Category: Federal agencies

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By Susan Jaffe | December 17, 2012  |  Kaiser Health News in collaboration with

Dan Driscoll used to be a smoker. During a regular doctor’s visit, his primary-care physician suggested that Driscoll be tested to see if he was at risk for an abdominal aortic aneurysm, a life-threatening condition that can be linked to smoking. The doctor said Medicare would cover the procedure. So Driscoll, 68, who lives in Silver Spring, had the test done and was surprised when he got a bill from Medicare for $214.

“I didn’t accept that,” he said, because based on everything he had read from Medicare, he was sure this was a covered service. So Driscoll did something that seniors rarely do: He filed an appeal.  Of the 1.1 billion claims submitted to Medicare in 2010 for hospitalizations, nursing home care, doctor’s visits, tests and physical therapy, 117 million were denied. Of those, only 2 percent were appealed.

“People lose, and then they lose heart, or they are too sick, too tired or too old, and they give up,” said Margaret Murphy, associate director of the Center for Medicare Advocacy, which has offices in Washington and Connecticut. “Or their kids are handling the appeal and they are too overwhelmed caring for Mom or Dad.”  [Continued at Kaiser Health News and The Washington Post.]

How To File A Medicare Appeal  Here are some basic steps for challenging Medicare coverage denials…. [Continued at Kaiser Health News.]

Seniors Need To Be Tenacious In Appeals To Medicare

By Susan Jaffe | December 17, 2012  |  Kaiser Health News in collaboration with

Dan Driscoll used to be a smoker. During a regular doctor’s visit, his primary-care physician suggested that Driscoll be tested to see if he was at risk for an abdominal aortic aneurysm, a life-threatening condition that can be linked to smoking. The doctor said Medicare would cover the procedure. So Driscoll, 68, who lives in Silver Spring, had the test done and was surprised when he got a bill from Medicare for $214.

“I didn’t accept that,” he said, because based on everything he had read from Medicare, he was sure this was a covered service. So Driscoll did something that seniors rarely do: He filed an appeal.  Of the 1.1 billion claims submitted to Medicare in 2010 for hospitalizations, nursing home care, doctor’s visits, tests and physical therapy, 117 million were denied. Of those, only 2 percent were appealed.

“People lose, and then they lose heart, or they are too sick, too tired or too old, and they give up,” said Margaret Murphy, associate director of the Center for Medicare Advocacy, which has offices in Washington and Connecticut. “Or their kids are handling the appeal and they are too overwhelmed caring for Mom or Dad.”  [Continued at Kaiser Health News and The Washington Post.]

How To File A Medicare Appeal  Here are some basic steps for challenging Medicare coverage denials…. [Continued at Kaiser Health News.]

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A new law passed in July to strengthen the work of the US Food and Drug Administration may hit some serious barriers to implementation. Susan Jaffe reports from Washington, DC.

image WORLD REPORT   Volume 380, Issue 9852, Pages 1458 – 1459, 27 October 2012

The massive drug and medical device safety bill that won extraordinary near-unanimous support in the US Congress—despite a budget crisis and a contentious political campaign—is facing major challenges less than 3 months after President Barack Obama signed it into law in July. And in the process, prospects may be fading for additional reforms. [MORE]

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image Volume 380, Issue 9848, Pages 1133 – 1134, 29 September 2012

WORLD REPORT  Comprehensive domestic health-care reform is one of the top defining issues in the campaign, overshadowing global health. Susan Jaffe reports from Washington, DC.

President Barack Obama and his rival Republican Mitt Romney would agree that the American health-care system is unsustainable, providing some of the world’s most expensive and yet fragmented care. But as they campaign for the presidency, the two candidates offer profoundly different solutions.

“The Affordable Care Act helps make sure you don’t have to worry about going broke just because one of your loved ones gets sick”, said Obama, describing his signature legislative achievement at a recent campaign stop in Colorado. “I don’t think a working mom in Denver should have to wait to get a mammogram just because money is tight”, he continued. “That’s why we passed this law. It was the right thing to do.” [more, as PDF]  

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image Volume 379, Issue 9828, Page 1775, 12 May 2012

The US Food and Drug Administration is calling for greater reliance on global partners to improve the safety of America’s foreign imports. Susan Jaffe reports from Washington, DC.

In its latest effort to promote a global strategy for protecting Americans against unsafe imported pharmaceutical, food, and medical products, the US Food and Drug Administration (FDA) has called for unprecedented international cooperation to cope with seemingly overwhelming challenges. FULL STORY

Medicare Combats Fraud With Billing Statements That Beneficiaries Can Understand

Susan Jaffe | March 7, 2012 | KAISER HEALTH NEWS produced in collaboration with 

In the latest effort to enlist seniors in the fight against Medicare fraud, federal officials have overhauled Medicare billing statements to make it easier to find bogus charges without a magnifying glass. ….And for those who might need an incentive to scour their bills, the new statements promise a reward of up to $1,000 for a tip that leads to uncovering fraud.[Continued here.]…

During open enrollment season, seniors can get help picking a Medicare drug plan

By Susan Jaffe | Kaiser Health News | November 11, 2011 | in collaboration with The Washington Post

Three weeks after suffering a heart attack, Bernie Hollander came to a recent meeting at Leisure World in Silver Spring with his wife, Rose, to learn about the Medicare drug plans being offered next year. “I’m a heart patient, I’m a diabetic – I have a lot of problems,” said Hollander, 81, who lives in the retirement community. But getting the expensive medications he needs isn’t one of them. e was at the meeting to get updated advice from Leta Blank, head of the Montgomery County Senior Health Insurance Assistance Program (SHIP).

published in collaboration with

Although drug coverage is optional, millions of Medicare beneficiaries enroll in a plan, and choosing the right one can be tricky. Seniors who want drug coverage must sort through dozens of policies covering different drugs from different pharmacies at different prices. Federal SHIP counselors can help untangle the details. [Continued on The Washington Post and Kaiser Health News, view video]…

Doctors skittish about health technology despite promise of big federal bucks

By Susan Jaffe  | Center for Public Integrity  |  July 7, 2011

The goal is to bring the last outposts of the nation’s health care system into the computer age, linking medical providers so that they can coordinate and improve patient care and — in the process—reduce unnecessary health care spending. But convincing everyone to use electronic health records has not been easy. …Neither  reward nor punishment has 

persuaded some small practice doctors — a troubling omen for the Obama administration, which believes that conversion of paper records to electronic form is a crucial step toward health care reform. [Continued]

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Medicare Steps Up Efforts To Monitor Seniors’ Prescriptions

By Susan Jaffe | KAISER  HEALTH  NEWS | March 23, 2010

This story was produced in collaboration with

Irene Mooney survived four heart attacks and still copes with high cholesterol, persistent indigestion and heart problems. Recently, she developed some dangerous new symptoms – suspicious bruising all over her body and severe fatigue. “I could barely put one foot in front of the other,” she says. A pharmacist discovered the culprit: Some of the very medications Mooney was taking to manage her medical conditions.

The pharmacist met with Mooney, examined her 13 medications and then contacted her doctor, who cut the dosage of one drug and replaced another, reducing her risk of uncontrollable bleeding. Mooney, 82, one of the devoted card players at her seniors’ complex, soon noticed the change. “I’ve been so much better,” she says.

The help Mooney got – called “medication therapy management” – was provided by Senior PharmAssist, a Durham, N.C., non-profit group that makes sure seniors use the right prescription drugs and take them correctly to prevent harmful side effects or drug interactions.

Now, medication management is coming to nearly 7 million seniors and disabled Americans enrolled in Medicare drug plans. [Continued at Kaiser Health News and USA Today

 

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