Archive for July 2011
The Value of Preventative Care
The Centers for Medicare and Medicaid (www.cms.gov/medicare) recently reported that some of the cost of Medicare’s Part D prescription coverage has been offset by fewer emergency room visits and hospital stays. In other words, enabling Seniors to get drugs to manage chronic conditions such as hypertension, heart disease and diabetes reduces the need for visits to the hospital to treat those conditions.
Also this week, AARP reports that persons over 65 who regularly see a primary care doctor live longer, healthier lives. Their regular communication with a medical professional who understands their overall medical condition and is able to treat symptoms before they turn serious contributes to both a higher quality of life and cost savings for the health care system. See http://www.aarp.org/health/doctors-hospitals/info-07-2011/primary-care-linked-to-longevity-health-discovery.html.
My March 7, 2011 blog post described Medicare’s new Wellness benefit, which covers the cost of an annual wellness physical and some diagnostic tests, with no deductible or co-pay. It is good news for Seniors that policy makers are finally recognizing that preventative care and management of chronic conditions is not only good for patients but manages cost for the entire system. It is up to us to utilize all of these benefits to maintain good health and quality of life.
Will Congress Repeal the CLASS Act?
Every time over the past 6 weeks that I have read that Congress and the President are close to agreement on legislation that will reduce the federal budget as a condition for raising the debt ceiling, 12 hours later, I read that it has fallen apart. Since, like all of us, I have plenty on my plate, I resolved not to read any more articles until a deal was finalized. After all, what’s the point of trying to understand a plan that isn’t going to be implemented anyway?
I broke that resolution this morning when I read the Executive Summary of the plan developed by “The Gang of Six.” Their plan, which includes both cost cutting and revenue increases, is fairly general at this point, which is why the specific recommendation to “repeal the CLASS Act” jumped out at me.
As I described in this blog back in March, the CLASS Act is designed to establish a national system of long term care insurance. It would allow employees to use a voluntary, government-sponsored insurance program to pay premiums through payroll deduction, and then receive a cash benefit when they can’t perform at least two of their activities of daily living, whether due to old age or a disability caused by disease or accident that could occur at any age. It isn’t designed to cover the full cost (so would never replace the benefits of private long term care insurance for those who qualify, and can afford it), but it would offset some of a family’s burden for long long term care.
Many details of the program have yet to be completed, and lots of smart people have expressed concern that the program won’t work, because only those who have a condition that makes them uninsurable in the private market will participate. Since the program is designed to be cost-neutral, this may make the premiums unaffordable for the very people for whom the Act was intended. Precisely because of these concerns, the Act requires the collection of premiums for 5 years before anything is paid out. In addition to that requirement, the Congressional Budget Office has estimated that the Act, when fully implemented, will save the government money by preventing, or at least delaying, the need for some individuals to turn to Medicaid to cover the cost of this care.
I try hard not to be cynical, but something seems odd about the inclusion of a specific directive to repeal this one law in a 5 page summary of sweeping economic reform. If this alarms you, too, you might want to check out the website of an organization called AdvanceClass, at http://www.advanceclass.org/, which is an advocacy group dedicated to the implementation of the CLASS Act and other initiatives to make long term care affordable.
Medicare and Hospice
As a proponent of hospice philosophy and care — comfort and dignity at end of life — it was concerning to read the article, “Hospice and Its Costs,” http:/newoldage.blogs.nytimes.com/2011/06/27. According to the article, hospice costs have risen dramatically over the last 10 years. In these tough economic times, and with Medicare in the spotlight, it would be easy to see the benefit eventually being scaled back. This could hurt the people who really need it. It’s one program that Medicare has done well and can have a tremendous impact on the physical and emotional well being of the terminally ill and their families. For one thing, hospice brings medical care providers to the patient where they can be tended to in their own environment and in the comfort of their own home. Perhaps there has been abuse of the Medicare benefit by some organizations. Perhaps patients are at times accepted into hospice too early with diagnoses such as dementia where it’s difficult to determine when they might die. The new requirement of “face-to-face” visits by physicians or nurse practitioners before a patient can be recertified to remain on hospice may be one way to identify those who should be discharged from the program and thereby bring Medicare costs down. But for those who truly have a limited life expectancy, hospice is an invaluable and needed service, especially for our elderly population and their families.
