 15 – the start of open enrollment.

Take advantage of some other great features to get just want you need:

• Search quickly for what you want and print only the pages you need, while getting the latest, up-to-date official Medicare information, including the most recent list of available plans
• Get “Medicare & You” in different formats like large print, eBook or audio
• Subscribe to get an e-mail when information is updated
• Access personalized information

And, if you’d like to trade in your printed copy for a paperless version, we’ve got you covered. You can choose to get your next “Medicare & You” handbook electronically by using the “go paperless” option. In a few simple steps, you’ll be all set. Sign up today and we’ll send you an e-mail including a link to the new online Medicare & You. It’s instant, current, and convenient.

Get yearly prostate cancer screenings

 Did you know prostate cancer is the most common cancer in American men?

Help prevent prostate cancer from affecting you or the men in your life. If you’re a man who’s 50 or older, make sure you get screened for prostate cancer every 12 months.

Your Medicare Part B (Medical Insurance) covers 2 tests to help find prostate cancer early, when treatment works best:

• Digital rectal exam—You pay 20% of the Medicare-approved amount after the yearly Part B deductible.
• Prostate Specific Antigen (PSA) test—Free to all men with Medicare 50 and older (coverage for this test begins the day after your 50th birthday).

Also, whether you’re seeking coverage information on prostate cancer screenings or another item, service or test, quickly find what’s covered by visiting our newly redesigned website.

Learn more about prostate cancer by visiting the American Cancer Society, the National Cancer Institute, and the Centers for Disease Control and Prevention.

Early detection matters: get screened every 12 months.