Issues with Medicare

Within the past six months, the Centers for Medicare & Medicaid Services (CMS) has been in the news for several major issues. The CMS, “announced a new project that seeks to test the feasibility of integrating Medicare claims history information with other Internet-based tools, which could ultimately allow people with Medicare to track their health care services and monitor their health care.” (Managed Care Outlook, May 15, 2006) <http://web.lexis-nexis.com.db.usip.edu/universe/document?_m=782fa44a8b52417bb9c57e11ddc5fc91&_docnum=11&wchp=dGLbVzz-zSkVb&_md5=43b0ba06598325bb58e7dfa57653fb2e>

This project, which is contracted with ViPS and Capstone Government Solutions, is scheduled for a six month trial to transfer Medicare claims data into personal health records (PHRs). Patients will be able to keep track of their personal health records by entering their prescribed medication drugs on a website and retrieving it with a password and confirmation number. Bringing one’s prescribed medication to the doctor’s office will be a thing of the past if this project is a success.

Mark B. McClellan, head of the Centers for Medicare and Medicaid Services announced in early September that he was going to resign from his office in order to spend more time with his family. Besides overseeing Medicare and Medicaid services, McClellan’s “signature task was overseeing the implementation of the new Medicare prescription drug benefit, which now helps more than 3 million seniors pay for their prescription medications.” (The Washington Post, September 6, 2006 Wednesday Correction Appended, Final Edition, A Section; A13, 696 words, Christopher Lee, Washington Post Staff Writer) < http://web.lexis-nexis.com.db.usip.edu/universe/document?_m=86a21526bc31c9160aed87082f444eba&_docnum=3&wchp=dGLbVzb-zSkVA&_md5=25c1ae2fffac8fae84a77da91e9dd41b> Although the new Medicare prescription drug benefit seemed like a great idea, many seniors were confused about the enrollment process and benefit coverage. Not only were seniors confused, but health providers and pharmacists had a difficult time understanding the benefit coverage from all the different plans. With the start of any new initiative, confusion always sprout up from all angles, but as time passes and more resources are available, the general public will start to have a better comprehension of the new Medicare prescription drug benefit plan.

Another new initiative that CMS hopes to be successful is their reimbursement for alcohol and drug screening and brief intervention (SBI). This initiative is scheduled to start next year, January 2007. According to Bertha Madras, deputy director of Demand Reduction from the White House Office of National Drug Control Policy, “About 22 million Americans have abuse and/or addiction problems; of these, about 10% are in treatment, and the vast majority of the rest are not in treatment, not because there is a problem with the system, but because they don't recognize the fact that they have a problem. Most do not seek help and remain unidentified." (http://www.medscape.com/viewarticle/544548) The goal of the program is to reduce cost and increase awareness of the detrimental effects that drugs and alcohol have on the body.

With the departure of Mark McClellan, CMS was faced with finding a replacement for the organization to move forward with its agenda. However, the Bush administration found his temporary replacement to be Leslie Norwalk, a lawyer who has also served on the Bush administration and the senior leadership team at CMS for the past five years as the deputy administrator. Leslie has been “a nationally recognized expert on Medicare issues and played a central role in the successful implementation of the prescription drug benefit and other reforms to Medicare and Medicaid,” said Mike Leavitt, secretary of the Health and Human Services Department. (http://www.washingtonpost.com/wp-dyn/content/article/2006/09/25/AR2006092501002.html)