KHN: We hear a lot about our Senator Elizabeth Warren. She wants people to be able to hear more by requiring #Medicare to pay providers to train people on how to use their #hearingaids

From Kaiser Health News:

Can You Hear Me Now? Senate Bill On Hearing Aids May Make The Answer ‘Yes’

Last December, Deb Wiese bought hearing aids for her parents, one for each of them. She ordered them online from a big-box retailer and paid $719 for the pair. But her parents, in their 80s and retired from farming in central Minnesota, couldn’t figure out how to adjust the volume or change the batteries. They soon set them aside.

“Technology is not only unfamiliar but unwelcome” to her parents, Wiese said. “I don’t know what the answer is for people like that.”

A bill introduced by Sen. Elizabeth Warren (D-Mass.) and Sen. Rand Paul (R-Ky.) in March could make it easier for her parents and millions like them to get assistance. It would allow Medicare to pay audiologists to teach beneficiaries how to adjust to and use their hearing aids as well as how to manage communication with other people, among other things.

Under current law, Medicare generally reimburses audiologists for diagnosing hearing loss in older adults but not for providing assistance to fit, adjust and learn to make the most of hearing aids.

The proposed bill comes on the heels of a law signed last summer by President Donald Trump that directs the Food and Drug Administration to establish and regulate a new category of hearing aid to be sold over the counter for people with mild to moderate hearing loss. People will be able to buy products off the shelf without consulting an audiologist or hearing aid dispenser, and standards for online sales will be tightened. The agency has three years to develop safety and other consumer protection standards.

The National Academies of Sciences, Engineering and Medicine recommended that the FDA take that step in a 2016 report.

Although it should improve access, the new law doesn’t address one of the biggest barriers faced by the nearly 50 million people with age-related hearing loss: insurance coverage.

Neither traditional Medicare nor most private insurers typically cover hearing aids. (Some Medicare Advantage plans provide some coverage, and some insurers may offer a discount if members use certain suppliers.)

“Cost has for many years been the No. 1 problem in the calls, emails and letters we get,” said Barbara Kelley, executive director and CEO of the Hearing Loss Association of America, a patient advocacy group. “People say, ‘I need hearing aids and I can’t afford them.’ It’s really heartbreaking.”

Only 10 to 20 percent of people with hearing loss have ever used hearing aids, according to studies. In addition to cost, lack of access to care and the stigma associated with wearing a hearing aid discourages people, Kelley said.

Losing the ability to hear well doesn’t just mean people have to turn the volume way up on their favorite TV shows. Hearing loss is associated with depression, social isolation and an increased risk for cognitive decline and dementia in older adults.

Hearing aid prices vary widely, ranging from an average $900 to $3,100 apiece, according to a survey of hearing care professionals by the Hearing Review. On the high end, devices may be Bluetooth-enabled to stream wirelessly from people’s cellphones to their hearing aids, among other perks.

But not everyone needs or wants that much help. “Some people are very mildly impaired,” said Kim Cavitt, a billing and reimbursement consultant and former president of the Academy of Doctors of Audiology who supports over-the-counter sales. “They don’t have a $3,000 problem, they have a $300 problem.”

Experts say they hope the over-the-counter hearing aid law will spur competition and product innovation and bring down prices.

One of the reasons hearing aid prices are often high is because the devices are typically bundled with a service package to fit, troubleshoot and maintain them.

Disentangling the service from the devices would benefit consumers, said Nicholas Reed, a faculty member at the Cochlear Center for Hearing and Public Health at Johns Hopkins Bloomberg School of Public Health who has studied over-the-counter hearing devices that provide results comparable to hearing aids.

In addition to basic hearing-aid fitting and maintenance, hearing care professionals can help people learn strategies to hear better, Reed said. For example, people learn to sit with their back to a wall at a restaurant to eliminate the sound behind them so they can focus on listening to the person in front of them.

“The over-the-counter law will lower the cost and make hearing aids more accessible,” Reed said. “But if the services aren’t covered, people, especially older adults with health literacy issues, will stop using them.”

Advertisements

KHN: Medicare Fails To Recover Hundreds Of Millions Of Dollars In Lab Overcharges

Used by permission. Note comment from Boston lawyer. Also published by STATnews. 

captureFive years ago, Companion DX Reference Lab hoped to cash in on cutting-edge genetic tests paid for by Medicare.

The Houston lab marketed a test to assess how a person’s genes affect tolerance for drugs such as opiates used to treat chronic pain. It also ran DNA tests to help treat cancer and urine screens to monitor drug abuse.

cms logoBut the lab went bust last year after Medicare ordered it to repay more than $16 million for genetic tests health officials said were not needed.

Companion Dx is one of at least six clinical labs mired in bankruptcy court after Medicare alleged they improperly billed the government for unnecessary urine, genetic or heart disease tests expected to cause hundreds of millions dollars in losses to taxpayers, an investigation by Kaiser Health News found.

As the nation’s bill for drug and genetic tests has climbed to an estimated $8.5 billion a year, there’s mounting suspicion among health insurers that some testing may do more to boost profit margins than help treat patients.

Medicare has slashed fees for urine tests and tightened coverage of some genetic screens, which can cost Medicare $1,000 or more per person. Private insurers, who mostly have paid these bills without question, also are taking a more penetrating look at spending on the controversial lab work.

Yet, getting these firms to repay Medicare and private insurers remains a formidable challenge. While some doctor-owned labs have dodged collection efforts for years, several testing firms deeply in debt to Medicare appear to have few assets to repay overcharges dating back years, court records show.

“Medicare shouldn’t be paying for dubious tests, but the time to catch that is in the very beginning when [labs] are asking for payment,” said Steve Ellis, vice-president of Taxpayers for Common Sense, a budget watchdog group. “They need to increase oversight so the dollars don’t go out the door in the first place.”

A spokesman for the federal Centers for Medicare & Medicaid Services (CMS) had no comment. Neither did the Department of Justice, which represents the government’s interests in court.

Labs can run a range of genetic and drug tests using a saliva sample, blood or urine specimen. The price tag to Medicare can mount quickly, especially when doctors order highly specialized tests for large numbers of patients. Two bankrupt labs that federal officials say routinely overused tests to detect rare heart ailments in the elderly, for instance, could end up owing the government a total of more than $200 million, court records show.

Some labs have kept operating in bankruptcy while others liquidated equipment and sold off assets. Several bankruptcy trustees, whose duty is to ferret out assets, are suing suppliers, insurers and some doctors to recover funds.

Whether they can raise the pile of cash needed to repay Medicare is doubtful.

Companion Dx, according to bankruptcy records, had $117,497 cash on hand at the end of September. Medicare is seeking the return of $16.2 million paid to the company for services “not considered medically necessary,” according to a January court filing.

The Texas lab had no comment, but in court filings has blamed its collapse on disagreements with Medicare over the merits of its tests and government audits that retroactively disallowed claims. Medicare pays only for services it deems “medically necessary,” and audits typically take many years to complete.

Companion Dx opened in January 2012 expecting to “capture favorable profit margins that existed in connection with this cutting edge technology,” the company wrote in its bankruptcy filing.

However, starting in 2013, Medicare began having second thoughts about the validity of some tests and ultimately decided to cover them on just 1 percent of patients, according to the company. The lab declared bankruptcy in July 2016. The case is pending.

Iverson Genetic Diagnostics Inc. is another lab that turned to bankruptcy court as Medicare tried to reclaim $19.7 million, court records show. The case is pending.

Medicare took aim at the Seattle firm in November 2013 after reviewing “numerous” complaints of billings for genetic tests that patients “had not actually received,” federal officials wrote in a court filing.

A later federal audit concluded that Iverson had charged Medicare for tests that were “not reasonable and necessary.” In September 2015, about two months after Medicare called for the refund, the lab filed for bankruptcy.

Iverson denied overbilling Medicare and is appealing the Medicare decision, which it said in a court filing “was not based upon sufficient or proper evidence.” And Iverson denied wrongdoing in court filings.

Neither the lab, now located in Charleston, S.C., nor its lawyers would comment.

In another case, Pharmacogenetics Diagnostic Laboratory LLC in Louisville exited bankruptcy in late October without repaying Medicare $26.3 million for disallowed genetic tests. The lab, set up in 2004 by two University of Louisville professors, strongly disputed Medicare’s findings but said they were the “primary reason” for the bankruptcy, court records show.

Charity Neukomm, a lawyer for the lab, said another medical group agreed to purchase all its assets “free and clear of liens.” That left nothing for the government.

There’s also little chance that Natural Molecular Testing Corp., a defunct genetic testing lab, will repay the $71 million it owes Medicare, according to John Kaplan, an attorney for the bankruptcy trustee.

Kaplan said the lab near Seattle, which opened in 2010, was “printing money from billing Medicare” until the government suspended payments in April 2013. The company filed for bankruptcy in 2013 in the face of a Medicare audit of its billing and concern over its business practices, such as paying some doctors who ordered its tests as much as $10,000 a month in consulting fees, according to court records.

Five years in, the bankruptcy case is expected to settle next year, but there’s likely to be “no cash left” to repay Medicare, Kaplan said.

Critics argue that Medicare has been slow to assess the benefits of new and controversial tests and technologies — even when soaring costs signaled a warning of possible overuse.

Spending on genetic testing, for example, shot up from about $167 million in 2013 to more than $466 million a year later, according to Medicare billing data. In 2015, the program spent about $317 million on the tests and some $165 million last year. Government auditors credit tighter oversight for the sharp decline in billing.

Ellis, the budget watchdog, said the “huge jump” in these bills should have “sent out a red flag.”

Medicare officials don’t routinely verify that the sales claims labs make to doctors are rooted in scientific evidence. Some labs have hawked genetic tests as a tool for making pain management safer. The labs contend the tests can pinpoint the proper drugs and dosage for each patient based on their genetic makeup, thus reducing the threat of overdose or other injury.

However, many experts argue that the science hasn’t caught up to the sales pitch — and that some high-priced tests may do little to diagnose or treat illness.

Genetic tests “are not ready for prime time,” said Charles Argoff, professor of neurology at Albany Medical College in New York. He said their impact on medical care “hasn’t been measured.”

Court records show that the legal battles to recover assets from failed labs often plod on for years, especially when trustees believe labs paid illegal fees or other kickbacks to persuade doctors to order dubious tests.

“Some of these cases never go away,” said David Schumacher, a Boston health care lawyer who has defended doctors against these claims. Still, he said that even after years of legal wrangling Medicare often is unlikely to “be made whole and fully repaid.”

The trustee for Heart Diagnostic Laboratory, which marketed a panel of blood tests to detect heart disease and other illnesses before its June 2015 bankruptcy, has filed more than three dozen lawsuits to recover money paid to doctors and medical offices, including suspect consulting fees.

“Our analysis is that all of these payments were tainted and therefore we’re entitled to go after them,” said Richard Kanowitz. He added: “It’s an uphill battle.”

 

NYTimes story on #readmission prevention coaches features Rhode Island program

From the NY Times New Old Age Column:

The transitions coach ducks into your mother’s hospital room for a brief introduction before she’s discharged. The coach explains that her job is to help keep patients safe at home and asks if she can call to set up a home visit.

Health researchers know that transitions — the hand-offs from one setting to another, as in hospital to home — often go awry.

“It’s so abrupt,” said Dr. Eric Coleman, a geriatrician at the University of Colorado, Denver (and a certified McArthur Foundation genius). “For three days people do everything for you, and then, 11 minutes before you leave, they turn the tables. ‘Nowyou take over.’ ”

Your parent is often sleep deprived and medicated at the time; little wonder that nationally, about one Medicare patient in five returns to the hospital within a month…

To lower that figure, Dr. Coleman began developing the Care Transitions Intervention program 15 years ago. If patients agree, a coach comes to their homes two to four days after discharge. She’s not there to change dressings or help them bathe; home health nurses or aides do that. Instead, over 45 minutes to an hour, the coach — generally a nurse, sometimes a social worker or other health care professional — asks about patients’ goals as they recover.

Here’s the RI program mentioned in the story.

Your tax dollars at work: How much Medicare pays your doctor

Screen Shot 2014-04-09 at 10.37.18 AMFor the first time — with a little legal prodding– Medicare has released information on how much it pays individual doctors.

The New York Times already has a searchable database. Check it out.

A tiny fraction of the 880,000 doctors and other health care providers who take Medicare accounted for nearly a quarter of the roughly $77 billion paid out to them under the federal program, receiving millions of dollars each in some cases in a single year, according to the most detailed data ever released in Medicare’s nearly 50-year history.

More here:

Bloomberg:Medicare Millionaires Totaling Almost 4,000 Seen in Data

LA Times

 

The importance of the hospital patient survey and more policy news

Two local bloggers contribute to the new edition of  Health Wonk Review,  a bi-weekly digest of health policy posts.

masthead-hwrHealthBlawg offers a wrap-up post on the health information technology and health care policy conference in DC earlier this month. The Datapaloozers are looking at data streams from the government and beyond in an effort to manage the health and the health care costs of various populations…policy blog posts.

Why are patient experience surveys crucial to gaining clues for improving patient care and comfort? Many hospitals use them, notes David Williams at Health Business Blog, even though providers may not always be enthusiastic about being rated. They’ve become more important since Medicare began using patient experience as a criterion for reimbursement. 

Readmission penalties in Massachusetts hit teaching hospitals

wheelchairsMedscape reports on a JAMA article looking at readmission rates:

Ninety-five-bed Falmouth (Massachusetts) Hospital on Cape Cod doesn’t have the national reputation of Massachusetts General Hospital, 77 miles to the north in Boston.

But the small hospital bests the big teaching hospital in the big city on this point — it’s not getting penalized by Medicare for excessive readmissions within 30 days of discharge. Massachusetts General, in contrast, will forego about 0.5 percent of its Medicare reimbursement in fiscal year 2013 because its readmission rate was higher than what the Centers for Medicare & Medicaid Services (CMS) projected based on the case mix, or medical complexity, of their patients.

Cambridge-based Institute for Healthcare Improvement offers a little perspective:

In this Viewpoint, we suggest that it may be more advantageous to view readmissions within a broader systems and community context that effectively engages all stakeholders to cooperatively improve outcomes…The Hospital Readmission Reduction Program has raised awareness of readmissions as an indicator of a fragmented health care delivery system. Yet financial penalties alone are not likely to drive change. As the nation moves toward comprehensive payment and delivery system reforms to promote integrated care, the focus should shift toward reducing avoidable hospital use, not just readmission, by strengthening primary and preventive care and chronic disease management for populations of patients at risk of poor health outcomes.

#Medicare boss Berwick for Massachusetts governor? Changing what makes sense #hcr #mapoli

Sure sounds like it from the Globe story.

Berwick, a Newton pediatrician and longtime Harvard faculty …has been contemplating a run for the past two or three months, meeting with 40 or 50 people, including political veterans and consultants. …“I’m strongly considering it,” said Berwick, whose interest in the office was first reported by State House News Service.  While he would bring deep policy knowledge to a governor’s race, it is unknown whether Berwick can mount a serious candidacy, as a newcomer to politics who has never raised money or glad-handed voters at a strip mall.

More from Politico.

BHN caught up with Dr. Berwick on Martha’s Vineyard this summer, where he introduced a health care documentary. There, he talked about the people who came to see him during his short tenure in Washington:

Instead of demonizing doctors and drug companies, he doesn’t blame any of the players, who are working within the system as it stands.

“They’re just doing what makes sense,” he said. “We have to change what makes sense.”

 For more on Dr. Berwick see: