Hospital Study: Greater spending linked to higher mortality

An extensive study of Medicare patients in California hospitals found that the more money spent on the care of the patients, the lower the mortality rate, according to Health Leaders Media.

The study, which was limited to patients with six common medical conditions, was published in this month’s Annals of Internal Medicine.

The study found that higher patient survival was linked with higher spending for each of the diagnoses.

Data was analyzed from Medicare patients who suffered from stroke, pneumonia, hip fracture, congestive hearth failure, gastrointestinal hemorrhage and acute myocardial infarction. The scope of the study included spending data from 208 hospitals over 9 years.

According to the study, during 1999 to 2003, for example, patients admitted with acute myocardial infarction to California hospitals in the highest quintile of hospital spending had lower inpatient mortality than did those admitted to hospitals in the lowest. The prediction of inpatient deaths would increase by 1,831 if all patients admitted with acute myocardial infarction were cared for in hospitals in the lowest quintile of spending rather than the highest. 

John Romley, of the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California, is lead author of the study. He says he and his colleagues worked to control factors like patient health status and hospital teaching affiliation.

The study contradicts findings from a previous Dartmouth Atlas of Health Care that spearheaded much of what is being looked at in healthcare reform regulations, that expensive care is not necessarily better care, and may in fact be worse care.

“If the results are real … that would suggest these reductions across the board in hospital spending might lead to worse outcomes for some patients,” Romley told Reuters Health. That doesn’t mean cuts wouldn’t still be cost-effective, if money elsewhere could better improve public health. But, he added, “it is important to understand the trade-offs.”

Do You Know the Difference Between Medigap and Medicare Advantage?

Both “Medigap” and Medicare Advantage plans are often referred to as “supplemental insurance” plans in Medicare articles and literature.  This language is confusing and somewhat misleading. Do you understand the difference?

Nicknamed “Medigap,” it is technically the only real “supplemental insurance”; its formal name is Medicare Supplemental Insurance. Only people enrolled in traditional Medicare can use a supplemental insurance plan.

Medigap is NOT a government run plan. Medigap is private insurance. You can buy it to defray some or most of your out-of-pocket costs. These might include:

• The hospital deductible for Part A, which is currently $1,100 for each hospital benefit period.
• Part B costs such as the percentage you pay for doctor’s visits and outpatient services.
• The costs of emergencies up to plan limits you incur when traveling overseas.
• Other costs as defined by the plan.

There are 10 types of medigap policies, and they are legally standardized, which means that the benefits you get are the same, regardless of who sells them to you.

However, that does not mean you will receive the same price from each insurer so it’s a good idea to check around. To compare the benefits in each Medigap plan, enter your zip code at Medicare Solutions.com to get started.

Medicare Advantage is an umbrella name for a VARIETY of private health plans which include HMOs, PPOs, PFFS (Private Fee For Service plan.)

Medicare Advantage, called “Medicare Part C” is an alternative to the traditional Medicare program. Those who enroll in Medicare Advantage may NOT purchase a Medigap plan or a stand-alone prescription drug plan.

Each Medicare Advantage plan covers all the same benefits as traditional Medicare (called “Part A” and “Part B”), but the plans operate on the copayment system and may offer extra benefits. Sometimes the copayments are lower than traditional Medicare, and sometimes not. Each plan is different.

For example, some plans may include vision and hearing services, and include prescription drug coverage at no additional cost. However, most plans will require you to go to in-network doctors, or to pay high co-pays if you go out of network.

To compare Medicare Advantage plans, go to Medicare Solutions.com and enter your zip code to begin.

The Medicare Payment Advisory Commission wants a copayment to discourage misuse of home health care services.

The congressionally appointed commission voted 13-1 to recommend that lawmakers impose the new charge. Two commissioners abstained and one was absent.

According to the Associated Press, home health services, which are currently covered under Medicare, cost taxpayers approximately $20 billion a year.

The co-pays, commission chairman Glenn Hackbarth said, would help avoid the benefit turning into a “long-term care social support system.”

Concerns with Medicare fraud and a tight budget have motivated the commission to look for cuts. Home health care was originally considered a “cost saver.” Now increasing costs and big differences in how communities around the country use the benefit have given lawmakers reason to make changes.

Exemption from the recommendation would include low-income patients covered by Medicaid, as well as those just discharged from the hospital. According to the AP, more than 30 million beneficiaries in traditional Medicare would be directly subject to the fee.

The recommendation was strongly opposed by AARP lobbyists who support a strong network of home providers to assist the more than 3 million seniors and disabled people on Medicare who are not able to easily leave home.

In September, AARP strongly supported The Home Health Care Planning Improvement Act of 2010, House Bill 4993 and Senate Bill 2814, which was a bi-partisan effort to expand the roles of nurse practitioners and physician assistant to allow them to certify home healthcare plans for Medicare patients.

In rural parts of the country, areas where the nation suffers from shortages of physicians, many Americans see nurse practitioners as their primary care provider.

From bone marrow cancer breakthroughs to drug development to treat blood cancer, medical research finds new ways, daily, to keep sick patients alive longer.

But the American obsession with having “the best health care” is not only costing billions annually—it is often taking the dignity out of a patient’s end days.

The system is broken, according to Richard Meyer, executive director for Online Strategic Solutions. Most patients want to spend their last days at home, but 75 percent either die at a hospital or nursing home. Meyer’s research study, conducted with cancer patients, found that many terminally ill patients “do not want to go through extensive treatments that have horrible side effects if there is no hope of a better quality of life.”

The problem, according to a Dartmouth Medical School’s Dr. Eliot Fisher is supply and demand. Fisher noted in Meyer’s research that hospitals need beds full of paying patients to bill their bills. And Medicare is restricted by law from denying patients the treatments required, based on cost.

“The real problem,” Dr. Fisher notes, “is that many of the patients that are being treated aggressively, if you ask them, they would prefer less aggressive care. They would prefer to be cared for at home. They’d prefer to go to hospice. If they were given a choice. But we don’t adequately give them a choice.”

Meyer notes that patients are too quickly sent from their overloaded GPs to hospitals, where they see a flurry of disconnected specialists who order tests, needed or not.  The result is patients receiving all kinds of costly and often unnecessary treatments for the underlying complications to their disease.

Last year, $55 billion was spent for doctor and hospital bills in the last two months of patients’ lives. Of that amount, research shows that 20 to 30 of the treatments had “no meaningful impact.” 

Dr. John Schumann, an internist with University of Chicago, calls hospitals “factories” and no place for the dying.

 “Hospitals are like giant factories where all the focus is on process: diagnosing, treating, rehabbing, and discharging. Death, while a natural endpoint, is still too frequently viewed as medical failure. Nothing could be further from the truth.”

Schumann argues that the patients and their families need to advocate loudly for the patient’s wishes:  to listen to their desire for how they want to end their life.

“I’d like to empower the folks … especially their family members and loved ones, who will be called on to help with decision making, to take the initiative and die at home. Or in hospice. Or on a mountain top in bright sunshine.”

Medicare Advantage health plan members can disenroll and return to Original Medicare from January 1 to February 14, 2011. This period is called the Medicare Advantage Disenrollment Period (MADP).

Regardless of whether your current Medicare Advantage plan included Part D drug coverage (PDP), you may disenroll during the MADP and will be eligible for a Special Enrollment Period (SEP) to enroll in Part D prescription drug plan. The effective date of a disenrollment request using MADP will be the first of the month following the date of the request. For example, a request made in January would be effective February 1.

Current Medicare Advantage-only (MA) plan members have three options:

1. Disenroll from the MA-only plan and return to Original Medicare
2. Disenroll from the MA-only plan, return to Original Medicare AND use the SEP to enroll in a PDP plan
3. Request enrollment in a PDP, resulting in automatic disenrollment from the MA-only plan

Current Medicare Advantage with Part D prescription drug (MA-PD) plan members have three options:

1. Disenroll from the MA-PD plan and return to Original Medicare
2. Disenroll from the MA-PD plan, return to Original Medicare AND use the SEP to enroll in a PDP plan
3. Request enrollment in a PDP, resulting in automatic disenrollment from the MA-PD plan

Current Medicare Advantage-only Private Fee-For-Service (PFFS) plan members (PFFS plans without Part D prescription drug coverage) have two options:

1. Disenroll from the PFFS plan and return to Original Medicare
2. Disenroll from the PFFS plan, return to Original Medicare AND use the SEP to enroll in a PDP plan

NOTE: PFFS members must first request disenrollment from the plan before requesting enrollment in a PDP.

If you have questions, call the Health Plan One Medicare expert at 1-800-328-7305.

During the annual Medicare Open Enrollment, going on now through December 31, people with Medicare can add, drop, or change their prescription drug coverage. They can also select a health plan for their 2011 coverage.

The Center for Medicare and Medicaid Services offer online comparison tools to help you decide what changes you need to make. The U.S. Government’s Medicare page also offers a “Plan Finder” that allows users to compare policies, research choices, and links to resources on enrollment.

Evaluate the “three Cs,” experts say, when you decide on a plan: cost, coverage and convenience. There are multiple factors such as mail-order services for prescriptions, coverage gaps, copayments, and others to consider as you weigh your options.

The online tools will assist you in estimating of your out-of-pocket costs and reviewing quality and customer service ratings from current plan members.

Since health care and prescription changes to Medicare can be confusing, an organization called State Health Insurance Assistance Program (SHIP) offers one-on-one counseling and assistance to families on Medicare.

11.3 million of the 46 million Medicare beneficiaries are cheering, because President Obama announced premiums for Medicare Advantage plans will be less costly next year. Meanwhile, enrollment next year should go up 5%.

MA plans (or Part C) are run by private insurance carriers but partially paid for by the government. They are more comprehensive plans than traditional Medicare. In additional to inpatient hospital or skilled nursing facility stays, MA plans also have dental and eye care. Medicare plans don’t have these extras, and Medicare recipients either do without these services or pay full price.

This news comes as a surprise because just yesterday, it was announced that premium costs for privately purchased individual and family insurance plans have gone up in the past year, and will likely continue to rise.  The New York Times reports that “…commercial insurance premiums for many people under 65 and many small businesses are increasing 10 percent to 25 percent or more.”

More surprising is the MA Plans will offer some additional benefits to seniors, as required by the Patient Protection and Affordable Care Act. These include an end to a cap on lifetime coverage. Some ‘luxury’ benefits such as discounted gym memberships, are gone.

“Despite the claims of some, Medicare Advantage remains strong and a robust option for millions of seniors who choose to enroll or stay in a participating plan today and in the future,” Donald Berwick, head of the Centers for Medicare and Medicaid Services (CMS), said in a statement. “The Affordable Care Act gave us new authority to negotiate with health plans in a competitive marketplace. As a result, our beneficiaries will save money and maintain their benefits.”

In other words, the government strong-armed private industry to not increase the premiums or cost sharing, even though CMS reimbursements increase was well below the medical trend costs.

The health care reform law gave power to CMS to reject potentially new plans, and also gave them the ability to negotiate with insurance carriers over the benefits of their MA products.  Medicare officials said they rejected 7 plans offered by 3 companies, but most insurers re-jiggered close to 300 plans to be acceptable to the government. The most common rejected proposal included an increase to seniors’ out of pocket expenses that created a profit for the insurance carrier.

This is good for the consumers, short-term, for sure. They get more services for less money. But in the long run, will it last?

WellPoint study concludes Boniva is not effective at preventing osteoporosis

Boniva is a bisphosphonate, among one of the most common treatments for the bone-thinning disease. Bisphosphonates treat osteoporosis by slowing down bone thinning, preventing bones from weakening and deteriorating. Osteoporosis patients who take bisphosphonates will preserve their bone density and avoid bone fractures—so long as the drug is effective.

The WellPoint study considered more than 25,000 of members who are treated by osteoporosis drugs, comparing Boniva, Actonel, and Fosamax.  Although the drugs should provide the same treatment to patients, WellPoint noted key differences between Boniva and the other two drugs. Ultimately, Fosamax and Actonel were more effective than Boniva: Fosamax and Actonel users spent less money on health care and were less likely to fracture their bones than patients on Boniva.   Plus, patients were more likely to continue and comply with treatment on Actonel.

As a result, the health insurance giant decided to restrict Boniva, and kept on the third tier of non preferred drugs on the WellPoint drug formulary. Another health insurance leader, Aetna, has also placed Boniva on its formulary’s third tier, preferring Actonel and the generic drug Fosamax.  Luckily for Boniva, it is still the first tier preferred drug for Cigna ahead of its two competitors.  WellPoint’s Medicare prescription drug plan still lists Boniva as a second tier prescription in the plan formulary.

Like many other health insurance companies, WellPoint hopes to reduce treatment costs by using the most effective medications at the best prices.  The 2010 health care reform provided $1 billion worth of funding to conduct comparative-effectiveness studies, hoping to both improve quality of care and cut health care costs.  If such studies are effective, they could truly slash costs and cut down on unnecessary expenses.

Earlier research linked Boniva use to bone fractures (specifically in the femur) and a higher risk of heart disease, although the Food and Drug Administration later found no correlation between Boniva, heart disease, and bone fractures. WellPoint’s research also did not find a correlation between Boniva and other bisphosphonates and certain femur fractures. Boniva is also linked to heartburn.

Genentech, the company that produces Boniva, claims that Boniva is cost effective.  Contrary to the WellPoint study, the company also states that patients find it very easy to comply with Boniva doses.

Ultimately, the most important point of the WellPoint study is the growing need to use cost-effective prescription drugs. As health care costs rise in the United States, comparative-effectiveness research will grow ever more important.  With widespread health care reform around the corner, comparative-effectiveness studies could be key to making health care affordable for all.

CIGNA will still accept clients enrolling during their individual election period (those aging in to Medicare or newly eligible to Medicare) and those with a Special Enrollment Period. Current clients who have CIGNA Medicare Access PFFS will not see a change in their 2010 benefits. They will continue to have coverage for the entire year. There will be no changes in benefits due to this decision.

Please note this does not effect plans such as CIGNA Medicare Rx, CIGNA Medicare Select Plus Rx, or any of CIGNA’s other medical or pharmacy plans.

At the urging of Senate Finance chairman Max Baucus who describes Humana’s letters as “mislead[ing] seniors regarding the subject,” CMS ordered Humana to stop sending out such letters. Both Baucus and CMS have put a warning to Humana and any other insurer that might get mixed up in health care reform politics, Baucus stating “it is wholly unacceptable for insurance companies to mislead seniors,” but, as the Wall Street Journal points out, “Humana merely made the mistake of trying to tell seniors the truth about what will happen to their coverage.”

CMS does not currently have a model for how insurance companies should respond to health care politics but, clearly, attempting to inform your current customers is not allowed. It should be noted that Humana has been extremely supportive of health care reform, save these changes to Medicare Advantage, despite all the fingers pointed at the insurance companies and their growing reputation as the “bad guys.” Finally, Humana attempts to defend itself through these letters, pointing out that if benefits were to be cut, it is not a consequence of Humana’s actions, but of the government. But Humana gets slammed.

Rather than arguing over words, Senator Baucus should set reimbursement levels for Humana and other managed care providers, so that they perform the way they were intended to! Save the government and taxpayers money, while offering high quality health plans. Humana should stop the clumsy PR campaign and defend their program with how they help taxpayers and beneficiaries—not simply scaring their members—be their claims true or not.