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Bayer, the folks who make aspirin and medical supplies, has a growing business in the diabetes care field.  With more than 20 million Americans currently suffering from diabetes and a projected 1 in 3 children aged 8 projected to contract the disease, there is big money in reaching diabetics and locking down their preferences.

The giant health care company has agreed to pay a fine of nearly $100 million to settle U.S. Justice Department allegations that they paid distributors to convert diabetic patients from their glucometer (a device that measures blood sugar), test strips (the expensive part of the proposition, ranging up to $1 each for the uninsured) and other supplies.

The federal agency says that supplier Liberty Medical received $2.5 million as payment for each Medicare patient converted.  The funds were designated “advertising”.

“If medical device manufacturers want to serve Medicare beneficiaries they must follow the law,” said Gregory G. Katsas, Assistant Attorney General for the Civil Division. “Paying healthcare suppliers to place a particular brand of device with Medicare beneficiaries violates the law and will not be tolerated.”

Bayer reportedly paid $375,000 to ten other suppliers. The $97.5 million fine settles claims against Bayer through 2007. The company was also required to enter into an agreement with the government regarding future conduct.

Posted under Customer Service

The consumer group representing people aged 50 or older and their spouses came out swinging this week against the government’s proposed Medicare Advantage rates.

“AARP believes inflated payments to Medicare Advantage plans are unfair and fiscally irresponsible. Congress should ensure that traditional Medicare and Medicare Advantage compete on a level playing field,” said AARP Director of Government Affairs David Sloane.

Last month, the independent Medicare Payment Advisory Commission (MedPAC) found that reimbursements to Medicare Advantage plans are 12 percent more than reimbursements to Medicare’s traditional fee-for-service program. All taxpayers and all Medicare members—not just the 18 percent of Medicare members enrolled in private MA plans – are funding these inflated payments.

“Right now Medicare payments clearly favor the MA program over traditional Medicare, which is unfair to the majority of beneficiaries who participate in the traditional program. The federal government should be financially neutral with regard to Medicare reimbursement,” continued Sloane.

Medicare Advantage plans were supposed to provide the same benefits as fee-for-service more efficiently—not at greater cost to the program. In the past, they were able to provide extra benefits to beneficiaries through the greater efficiencies achieved by managed care (e.g., care coordination, negotiated prices, provider networks). Today, because of the excess payments to the plans, they have no incentive to achieve these efficiencies.

According to the nonpartisan Congressional Budget Office (CBO), the federal government could save $65 billion over five years and $160 billion over 10 years, if Medicare Advantage plans were paid at the same rates as traditional Medicare providers.

Posted under Customer Service

In spite of the high use of complementary and alternative medicine (CAM) among people age 50 or older,69 percent of those who use CAM do not talk to their doctors about it, according to a new survey conducted by AARP and the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health. The survey examined conversations between patients and their physicians regarding CAM use.

CAM is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. It includes such products and practices as herbal supplements, meditation, homeopathy, and acupuncture.

“We know that people 50 and older tend to be high users of complementary and alternative medicine, but this study was the first to explore gaps in communications regarding the use of CAM between patients and their physicians,” said Cheryl Matheis, AARP Director of Health Strategies. “Communication is important to ensure the wise use of all conventional and CAM therapies.”

Differences in communication practices across demographic groups were also found. Women were more likely than men to have discussed CAM use (26 percent versus 16 percent) and what types of therapies to use (70 percent versus 51 percent). In addition, people with incomes of $75,000 or more (31 percent) or $25,000 to $49,999 (25 percent) frequently discussed CAM use with doctors.

“An open dialogue between consumers and their physicians is critical to ensuring safe and appropriate integrated care,” said Margaret A. Chesney, Ph.D., NCCAM’s Deputy Director. “As the Federal Government’s lead agency for scientific research on CAM, NCCAM is especially committed to educating both consumers and health care providers about the importance of discussing the use of CAM and providing evidence-based information to help with health care decision-making.”

This telephone survey, administered to a nationally representative group of 1,559 people age 50 or older, revealed some reasons why doctor-patient dialogue is lacking. Respondents most often did not discuss their CAM use with doctors because the physicians never asked (42 percent); they did not know that they should (30 percent); or there was not enough time during the office visit (19 percent). Interestingly, men who had seen a doctor were more likely than women not to have discussed CAM because their doctors never asked (46 percent versus 38 percent).

Other highlights from the survey report include:
Dialogue Topics

* The topics most often discussed with doctors were the effectiveness of a CAM therapy (67 percent); what to use (64 percent); how a CAM therapy might interact with other medications or treatments received (60 percent); advice on whether to pursue a CAM therapy (60 percent); and safety of a CAM therapy (57 percent).

Prescription and Over-the-Counter Medication Use

* Nearly three-fourths of respondents said they take one or more prescription medications; in addition, 59 percent of respondents said they take one or more over-the-counter medications. Twenty percent of respondents reported taking more than five prescription medications.
* The high number of prescription and over-the-counter medications used by this group underscores the need for consumers and physicians to discuss all therapies, including CAM, to ensure safe, integrated care.

View a complete copy of the survey report

Posted under Health

AARP CEO Bill Novelli issued the following statement on the Medicare prescription drug plan implementation:

Clearly, there are problems with the implementation of the new Medicare prescription drug plan. We take these problems very seriously.

The bottom line is that some people are not getting the drugs they need. This is unacceptable. If an individual has proof of eligibility, there is absolutely no reason they should pay more than required or leave a pharmacy empty-handed.

We must all do what it takes to solve the problem.

AARP is in constant contact with Medicare administrators, plan providers, pharmacies and others. Our own endorsed plan is working to resolve problems and improve customer experience. AARP is also working to inform members and the public to bring any and all enrollment documentation, government-issued Medicare card and photo identification to the pharmacy. If individuals are having trouble at one pharmacy we are recommending they try another, given that some pharmacies are handling filling prescriptions differently.

With the Medicare prescription drug program, millions of Americans now have the opportunity to access affordable prescription drugs. Providing a prescription drug benefit is the most significant change to Medicare in its 40 year history. More than one million prescriptions are being filled every day and people are realizing savings.

Posted under Health

There is a gult of information and advice about the new Medicare prescription changes that take effect tomorrow with coverage beginning January 1.

For all the official news and advice on this topic, Consumer Help Web recommends you use the government’s easy-to-navigate and consumer-friendly site.

You can get there at http://www.medicare.gov/pdphome.asp.

“This is too important an issue to leave up to other organizations,” said Consumer Help Web President Joan Bounacos. “The government has done an excellent job in presenting this information in a clear and easily understood manner. We urge any Medicare eligible person to simply visit the official site only to have their questions answered.”

Posted under Health

Consumers protected by Medicare who appeal decisions can participate in a streamlined process that has a goal of resolving issues within 90 days as the function moves from the Social Security Administration (SSA) to the Department of Health and Human Services (HHS). HHS is the government agency that oversees Medicare. HHS reported earlier this month that it has created an Office of Medicare Hearings and Appeals for this program.

The change, which was mandated by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, took effect July 1.

“As HHS assumes responsibility for handling Medicare hearings, we are committed to making the appeals process better, faster and more convenient for seniors and other people with Medicare,” HHS Secretary Mike Leavitt said. “Our goal is to eliminate the need for an aged or disabled beneficiary to travel if other resources are available closer to home.”

To reach its goal, the government agency said it would begin using video conference technology in more than 1,000 sites nationwide

Posted under Health