States Cut Medicaid Drug Benefits To Save Money

Illinois Medicaid recipients have been limited to four prescription drugs as the state becomes the latest to cap how many medicines it will cover in the state-federal health insurance program for the poor.

Doctors fear the state’s Continue reading

What is Iatrogeny?

Virtually every medicine can have side effects, and with so many being used by so many older adults, the potential for harm is high. Patients need to know that just because lots of medicines don’t require prescriptions doesn’t mean they’re harmless. Aspirin is a classic example. When you combine all the different forms of aspirins we are talking about over 15,000 deaths a year in the United States alone.

It is not ethical to try to study such combinations and effects for all such studies involve poisoning the subjects studied with multiple poisons. It is no longer appropriate to consider drugs or nutritional medical agents in isolation because the needs of patients are many meaning  Continue reading

Despite Rise in Patients, Emergency Rooms are Closing

More Americans are seeking care in hospital emergency rooms. Yet, almost a third of urban and suburban emergency departments have closed over the past two decades.

The number of ERs in non-rural areas in the U.S. fell 27 percent between 1990 and 2009, according to a study published last week in the Journal of the American Medical Association. That’s an average of 89 closures per year.

Illinois has lost 23 non-psychiatric hospitals — and their emergency rooms — since 1990, with the most recent closure being that of Michael Reese Hospital in 2009, according to the Illinois Hospital Association.

Illinois hospitals are not allowed  Continue reading

Impact of the New Health Law on the Digital Health Industry

This month’s newsletter is part 2 of a three-part series examining the new healthcare law’s impact on the technology sector. This month, we focus on the health insurer side. In the final Issue, we will look into the medical device industry to analyze its exposure and upside under the new health law.

The Patient Protection and Affordable Care Act (“Affordable Care Act”), passed in the spring of 2010, has some favorable provisions for health insurers. The law, after its full enactment in 2014, will require near universal coverage,  Continue reading

More Medicare, Medicaid Patients Turning to Alternative Therapies.

The use of complementary and alternative medicine (CAM) is increasing in the United States. According to the National Center for Complementary and Alternative Medicine (NCCAM), about 38% of adults in the US used some form of CAM in 2007. Most of those are women with higher levels of education and income, however it appears that more patients on government healthcare plans, such as Medicare and Medicaid, are also using CAM due to frustration with access to standard healthcare.

NCCAM defines CAM as a “group of diverse medical and health care systems, practices, and products that are not generally considered to be part of conventional medicine.” Therapies include acupuncture, biofeedback, chiropractic care, diet and nutrition-based therapies, homeopathic treatment, hypnosis, massage, naturopathy, and exercises such as yoga and tai chi.

Most health insurance plans does not cover CAM, including Medicare and Medicaid, and patients must pay out of pocket. Naturopathic doctors, for example, are not eligible to be Medicare or Medicaid providers and have to charge patients “fee for service.” Even plans that offer coverage usually do so at a higher deductible cost than conventional care. Usually this is a deterrent for patients who have budget restraints.

However, budget cuts have caused a reduction in services for many Medicaid patients and due to low reimbursement rates, many doctors are opting out of the Medicare program. These patients are forced to seek care elsewhere or try other options. For example, a survey by Flexcin International of Fort Myers, Florida, a company that makes an all-natural arthritis supplement, found that in states where significant Medicaid cuts were occurring, patients were increasing their use of their over-the-counter product.

Read: HAP Medicare Advantage Options Include Acupuncture, Chiropractic Care

Chiropractic care is one area of complementary medicine that is gaining coverage under some health plans, including Medicare, although such coverage is usually limited. Plans either put a limit on the number of treatments one can receive or limit the procedures that are covered. Medicare, for example, will only cover manual manipulation for subluxation of the spine.

Acupuncture is another area that is increasingly gaining coverage due to the greater number of solid medical evidence that it is able to treat certain conditions and symptoms. Medicare specifically excludes treatment by acupuncture. Those states that provide coverage under their Medicaid program limit the benefits or require that coverage be provided only for treatments by a licensed physician (MD or DO).

Health insurance rarely covers the costs of other types of CAM therapies, so these become out of pocket expenses. However, some patients view a $10 bottle of nutritional supplements as preferable to a $25 physician co-pay plus the cost of a prescription, particularly when access to supplements is easier than finding a doctor who will accept a government health plan. Unfortunately, alternative medicine (that which is used instead of conventional medicine instead of as a complementary therapy) can, in some cases, be dangerous.

Read: Medicare Out of Pocket Expenses

The National Institutes of Health offer seniors and other Americans information on choosing complementary and alternative therapies wisely. Most important is to be an informed consumer. Learn the facts about CAM therapies, including the potential risks. It is wise to present your primary care physician with a list of all of your health conditions and current medications and speak to him or her about the addition of a CAM therapy. Include a discussion of budget restraints or frustrations with healthcare access to find the group of treatments that is best for you.

Telemedicine Acknowledged by Medicare

American Medical News: Through teleconferencing technology, doctors are able to treat patients who live far away without access to a specialist. “Nationwide, telemedicine increasingly is being used to bridge gaps in access to care in rural and other medically underserved communities that have a hard time recruiting physicians. … The Centers for Medicare & Medicaid Services is making changes to promote telemedicine. In June, the agency proposed new policies that would make it easier for hospital officials to credential physicians who provide telemedicine services at their facilities. And in January 2011, CMS will expand Medicaid coverage for remote services, including disease management training for patients with diabetes or kidney disease” (Krupa, 11/22).

Austin American-Statesman: “Tech executives say Austin is positioned to be a player in health care technology, thanks to its deep pool of business software talent that is comfortable working in a startup environment and has expertise in creating products that save companies money. … So far, a handful of promising venture-backed players have emerged. … All in all, hundreds of computer hardware, software and services companies are competing for a piece of the market, which accelerated in 2009 with the passage of the federal economic stimulus bill, which set aside $19 billion in incentives for health care information technology. By one estimate, the government’s push to spur health care computer spending will help drive global health care IT spending to $106 billion by 2014, up from nearly $89 billion this year (Hawkins, 11/21).

The (Newark, N.J.) Star-Ledger: “Under federal health care reform, doctors must convert to an electronic system capable of chronicling each patient visit, tracking their care and sharing that information with hospitals and other doctors by 2015 — or the federal government will withhold some of the money it reimburses them for treating Medicare and Medicaid patients. … But so far, neither the promise of incentive nor threat of punishment is enticing a large number of New Jersey doctors to make the big switch. Only 20 percent of physicians in New Jersey have incorporated electronic medical records into their daily practice, compared to nearly 30 percent nationally, state Health and Senior Services Commissioner Poonam Alaigh said” (Livio, 11/21).

Medical Programs Missing Millions of Kids

An estimated five million uninsured children in the United States were eligible for Medicaid or the Children’s Health Insurance Program (CHIP) but were not enrolled in either plan, according to a new report.

The study published on Friday in the journal “Health Affairs” recommended policy reforms and broader efforts to get uninsured children into government medical programs, including the use of income tax data for automatic enrollment.

An estimated 7.3 million children were uninsured on an average day in 2008 and 65 percent of them were eligible for Medicaid of CHIP coverage, the report said.

President Barack Obama, who signed landmark healthcare reforms into law in March, has made providing health care to all Americans a top priority of his administration.

Thirty-nine percent (1.8) million of eligible uninsured children live in just three states — California, Texas and Florida, the report by the Washington-based Urban Institute Health Policy Center said. Sixty-one percent (2.9 million) of uninsured children live in 10 states, the report said.

“This new data will help us to focus our efforts and our grant funding where they are most needed,” U.S. Secretary of Health and Human Services Kathleen Sebelius said in a statement. “We now have a much better sense of where most uninsured children live, and which communities may need more help.”

Medicaid is the joint state-federal health plan for the poor, disabled and elderly. CHIP provides low-cost coverage for children in families who earn too much to qualify for Medicaid but cannot afford private health insurance coverage.

“No child should have to skip a doctor’s appointment or go without the medicine they need because their family can’t pay,” Sebelius said, challenging state and local officials to “find and enroll those five million kids.”