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Welcome to MEDICARE WATCH, a biweekly electronic newsletter of the Medicare
Rights Center
Vol. 11, No. 4: February 19, 2008
Contents:
*FAST FACT
*MEDICATION ERRORS COMMON AMONG OLDER AMERICANS
*PRIVATE MEDICARE PLANS REPLACE RETIREE COVERAGE
*OVERCROWDING AT ERs REACHES CRISIS LEVEL
*CASE FLASH: MEDICARE COVERAGE AFTER SSDI TERMINATION
1. FAST FACT
The number of American doctors specializing in primary care in U.S. residency
programs has decreased from 23,801 in 1995 to 22,146 in 2006, according to a
recent report by the Government Accountability Office. Senator Bernie Sanders,
Independent of Vermont, suggested the report reflects an increasing dependence
on international providers for primary care and recommended Congress offer more
scholarships to American students interested in specializing in primary care
("Primary Care Professionals: Recent Supply Trends, Projections, and Valuation
of Services
(http://www.kintera.org/TR.asp?a=esJVKaOMIjLOJ9J&s=twK9JlNVKeI2JgO4E&m=edLIIPOuFjIVF),"
Government Accountability Office, February 11, 2008).
2. MEDICATION ERRORS COMMON AMONG OLDER AMERICANS
Over 375,000 older Americans become ill or die from medication errors each
year, according to a recent study published in the Journal of the American
Medical Association. Researchers found that a total of 1.5 million Americans
suffer adverse drug reactions from noncompliance or mistakes in their drug
regimens every year. Although Americans over 65 make up just 12 percent of the
population, they account for one-fourth of the adverse reactions.
Researchers found that miscommunication among patients, physicians and
pharmacists over drug regimens, incompatible use of both over-the-counter and
prescription drugs, and patients' failure to follow directions are the most
common causes for medication errors.
The authors propose expanding e-prescribing to reduce the number of medication
errors. E-prescribing would allow doctors to prescribe medications
electronically and route them directly to patients' pharmacies. With an
electronic record of the patients' medications, doctors and pharmacists can
detect errors or potential drug interactions more quickly and prescribe
medications that will be covered by each patient's drug plan.
Dr. Michael Williams summed up the benefits of electronic prescribing to Senior
Spectrum, stating that "with e-prescribing I make prescribing decisions based
on drug-to-drug interactions, allergies and coverage rules, in addition to my
patients' clinical needs."
Experts, however, recognize that electronic prescribing would not completely
eliminate the potential for medication errors among older Americans. Many older
adults have difficulty organizing and administering their medications,
prompting researchers to suggest that in addition to e-prescribing, pharmacists
should provide older adults with controlled dispensing systems, where
medications are provided in presorted packets with the specific date and time
the medication should be taken.
3. PRIVATE MEDICARE PLANS REPLACE RETIREE COVERAGE
Large employers are increasingly enrolling their retirees in private Medicare
health plans rather than providing coverage that wraps around Original
Medicare, according to a recent report in the Los Angeles Times. In 2007,
Michigan saved $40 million by moving retired teachers and public school workers
to private Medicare plans. Other states and corporations have followed suit,
announcing plans to replace medical coverage for retirees over 65 with private
Medicare coverage in the coming months.
Employers are primarily looking to private-fee-for-service (PFFS) plans, which
are Medicare plans that operate without provider networks and with little
federal regulation, to replace coverage for older retirees. PFFS plans are a
popular choice because recipients can access coverage anywhere in the country
if their provider accepts the plan's payment terms.
Employers also find the plans to be a cheaper method of bridging gaps in
Medicare, particularly when compared to supplemental coverage like Medigaps.
Private Medicare health plans can charge employers lower premiums because of
the subsidies they receive from the federal government to replace Original
Medicare coverage. PFFS plans are paid on average 117 percent of the cost of
providing coverage under Original Medicare.
Critics contend that Michigan's move to place 100,000 retirees in private
Medicare programs does not save money, but simply shifts the cost of providing
coverage from the state to the federal government. Cost-shifting through PFFS
plans in particular will likely accelerate the depletion of the Medicare trust
fund, which is already strained by overpayments to private Medicare plans, and
will continue to increase Part B premiums for all people with Medicare.
Administrators at the Centers for Medicare & Medicaid Services are still unable
to provide the rate at which employers are shifting retiree coverage to private
Medicare plans, as there is not yet a federal "reporting mechanism" to monitor
the trend. However, Eastman Kodak, IBM and Xerox, as well as the Kentucky and
Pennsylvania state governments, have all recently announced plans to use
private Medicare health plans in place of retiree supplemental medical
coverage.
4. OVERCROWDING AT ERs REACHES CRISIS LEVEL
Overcrowding at American emergency rooms has reached "crisis levels," and will
likely prevent the nation's emergency care network from sustaining its role as
a safety net for uninsured and low-income Americans, according to several
recent studies covered in the Los Angeles Times.
The American College of Emergency Physicians surveyed 1,000 emergency room
doctors in September, and found that one in five doctors, or 20 percent, had
seen a patient die while waiting for emergency care. Emergency room wait times
for chronically ill patients are up 150 percent from 1997, forcing those
suffering from heart ailments to wait, on average, a full hour before receiving
emergency care.
In 2006, the National Institute of Medicine warned that emergency rooms in the
United States had reached a "breaking point," as increasing demand surpassed
the dwindling number of beds available. Insurance companies have cut payment
rates for emergency care, leaving little funding for emergency departments to
take on increasing numbers of uninsured and chronically ill patients who seek
emergency care and cannot afford to pay.
More recently, doctors have seen emergency rooms resort to "boarding," where
patients are placed on gurneys in hospital hallways, to wait until beds become
available. Lark Galloway-Gilliam, executive director of Community Health
Councils, which advocates for improved access to health care, describes the
situation as desperate. She told the Los Angeles Times, "We now see patients
getting sicker and going to ERs, and the ERs don't have the capacity to deal
with this volume and level of illness."
5. CASE FLASH: MEDICARE COVERAGE AFTER SSDI TERMINATION
Mr. V is a 52-year-old man who permanently injured his arm in a car accident a
few years ago. Due to his disability, Mr. V has had Medicare as his primary
insurance for the past two years. Mr. V's employer insurance has been his
secondary coverage because the business where he works has fewer than 100
employees.
In the last year, Mr. V's condition did not medically improve, but his ability
to work improved dramatically. Mr. V got a notice from Social Security in
January stating that because he has been able to do a substantial amount of
work, his Social Security Disability Insurance (SSDI) would be terminated at
the end of his nine-month trial work period. Mr. V needed to find out how long
he would continue to have health coverage through Medicare.
Mr. V called the Medicare Rights Center and asked the hotline counselor how
having his SSDI discontinued would affect his Medicare coverage. The counselor
first reminded Mr. V that he has the right to appeal Social Security's decision
to terminate his disability benefits. The counselor then told Mr. V that if he
were not working, all of his Medicare coverage would terminate at the end of
February, or the month after the month that he got the termination notice from
Social Security.
However, because he was continuing to work and because his condition had not
medically improved, his Medicare coverage would remain active for 93 months
after the month that he got the termination notice from SSA (after completion
of the 9-month trial work period). All of his Medicare coverage would end at
this time. At the end of this 93-month period, Mr. V's employer insurance would
be his primary insurance again.
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Medicare Watch is MRC's fortnightly newsletter, established to strengthen
communication with national and community-based organizations and professional
agencies about current Medicare policy and consumer issues. Each edition
contains news of recent policy developments affecting Medicare and health care
generally and a case story from our hotline that illustrates steps
professionals can take to get older adults and people with disabilities the
health care they need.
The Medicare Rights Center (MRC) is the largest independent source of Medicare
information and assistance in the United States. Founded in 1989, MRC helps
older adults and people with disabilities get high-quality, affordable health
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