Diabetes Programs Reauthorized
The House and Senate voted last month to reauthorize two diabetes programs through the end of fiscal year 2010: the Special Diabetes Program for Indians and the Special Statutory Funding Program for Type 1 Diabetes Research. The programs fund research in diabetes prevention and treatment, including TrialNet, an international clinical research network that receives half its funding from the statutory funding program. The two programs have each been receiving $150 million annually. “We applaud Congress for their vote to extend the Special Diabetes Programs,” R. Stewart Perry, chair of the board of the American Diabetes Association, said in a statement. “We know the value of these programs and the real difference they make in the quality of life for millions of people with diabetes.”
Statin Use Zooming
Americans spent $20 billion on statin medications in 2005, a massive rise from just 5 years earlier, when that tally was about $8 billion, according to the Agency for Healthcare Research and Quality. The 156% increase in spending went toward well-known drugs such as Lipitor, Lescol, Pravachol, and Zocor, the agency reported. In 2000, 16 million people said they had purchased at least one statin. By 2005, almost twice as many (30 million) had purchased a statin. Outpatient prescriptions zoomed from 90 million to 174 million. Each individual who took a statin saw expenditures increase from $484 per year to $661 annually. The AHRQ did not determine how much of that was covered by insurers and how much was out-of-pocket cost to the individual. The AHRQ data are drawn from the Medical Expenditure Panel Survey, which details health services used by civilian, noninstitutionalized Americans.
Crocs OK'd by Medicare
Crocs, the well-known plastic clogs, have become the first molded shoe to be accepted into Medicare's shoe program for diabetes patients. Medicare's stamp of approval means that providers can fit Medicare beneficiaries for the company's Custom Cloud model; the cost of the shoes will be reimbursed by Medicare. The approved shoe comes with three pairs of heat-moldable orthotic insoles. “We are thrilled with the Center for Medicare and Medicaid Services' decision to include CrocsRx footwear in the Medicare program,” said Eddie Scott, director of CrocsRx. “CMS acceptance is an enormous accomplishment.”
Claims by Dead Doctors Paid
In the past 8 years, Medicare has paid more than $76.6 million in durable medical equipment claims that contained the Unique Physician Identification Numbers of dead physicians, according to a congressional subcommittee investigation. The probe, from the Senate Permanent Subcommittee on Investigations, found that from 2000 through 2007, Medicare paid for at least 478,500 claims that contained the UPINs of deceased doctors. Medicare was unable to stop the claims even though the CMS took steps in 2002 to reject claims using invalid or inactive UPINs, the report said. UPINs were replaced this year by National Provider Identifier numbers. The subcommittee recommended that the CMS strengthen procedures to deactivate NPIs after physician death, and initiate regular NPI registry and claim audits.
CMS Issues PQRI Payments
Physicians who successfully reported quality measures to Medicare in 2007 as part of the Physician Quality Reporting Initiative should be receiving their bonus payments this month Officials at the Centers for Medicare and Medicaid Services announced that they had paid out more than $36 million in bonuses to physicians and other health professionals as part of the PQRI. Of the approximately 109,000 health professionals who reported data on Medicare services provided during July 2007-December 2007, more than 56,700 met the reporting requirements and will be receiving bonus checks. The average bonus paid to an individual provider was more than $600, and the average bonus for a group practice was more than $4,700, the CMS said. “These payments to physicians for participating in the PQRI are a first step toward improving how Medicare pays for health care services,” Kerry Weems, acting administrator, said in a statement. Under the PQRI, physicians could earn bonus payments of up to 1.5% of their total allowed Medicare charges by successfully reporting quality data for Medicare services. Also, physicians and other health professionals can now access confidential feedback reports on their performance by registering with the Individuals Authorized Access to CMS Computer Services-Provider Community (IACS-PC). More information on the program is available at