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Touchstone Health - Breaking Health and Medicare News

CMS Progresses Toward Goal to Slash Medicare FFS Error Rate in Half by 2012

Progressing toward its goal to cut the Medicare Fee-for-Service error rate from 12.4% to 6.2% by 2012, CMS witnessed a 1.9% drop in error rate from FY 2009 to FY 2010, according to Deborah Taylor, CFO and Director of CMS' Office of Financial Management.  Taylor announced these results as part of a testimony on March 17, 2011 with HHS Inspector General Daniel R. Levinson before the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies.

Reporting that only 2% of improper payments were due to fraud, Mr. Levinson stated, "Insufficient documentation, miscoded claims and medically unnecessary services and supplies accounted for 98 percent of the improper payments."

The offices of Ms. Taylor and Mr. Levinson are collaborating on developing new ways to detect and stop payment on claims errors, such as improving controls, educating providers and clarifying guidance.

By Jaimie Oh
Becker's Hospital Review - March 21, 2011
Click here for the full article

'Nearly 4 million Medicare beneficiaries receive help with prescription drug cost under Affordable Care Act'

The U.S. Department of Health and Human Services (HHS) announced this week that nearly 4 million people with Medicare who reached the program’s Part D coverage gap in 2010 have received a one-time, tax-free $250 rebate check.  A similiar number is expected to enter the coverage gap in 2011.

Additionally, nearly 48,000 Medicare beneficiaries have already benefited from the the new 50% discount on covered brand-name drugs, saving them $38 million.

HHS Secretary Kathleen Sebelius states, “For too long, many seniors and people with disabilities have struggled to choose between paying for needed prescription medication and other necessities, like food, rent and utilities.  The Affordable Care Act is delivering more affordable prescription drugs to seniors and giving everyone on Medicare better benefits.”

New York ranks among the top five states with the highest number of people receiving rebate checks.

By the U.S. Department of Health and Human Services
March 22, 2011
Click here for the entire press release

'Medicare Part D: A Health Care Success Story'

This article reports on the success of Medicare Part D, the Medicare prescription drug program.  A recent survey showed that 85% of enrollees are satisfied with their coverage.

In addition, the Medicare Part D program is saving money while costing less than earlier anticipated.  A recent report from the Medicare Trustees anticipates that future Part D spending will be below previous projections.  According to the report, total Part D costs have declined by 41% ($261 billion).  Moreover, the average monthly beneficiary premium for Part D coverage is $30 this year, far below the $53 originally forecast and an increase of only $1 over last year’s average premium.

Don Berwick, administrator of the government’s Centers for Medicare & Medicaid Services, states “These very modest increases in premiums, along with the new discounts...are going to make medications more affordable to Medicare beneficiaries.”

By NAPSI - March 16, 2011
Click here for the entire article

Report Shows More Than 150,000 Medicare Part B Beneficiaries Received Annual Wellness Visits

The Deparment of Health and Human Services released a report this week which annouced that in less than two months, more than 150,000 seniors and others with Medicare have received an annual wellness visit.  These annual wellness visits are now covered by Medicare free of charge through the Affordable Care Act.

The report goes on to state that the annual wellness visits will lower costs, such as Medigap premiums for employers, states and people with Medicare.  More Medicare beneficiaries are expected to get their annual wellness visits and other recommended preventive services.

Secretary Sebelius is quoted as stating “The Affordable Care Act is bringing new preventive benefits and savings to millions of Medicare beneficiaries this year.  Seniors and others with Medicare are already taking advantage of these important preventive services and wellness visits, which can help lower costs, prevent illness, and save lives.”

By the US Department of Health and Human Services
March 16, 2011
Click here for the entire press release

'New GAO Report Highlights Importance of Health Care Reform Law's Medicare Drug Savings for Seniors'

A new GAO report released this week shows that prescription drugs costs were increasing at too high a rate in 2010. 'GAO found that between 2006 and 2010, prices for commonly used brand-name drugs increased at an annual rate of 8.3%.'

The health care reform law (Affordable Care Act) should help with drug costs to Seniors.

The article furthur illustrates the importance of closing the Medicare donuthole for prescription drugs. Read the complete article at the link below to see other aspects of the GAO report from the committee of house representatives.

By: Federal Information & News Dispatch, Inc
Insurance News Net - March 14, 2011

Click here for full article

White House Appeals Florida Judge's Ruling on Health Care Law

Earlier this week, the Justice Department filed notice to appeal Judge Roger Vinson's January ruling that the health care law was unconstitutional.  Through this appeal, Judge Vinson's order was prevented from taking effect, at least for now.

According to the article, the 11th Circuit Court of Appeals could hear arguments in late summer or early fall. 

Twenty-six other states look to block the law under the grounds that it is unconstitutional. 

By Jennifer Haberkorn - March 8, 2011
Click here for the full article

'From California To The New York Island, A New Understanding Of Higher Medicare Spending'

Many suspect that New York City or California would have high or higher then average Medicare spending costs, the dollars spent on procedures at doctor offices and hospitals.  However after a recent study conducted by the Center for Medicare and Medicaid Services (CMS) has shown that suspected areas including New York City actually have lower then national average spending on Medicare costs.  The state with the highest spending is Maryland. 

Many factors come into play when determining costs in different geographical regions such as population, condition or health of patients in the area and number of providers and hospitals.  The CMS analysis of these findings could have an effect on ongoing debates regarding Medicare payments reward programs. 

To see the difference among states and regions read the article from Kaiser Health News that details the report as well as local New York spending numbers.

By: Jordan Rau
Kaiser Health News - March 8, 2011

Click here for full article

NQF Endorses 21 Measures for Nursing Homes

The National Quality Forum (NQF) issued a press release last week around the endorsement of a new set of 21 measures for use in CMS's Nursing Home Compare, an online tool which compares the care of 17,000 nursing homes nationwide.  These new measures will replace the 17 measures that were previously endorsed in 2004.

“Choosing where to go for long- or short-term care in a nursing home is an incredibly important decision,” said Janet Corrigan, NQF president and CEO. “Patients and their families need reliable information on the quality of care being provided in skilled nursing facilities so they can make informed decisions about the place they will receive care on a daily basis. The quality data derived from these measures will provide important information about infection rates, patient care experiences, and the general health of residents in nursing homes across the country.”

The newly issued 21 endorsed measures are the following:

  1. Physical therapy or nursing rehabilitation/restorative care for long-stay patients with new balance problem (RAND)
  2. Percent of residents experiencing one or more falls with major injury (long stay) (CMS)
  3. The percentage of residents on a scheduled pain medication regimen on admission who report a decrease in pain intensity or frequency (short stay) (CMS)
  4. Percent of residents who self-report moderate to severe pain (short stay) (CMS)
  5. Percent of residents who self-report moderate to severe pain (long stay) (CMS)
  6. Percent of residents with pressure ulcers that are new or worsened (short stay) (CMS)
  7. Percent of high-risk residents with pressure ulcers (long stay) (CMS)
  8. Percent of residents assessed and appropriately given the seasonal influenza vaccine during the flu season (short stay) (CMS)
  9. Percent of residents assessed and appropriately given the seasonal influenza vaccine (long stay) (CMS)
  10. Percent of residents assessed and appropriately given the pneumococcal vaccine (short stay) (CMS)
  11. Percent of residents assessed and appropriately given the pneumococcal vaccine (long stay) (CMS)
  12. Percent of residents with a urinary tract infection (long stay) (CMS)
  13. Percent of low-risk residents who lose control of their bowels or bladder (long stay) (CMS)
  14. Percent of residents who have/had a catheter inserted and left in their bladder (long stay) (CMS)
  15. Percent of residents who were physically restrained (long stay) (CMS)
  16. Percent of residents whose need for help with activities of daily living has increased (long stay) (CMS)
  17. Percent of residents who lose too much weight (long stay) (CMS)
  18. Percent of residents who have depressive symptoms (long stay) (CMS)
  19. Consumer Assessment of Health Providers and Systems (CAHPS®) Nursing Home Survey: Discharged Resident Instrument (ARHQ)
  20. Consumer Assessment of Health Providers and Systems (CAHPS®) Nursing Home Survey: Long-Stay Resident Instrument (ARHQ)
  21. Consumer Assessment of Health Providers and Systems (CAHPS®) Nursing Home Survey: Family Member Instrument (ARHQ)


By the National Quality Forum
Issued March 3, 2011
Click here for the press release

Tax Tips for Medicare Beneficiaries

Taxes are due next month! The Wall Street Journal's MarketWatch website shared tips for filing your tax return, which included tips specifically geared towards Medicare recipients.

You can only claim a Schedule A itemized deduction for unreimbursed medical expenses to the extent they exceed 7.5% of your adjusted gross income.  This should not be a problem if you remember to include the following:

  • Premiums for Medicare Part B coverage, which for 2010 ranged from $1,157 to $4,243 per covered person -- depending on your income level.
  • Premiums for Medicare Part C coverage (Medicare Advantage HMO-type coverage).
  • Premiums for Medicare Part D coverage (prescription drugs).
  • Premiums for Medicare supplemental insurance (Medigap coverage).
  • Premiums for qualified long-term care insurance, subject to the 2010 age-based limits per covered person.

By Bill Bischoff - March 2, 2011
Click here for the full article

The Emerging Senior Cyber Culture

Access to modern technology and the Internet is opening a new world of learning and resources for older generations. The number of senior citizens embracing high-tech solutions is on the rise, bridging the gap between young and old.

A greater number of seniors use new technology as it becomes more affordable and accessible. In the last decade, computer usage has doubled and online activity has tripled among Americans ages 65 and up. As older adults discover additional benefits, they spend more time in cyberspace.

The 2010 Generations report by the Pew Research Center’s Internet & American Life Project explored how different generations utilize the Internet. The study demonstrated a significant increase in the number of active online seniors compared to last year’s findings, showing that 58% of seniors ages 65-73 (the Silent Generation) and 30% of those ages 74 and older (the G.I. Generation) used the Internet.

Becoming computer savvy promotes additional health benefits and incentives for seniors. The report showed that seniors who become adept computer users show a greater association with the world around them. Study findings concluded that computer use by seniors can improve their overall mental health. Fewer symptoms of depression were reported than their counterparts who aren’t technologically connected.

Moreover, the online behavior of older generations is gradually mirroring the behavior of younger generations. Their online daily activity revolves around checking e-mail, accessing news and health information, researching products and services, making purchases, watching videos, playing games and social networking. Seniors can use the Internet to reunite with people from their past and can even connect with long-distance family members and friends.

A member of Touchstone Health’s Facebook Page told us that her aunt and uncle in Florida – both in their 80s – follow the adventures of their world-traveler granddaughter on Facebook. They also use Skype to stay part of their great-grandchildren’s lives as they grow up in New Jersey. “I remember the first time I spoke to my 89-year-old aunt on Skype,” she recalled. “She told me she never imagined technology like this being so easily accessible.”

Despite the rise in seniors adopting new technology, some remain intimidated by computers. To address this concern, Touchstone Health community representatives offer computer education classes in an effort to modernize seniors’ lives and educate them about new technologies. These classes encompass basic computer training and an introduction to the Internet and are available at various senior centers throughout New York City.

Y0064_H3327_THPSMK_2060 Approved
Touchstone Health HMO, Inc. is a Medicare-approved Health Maintenance Organization with a Medicare Advantage Prescription Drug contract with the federal government and a contract with the New York State Medicaid program. The plan is available to anyone enrolled in Part A and Part B through age or disability and who continues to pay their Medicare Part B premium. Copayment, service area, and benefit limitations apply. Members must use contracted providers to receive plan benefits, except in an emergency, urgent care, and for out-of-area dialysis. The Touchstone Health Medicare Advantage and Prescription Drug plans are Total, Prestige, Power, Clear and Freedom. Enrollment in Touchstone Health depends on contract renewal.