Category Archives: Medicare
The U.S. Department of Health & Human Services (HHS) last week released a report that looks at Medicare patients’ access to care before and after the enactment of the Affordable Care Act. The report from HHS’s Office of the Assistant Secretary for Planning and Evaluation finds that Medicare beneficiaries’ access to care has remained high and stable in recent years.
The percentage of office-based physicians accepting new Medicare patients remained stable from 2005 to 2012, at approximately 90 percent. That rate is “quite similar” to the number of physicians accepting new privately insured patients during the same time period, the report says.
The report also finds that the number of providers participating in and billing Medicare steadily increased during those years.
“Based on multiple data sources, Medicare beneficiaries’ access to care appears to be excellent: it has been stable over the past five years and is comparable to or better than access reported by privately insured individuals,” the report says.
Samir Soneji, PhD, is an alumnus of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program, and an assistant professor at the Dartmouth College Institute for Health Policy and Clinical Practice and the Norris Cotton Cancer Center. His study on the statistical security for Social Security was published in the August 2012 issue of Demography. Read the study.
Human Capital Blog: This study is a follow-up to your previous research. Can you briefly describe what you’ve studied up to this point?
Samir Soneji: Previously we studied the impact of historical smoking and obesity patterns on future mortality and life expectancy trends. For men there’s been a steady decline in cigarette smoking, and so also a gain in life expectancy. Women have also experienced a decline in cigarette smoking, but not as quickly. The rise in obesity has been much more recent than the historic decline in smoking, and we don’t know yet the impact of that rise. There’s a lag—the effect of today’s obesity may affect the population in 15-20 years, or later. One possibility may be that the rise in obesity may partially offset what’s been achieved by the historic reductions in smoking. Taking these factors into account, we found that both men and women will have an increase in life expectancy in the next 25 to 30 years.
HCB: Your new study looks at the solvency of Social Security. Tell us more about what you were analyzing.
Soneji: The Social Security Administration and Medicare use the same mortality and demographic forecasts to determine the number of beneficiaries, and the number of working age adults who are contributing payroll taxes to support those retirees.
Human Capital News Roundup: Genome sequencing of tumors, Medicare physician fees, cervical cancer among Latinas, and more.
Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) scholars, fellows and grantees. Some recent examples:
Alejandra Casillas, MD, MPH, an RWJF Clinical Scholar, spoke to New America Media about why Latinas have the highest rates of cervical cancer. Many women don’t go to the doctor as much as recommended because of a cultural belief that their families come first, Casillas says, so raising awareness among men could help encourage more women to get Pap tests.
Healthcare Finance News reports on The Primary Care Team: Learning from Effective Ambulatory Practices (the LEAP Project), a recently launched RWJF initiative designed to make primary care more accessible and effective by identifying practices that maximize the services of the primary care workforce. Learn more about the LEAP Project and read an RWJF Human Capital Blog post about it.
A team led by scientists from the Broad Institute and Dana-Farber Cancer Institute—including RWJF Harold Amos Medical Faculty Development Program alumnus Levi Garraway, MD, PhD—has sequenced the genomes of 25 metastatic melanoma tumors, MediLexicon reports. The first high-resolution views of the genomic landscape are published online in the journal Nature.
RWJF Scholar in Health Policy Research and political scientist Brendan Nyhan, PhD, gave comments to NPR’s Morning Edition about the political landscape, discussing why and how voters reject facts about the political parties or politicians to whom they are loyal. Nyhan’s ongoing research suggests that people may be better able to deal with cognitive dissonance—“the psychological experience of having to hold inconsistent ideas in one's head”—if they are first given an image or ego boost.
Human Capital News Roundup: Rising Medicare expenses, community-based health care, breast cancer prevention and more.
Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program site director Ana Diez Roux, MD, PhD, MPH, and RWJF Interdisciplinary Nursing Quality Research Initiative (INQRI) co-investigator Christopher Ruhm, PhD, were cited in a Bloomberg column by former Office of Management and Budget director Peter Orszag. The research of both investigators shows, counter-intuitively, that life expectancy rises during periods of economic downturn.
Dawn Alley, PhD, an alumna of the Health & Society Scholars program, is the lead author of a study that finds that obesity—and the chronic conditions that often come with it—are a major contributor to the growth in Medicare expenses. Each obese beneficiary adds an additional $149 a year to Medicare, Reuters reports.
An assessment tool used by the federal government to determine if a community health center is functioning as a “patient-centered medical home” may not accurately reflect the quality of the diabetes care the health center provides, according to a study led by RWJF Clinical Scholar Robin Clarke, MD. The researchers found no significant relationship between passing the assessment and the quality of diabetes care provided, Cardiovascular Business reports. Health Canal also reported on the findings.
Human Capital News Roundup: Nurse faculty shortage, cervical cancer among Latinas, fitness benefits for Medicare beneficiaries, and more.
Here’s a sampling of recent news coverage of the work of Robert Wood Johnson Foundation Scholars and Fellows:
Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows alumna Juliann Sebastian, PhD, RN, FAAN, dean of the College of Nursing at the University of Nebraska Medical Center, wrote an op-ed in the Journal Star about Nebraska’s nursing shortage. “The growing shortage of nurses is not for lack of interest among students,” she writes. “We cannot accept more students, however, for two primary reasons: We lack adequate space to accommodate their instruction, and we do not have enough faculty to teach them.”
Teresa Garrett, MS, RN, also an Executive Nurse Fellows alumna, spoke to the Salt Lake Tribune about the importance of exercise in preventing colds. “We’re always telling people exercise is good for you,” she says. “It builds up your immune system, you are healthier, you drink more water, you do all the things you’re supposed to do.” Garrett is director of disease control and prevention at the Utah Department of Health.
Executive Nurse Fellows alumna Cynthia Barginere, RN, DNP(c), FACHE, vice president and chief nursing officer at Rush University Medical Center in Chicago, spoke to Nurse.com and WSL-TV about the Center’s new 14-story hospital building.
Researchers at UT Medicine, the faculty medical practice of the University of Texas School of Medicine in San Antonio, are looking for healthy, ethnic minorities in South Texas to participate in a research trial on the health effects of taking baby aspirin every day, according to the Southside Reporter. RWJF Harold Amos Medical Faculty Development Program scholar Sara Espinoza, MD, is the lead investigator for the “Aspirin in Reducing Events in the Elderly” study.
Zane Gates, MD, an RWJF Community Health Leader, spoke to WTAJ-TV about changes to eligibility criteria for food stamps in Pennsylvania – changes driven by state and federal funding cutbacks. The new criteria will reduce the number of state residents who qualify for assistance. Gates runs a free clinic in Altoona, and many of his patients receive food stamps, the station reports.
Patrick H. Conway, M.D., M.Sc., is an alumnus of the Robert Wood Johnson (RWJ) Foundation Clinical Scholars program (2005 – 2007) and the new Chief Medical Officer for the Centers for Medicare & Medicaid Services.
I am writing to update the RWJ Clinical Scholars “Family,” the Foundation community and friends, on a new career development. For those whom I haven’t met, I was a RWJ Clinical Scholar at the University of Pennsylvania. I recently took on the role of Chief Medical Officer for the Centers for Medicare & Medicaid Services (CMS) and Director of the Office of Clinical Standards and Quality (OCSQ) for CMS. I report directly to Dr. Don Berwick, the Administrator, and have already learned a lot from him.
The Chief Medical Officer (CMO) portion of this role entails being the senior clinical advisor to the Administrator of CMS, representing the agency to a wide range of stakeholders, and shaping policy across the agency. I work closely with regional CMS CMOs across the country.
The Director of OCSQ role entails leading an office of hundreds of staff, thousands of contractors, and a budget exceeding $1.3 billion annually. Our office is responsible for all quality measures for CMS, including how the measures link to payment. We are responsible for programs such as value-based purchasing for hospitals and other providers, the hospital inpatient quality reporting program, and physician quality reporting system. We are working to align measures across programs, focus on outcomes when possible, improve patient safety, and incentivize coordinated care across settings. We lead quality improvement organizations (QIOs) in all 50 states and three territories and we plan to further develop these organizations into learning networks supporting improvement directly at the front lines of care.
The office is also responsible for all coverage decisions for CMS, including provider services, medical devices and biologics, and diagnostic testing. We believe these coverage decisions can better support quality of care and evidence development.
We are also responsible for all clinical standards, such as conditions of participation, for CMS. We are currently rewriting the hospital conditions of participation, which would be the first time that these have been updated in decades. These conditions guide the survey and certification work done across the country by Joint Commission and CMS surveyors.
Finally, the office contains the information systems group that supports collection of quality measurement data from hospitals, physicians, and other providers across the country.
A newly released study from RWJF Clinical Scholar (2009-2011) Lenard Lesser, M.D., finds that Medicare covers only a fraction of the preventive care services recommended by a government task force, and that health care reform should be able to mend the current disconnect between Medicare reimbursement policies and the recommendations of the U.S. Preventive Services Task Force (USPSTF), charged by the government with reviewing clinical preventive health services. In particular, Lesser’s study points to the need to improve coordination between assessing the risk for certain illnesses and ensuring that patients receive the appropriate tests and follow-up clinical services. In addition, Lesser finds a persistent and disturbing lack of coverage for obesity and nutritional services, both of which are recommended by the task force and important for maintaining good health.
The study was published in the January/February issue of the Annals of Family Medicine.