A recent story from The Hill:

The Obama administration on Wednesday expanded Medicare to cover more seniors hoping to kick their tobacco habits.  

“Most Medicare beneficiaries want to quit their tobacco use,” Health and Human Services Department (HHS) Secretary Kathleen Sebelius said in a statement announcing the move. “Now, [they] can get the help they need.”

Under previous rules, Medicare covered tobacco-related counseling only for beneficiaries already suffering from a tobacco-related disease. 

Under the new policy, Medicare will cover as many as two tobacco-cessation counseling tries each year, including as many as four individual sessions per attempt.

The move is the latest in a string of White House efforts to shift the nation’s healthcare system toward prevention, in lieu of simply treating diseases after they’ve developed.

If successful, the new tobacco policy could pay dividends. Of the 46 million Americans estimated to smoke, about 4.5 million are seniors older than 65, HHS says. And nearly 1 million more smokers are younger than 65, but eligible for Medicare benefits. 

They aren’t cheap. Tobacco-related diseases are estimated to cost Medicare about $800 billion between 1995 and 2015.

Donald Berwick, head of the Centers for Medicare and Medicaid Services, said the expansion lends seniors valuable help “to avoid the painful — and often deadly — consequences of tobacco use.”

The change affects Medicare Parts A and B — hospital care and physician services — but not Part D, which already covers smoking-cessation drugs for all beneficiaries.

Here are excerpts from a Kaiser Health News article:

….Under the new health care overhaul law, doctors who refer Medicare and Medicaid patients to in-house imaging machines must disclose in writing that they own the equipment. They’ll also have to tell their patients they can get the services elsewhere, and provide a list of 10 alternative sites within 25 miles. The rule takes effect next year.

An increase in spending, then a drop

Adrienne Dresevic, a lawyer with the Health Law Partners firm, based in New York City and Southfield, Mich., says the new disclosure requirement underscores concerns among some lawmakers about physicians who refer patients to in-house imaging machines. “This is just the beginning” of efforts to tighten self-referral rules.

Medicare spending on imaging services paid to doctors rose sharply in the past 10 years — to $13.7 billion in 2006 from $6.6 billion in 2000, according to the Centers for Medicare and Medicaid Services. Spending declined to $12.1 billion in 2009, after Congress cut reimbursement rates. But the number of advanced imaging tests has continued to increase, albeit at a slower rate, according to agency data. The agency does not break out data for imaging services provided under the in-office exemption.

Exception raises radiologists’ ire

Since the early ’90s, doctors have generally been barred by federal law from referring patients for certain services —including imaging and lab tests — to entities in which they have a financial interest. But that law exempts doctors who provide such services in their offices. Lawmakers figured it would be more convenient for patients if the doctors could get an in-house X-ray to make a diagnosis.

Over the past several years, cardiologists, orthopedic surgeons, urologists and other specialists have used the exception to buy increasingly high-tech and expensive imaging equipment for their offices.

Some doctors have leased time on machines at existing imaging centers, arguing that the centers were part of their office practices and thus exempt from the self-referral law, according to the Medicare Payment Advisory Commission, which advises Congress on Medicare issues. This trend has infuriated radiologists, who are expert at reading images and find themselves competing with other specialists who are opting to move or keep their tests in-house.

FOR THE FULL ARTICLE CLICK HERE.

I was talking to a client this weekend and she is clearly not a fan of “Obamacare”, as she called it.  As we talked, she raised several of her concerns about the future of Medicare and health care in general.  I thought it was interesting that each of her concerns is addressed under the Affordable Health Care Act that was passed earlier this year.

Relief in the Donut Hole:

“Karen” (name changed) takes several brand drugs and will go into the donut hole in September.  She said she was fortunate last year that her doctor gave her samples of Plavix so she didn’t have to pay full price while she was in the donut hole.  This year she says she’s going in the donut hole even earlier.

I told Karen that she will receive a check for $250 when she goes into the donut hole this year – thanks to the Affordable Healthcare Act. I told her she will get more relief next year when she will pay half-price for her brand name prescriptions while in the donut hole.  I also told her that the Affordable Health Care Act includes the phasing out of the donut hole over the next several years.

Karen was pleased to learn that she will get some help with her high drug costs and she had not heard of these benefits that are part of the Affordable Health Care Act.

Holding the Line on Expensive Imaging Tests:

Karen’s last job was with a group of orthopedic specialists and she said she thought they ordered too many MRIs and other expensive tests.  She also said this group of doctors owned the imaging center to which patients were referred.

I told Karen that the Affordable Health Care Act cuts payments to doctors for many of these expensive tests and sets new rules for doctors who have a financial interest in imaging centers and equipment.  These new rules are designed to cut down on the rising number of MRI’s, CT and PET scans, many of which seem to benefit the doctors’ bottom line more than their patients.  Karen thought this was a good idea.

Focus on Primary Care doctors:

Karen said her experience with specialists showed her that they make lots of money, but she is concerned about primary care doctors because she has heard there are not enough of them to treat new patients and the elderly.

I informed Karen that the Affordable Healthcare Act will raise the Medicare payments for primary care physicians by 10%.

Going Broke from Medical Bills:

Karen said she has an ongoing fear that a chronic illness or cancer might wipe out the money she and her husband  have saved up for their retirement.  Karen has a Medicare Advantage plan and I reminded her that she has a cap on her annual out-of-pocket expenses.  So if she spends $3,400 on co-pays for medical services during the year, she will hit her cap and will have no more co-pays for the rest of the year.

I told Karen that the Affordable Health Care Act requires that all Medicare Advantage plans have such a cap starting in 2011.  Karen is already in a plan with a cap because I don’t suggest people enroll in a plan without one.  Next year every Medicare Advantage plan will have a cap on enrollees’ expenses.

Karen was relieved to hear this news. She had forgotten about this detail in her plan and she said she would sleep better knowing that she has some protection from medical bills.

As we ended our conversation I did not ask Karen if her view of “Obamacare” had changed.  I don’t want to get into political discussions with clients, but I clearly need to educate them about the very positive benefits that are coming to their Medicare coverage as a result of the Affordable Healthcare Act.