Medicare Risk Reduction Demo
Officials at the Centers for Medicare and Medicaid Services are seeking proposals for a new demonstration project that will test the effectiveness of health promotion programs in the Medicare population. The Medicare Senior Risk Reduction Demonstration will target multiple risk factors for chronic diseases, including physical inactivity, obesity, smoking, depression, high blood pressure, high cholesterol, and high blood sugar. Officials will also look at underuse of Medicare preventive benefits. CMS officials plan to select up to five organizations to participate in a 3-year demonstration project; participants will be announced next spring. Officials plan to invite about 85,000 Medicare fee-for-service beneficiaries to take part. Beneficiaries will complete a risk assessment, receive information on their specific health risk factors, and receive referrals to community resources that can help them to make lifestyle changes. They will have the option of sharing the information with their physicians. “This demonstration can support doctors and other health professionals by providing support in their efforts to help seniors make important changes, such as starting an exercise program and using recommended preventive care,” the agency said in a statement.
DEA Reverses Pain Rx Restrictions
A new proposal from the U.S. Drug Enforcement Administration would allow physicians to issue up to a 90-day supply of schedule II controlled substances in a single visit. The notice of proposed rule making, which was issued in September, is open for public comment until Nov. 6. If finalized, the proposal would reverse the agency's previous position that physicians must write new prescriptions each month. Instead, physicians would be able to issue three monthly prescriptions at once, specifying the fill date for each prescription. The agency also issued a statement aimed at answering physician questions about dispensing pain medications. “Today's policy statement reaffirms that DEA wants doctors to treat pain as is appropriate under accepted medical community standards,” DEA Administrator Karen P. Tandy said in a statement. “Physicians acting in accordance with accepted medical practice should be confident that they will not be criminally charged for prescribing all appropriate pain medications.” The American Academy of Pain Medicine (AAPM) praised the proposal, noting that it could help to eliminate the burden on cancer patients and others with chronic pain who have been forced to visit their physician every month for a new prescription, an AAPM statement said.
Fueling the Rise in Medicare Costs
The rapid growth in spending for Medicare beneficiaries is largely because of the increasing portion of those beneficiaries receiving treatment for five or more conditions in a year, according to a study published in an online edition of Health Affairs. Between 1987 and 2002, the number of beneficiaries who sought care for five or more conditions rose from about 9 million to 19.8 million. In 2002, beneficiaries with five or more conditions accounted for more than 75% of health spending, according to the study. And Medicare beneficiaries with three or more conditions accounted for 92.9% of health care spending in 2002. “One of the biggest challenges we face is that the Medicare system makes it very difficult for physicians to effectively treat people with multiple chronic illnesses,” Kenneth E. Thorpe, the study's lead author and chair of the department of health policy management at Emory University, Atlanta, said in a statement. “Medicare's fee-for-service structure does not reimburse for services critical to medically managing chronic illness—preventative measures, monitoring medication intake and blood sugar.” The researchers received support from the Pharmaceutical Research and Manufacturers of America.
Mammography Access 'Adequate'
The national capacity to provide mammography services is adequate, despite a 6% drop in the number of mammography facilities from 2001 to 2004, according to a recent report from the U.S. Government Accountability Office. In addition to the decrease in the number of facilities, the GAO reported a 4% drop in the number of machines, a 3% drop in the number of radiologic technologists, and a 5% drop in the number of physicians who interpret mammograms. Experts interviewed by the GAO said that the capacity nationwide is likely adequate to meet the current demand for screening and diagnostic mammograms but cautioned that there could be access problems in the future. The report was requested by Sen. Arlen Specter (R-Pa.) and Sen. Barbara Mikulski (D-Md.).
U.S. Cancer Deaths Decreasing
The rate of new cancers was stable from 1992 to 2003, but deaths from malignancies continued to decline, according to the “Annual Report to the Nation on the Status of Cancer” in the Oct. 15 issue of Cancer, published online in September. The cancer incidence for men was stable from 1995 to 2003, but the incidence for women increased from 1979 to 2003. Death rates decreased for 11 of the 15 most common cancers for men and for 10 of the 15 most common cancers for women. Incidence rates for breast cancer stabilized from 2001 to 2003, but it's not clear if that is a true trend, according to the report. Women saw a decrease in new cancers of the colon, uterus, ovaries, stomach, and cervix and an increase in non-Hodgkin's lymphoma, melanoma, leukemia, and lung, bladder, and kidney cancers. Men saw a decrease in colon, stomach, oral, and lung cancers but an increase in prostate, liver, kidney, and esophageal cancers, and in leukemia and myeloma.