Uninsured Get Inefficient Care
The uninsured not only face a “downward spiral” in health, they also experience inefficiencies in care, a report from the Commonwealth Fund found. Uninsured persons are more likely to go without the care or screening tests that could prevent serious health problems, are less likely to have a regular doctor (41% vs. 86% of insured adults), and are more likely to face fragmented care. “Nearly one-quarter (23%) of adults who are currently uninsured or had a time uninsured reported that test results of records were not available at the time of a doctor's appointment, compared with 15% of insured adults. Nearly one-fifth (19%) of uninsured adults had duplicate tests ordered, compared with 10% of insured adults,” the study said. Researchers found that an “alarmingly high proportion (59%) of adults” with chronic illnesses such as diabetes and asthma who were uninsured for a time in the past year went without their medications because they couldn't afford them. The findings are from the Commonwealth Fund Biennial Health Insurance Survey, a nationally representative sample of 4,350 U.S. adults aged 19 years and older, conducted via phone August 2005-January 2006. This analysis focuses on the population aged 19–64.
Glaucoma Screening
Hispanic Americans aged 65 years and older are now eligible for glaucoma screening under Medicare. Medicare will pay for glaucoma screening exams provided by (or under the direct supervision of) an ophthalmologist or optometrist who is legally authorized to perform the services under state law. At least 11 months must have passed since the last covered screening. In 2002, Medicare began covering glaucoma screening for patients with diabetes, those with family history of glaucoma, and for African American beneficiaries aged 50 years and older—all of whom are considered to be at high risk for the disease.
FDA Eyes Phase IV
The Food and Drug Administration has hired a contractor to conduct a thorough evaluation of the postmarketing study process for collecting information about drugs, devices, and biologics, the agency said in a statement. Such phase IV studies help to further define a product's safety, efficiency, or optimal use, the agency said. “Greater internal consistency across the medical centers at FDA for requiring, requesting, facilitating, and reviewing postmarketing study commitments” is the goal. Booz Allen Hamilton was awarded the contract last month, and is expected to take about a year to finish, according to the FDA.
Part D Cash Flow Woes
Administrative improvements in Medicare Part D have not eased cash flow pains for independent pharmacists, a survey found. The National Community Pharmacists Association surveyed 5,000 of its members; one-third said the Part D cash flow crisis may threaten the viability of their businesses. During the program's initial days, pharmacists nationwide dispensed millions of dollars in emergency prescriptions when eligibility could not be verified, and claims could not be processed due to problems with plan databases. Even now, payment procedures for low-income seniors eligible for both Medicare and Medicaid have “drastically slowed payment schedules,” the NCPA said. Under Medicaid, pharmacists were reimbursed weekly; under Medicare Part D, prescription drug plans issue reimbursement checks generally only once every 4 weeks and prescription claims filing may delay payment by additional weeks. Some 525 independent pharmacies (10.5%) responded to the faxed survey.
Prescribing Scooters, Wheelchairs
Prescribing power wheelchairs and scooters for patients should be easier under a new Medicare rule. The final rule, published in the Federal Register, requires a face-to-face evaluation, but also extends the time allowed to submit the prescription and other paperwork to the supplier from 30 days to 45. Also, a requirement that a specialist physician such as an orthopedic surgeon or rheumatologist assess the patient's ability to operate the equipment has been removed. An additional payment has been provided via an add-on CPT code to recognize the additional work and resources required to document the patient's need for a power device. A beneficiary being discharged from the hospital does not need to have a separate face-to-face exam. If a physician has an established treatment relationship with a patient, a face-to-face exam is not required, but documentation of need based on previous visits must be provided, according to the rule.
Tobacco Settlement Funds Waning
States will likely receive $400 million less tobacco settlement funds in fiscal year 2006 than in 2005, a Governmental Accountability Office study has found. GAO said the decline occurred because states have been selling bonds based on expected revenue from tobacco companies. States are “selling proceeds for pennies on the dollar,” and will have less to spend on health care, said Eric Lindblom, director for policy research at the Campaign for Tobacco-Free Kids. Tobacco settlement money was supposed to be spent on public health, especially to prevent smoking and treat its effects, he said, adding that when states have million of dollars coming in from tobacco companies, it is easier for health advocates to push for spending on smoking-related health matters. A recent paper from the campaign said that California and Massachusetts were saving as much as $3 in smoking-related health-care costs for every dollar spent on tobacco prevention when their programs were adequately funded. This is the last such report the GAO is set to perform under current federal law.