medicare

Many patients in the US struggle to afford their prescription drugs. The inability to take medications as prescribed can lead to worse health outcomes.

Below are 7 strategies that patients can use to respond to high prescription drug costs in the US.

Author/s:

Kristin L Walter

Interventional Treatments for Acute and Chronic Pain: Systematic Review

Bethie Seay — Mon, 13 Sep 2021 05:00:00 +0000

Date Added:

September 13, 2021

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.23970/AHRQEPCCER247

A review of the evidence regarding the use of vertebroplasty, kyphoplasty, and cool radiofrequency denervation for acute and chronic back pain.

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Objective. To evaluate the benefits and harms of selected interventional procedures for acute and chronic pain that are not currently covered by the Centers for Medicare & Medicaid Services (CMS) but are relevant for and have potential utility for use in the Medicare population, or that are covered by CMS but for which there is important uncertainty or controversy regarding use.

Data sources. Electronic databases (Ovid® MEDLINE®, PsycINFO®, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews) to April 12, 2021, reference lists, and submissions in response to a Federal Register notice.

Review methods. Using predefined criteria and dual review, we selected randomized controlled trials (RCTs) for 10 interventional procedures and conditions that evaluated pain, function, health status, quality of life, medication use, and harms. Random effects meta-analysis was conducted for vertebral compression fracture; otherwise, outcomes were synthesized qualitatively. Effects were classified as small, moderate, or large using previously defined criteria.

Results. Thirty-seven randomized trials (in 48 publications) were included. Vertebroplasty (13 trials) is probably more effective at reducing pain and improving function in older (>65 years of age) patients, but benefits are small (less than 1 point on a 10-point pain scale). Benefits appear smaller (but still present) in sham-controlled (5 trials) compared with usual care controlled trials (8 trials) and larger in trials of patients with more acute symptoms; however, testing for subgroup effects was limited by imprecision. Vertebroplasty is probably not associated with increased risk of incident vertebral fracture (10 trials). Kyphoplasty (2 trials) is probably more effective than usual care for pain and function in older patients with vertebral compression fracture at up to 1 month (moderate to large benefits) and may be more effective at >1 month to ≥1 year (small to moderate benefits) but has not been compared against sham therapy. Evidence on kyphoplasty and risk of incident fracture was conflicting. In younger (below age for Medicare eligibility) populations, cooled radiofrequency denervation for sacroiliac pain (2 trials) is probably more effective for pain and function versus sham at 1 and 3 months (moderate to large benefits). Cooled radiofrequency for presumed facet joint pain may be similarly effective versus conventional radiofrequency, and piriformis injection with corticosteroid for piriformis syndrome may be more effective than sham injection for pain. For the other interventional procedures and conditions addressed, evidence was too limited to determine benefits and harms.

Conclusions. Vertebroplasty is probably effective at reducing pain and improving function in older patients with vertebral compression fractures; benefits are small but similar to other therapies recommended for pain. Evidence was too limited to separate effects of control type and symptom acuity on effectiveness of vertebroplasty. Kyphoplasty has not been compared against sham but is probably more effective than usual care for vertebral compression fractures in older patients. In younger populations, cooled radiofrequency denervation is probably more effective than sham for sacroiliac pain. Research is needed to determine the benefits and harms of the other interventional procedures and conditions addressed in this review.

Author/s:

Chou, R., Fu, R., Dana, T., Pappas, M., Hart, E., Mauer, K. M.

Quick Guide to Primary Care First

Devin Evans — Wed, 24 Mar 2021 05:00:00 +0000

Date Added:

March 24, 2021

Publisher:

Center for Medicare and Medicaid Innovation

Publication Date:

February 18, 2021

URL:

Quick Guide to Primary Care First

Type:

Notifications and Opportunities

Format:

Slides

Keywords

MeSH

This appears to be an opportunity to test value-based purchasing for CMS. The due date for applications is May 28. James W. Mold, MD, MPH

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Primary Care First is a voluntary five-year payment model that rewards value and quality by offering an innovative payment structure to support advanced primary care delivery. Primary Care First aims to improve quality and access to care for all patients, particularly those with complex chronic conditions. The model also aims to reduce Medicare spending by preventing avoidable inpatient hospital admissions.

Author/s:

Primary Care First

Prevention, Diagnosis, and Management of Chronic Wounds in Older Adults

Brian Desmarais — Thu, 09 Apr 2020 00:38:07 +0000

Date Added:

April 8, 2020

Journal/Publication:

Mayo Clinic Proceedings

Publication Date:

October 1, 2020

URL:

Prevention, Diagnosis, and Management of Chronic Wounds in Older Adults

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1016/j.mayocp.2019.10.014

Keywords

MeSH

A nice review of chronic wound prevention and care principles from Mayo. James W. Mold, MD, MPH

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Chronic wounds are common, disproportionately affect older adults, and are likely to be encountered by providers across all specialties and care settings. All providers should be familiar with basic wound prevention, identification, classification, and treatment approach, all of which are outlined in this article.

Author/s:

Hoversten, K.P., Kiemele, L.J., Stolp, A.M., Verdoorn, B.

How to use ICD-10-CM, new lab testing codes for COVID-19

Brian Desmarais — Sat, 14 Mar 2020 20:23:31 +0000

Date Added:

March 14, 2020

Journal/Publication:

AAP News

Publisher:

American Academy of Pediatrics

Publication Date:

March 12, 2020

URL:

How to use ICD-10-CM, new lab testing codes for COVID-19

Type:

Practice Management Reviews and Guidelines

Format:

Web Page

Keywords

coding

MeSH

International Classification of Diseases

severe acute respiratory syndrome coronavirus 2

delivery of health care

health resources

Respiration Disorders

SARS Virus

Respiratory System

Healthcare Common Procedure Coding System

medicare

Fee Schedules

Health Planning

Advice regarding how to code for testing and management of patients with COVID-19 symptoms and infection. James W. Mold, MD, MPH

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Not available.

Author/s:

AAP Division of Health Care Finance

Summary of Revisions: Standards of Medical Care in Diabetes—2020

John Bayhi — Sat, 14 Mar 2020 19:35:38 +0000

Date Added:

March 14, 2020

Journal/Publication:

Diabetes Care

Publisher:

American Diabetes Association

Publication Date:

January 1, 2020

Issue:

Supplement 1

Volume:

Pages:

S4-S6

URL:

Summary of Revisions: Standards of Medical Care in Diabetes—2020

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.2337/dc20-Srev

Keywords

PMID (1):

31862743

MeSH

Sodium-Glucose Transporter 2 Inhibitors

Diabetic Ketoacidosis

Ficus

Glucagon-Like Peptide-1 Receptor

glycated hemoglobin a

cardiovascular diseases

Consensus

Farmers

Cystic Fibrosis

Transients and Migrants

Pharmaceutical Preparations

depression

Smell

Patient Comfort

electronic nicotine delivery systems

Blood Glucose Self-Monitoring

celiac disease

follow-up studies

Latent Autoimmune Diabetes in Adults

seasons

social determinants of health

Standard of Care

Time-to-Treatment

united states food and drug administration

risk reduction behavior

Centers for Disease Control and Prevention

glucagon-like peptide 1

anxiety disorders

Feeding and Eating Disorders

thyroid diseases

Infections

This is a three-page summary of the 2020 updates to the ADA Guidelines for Type 2 diabetes. James W. Mold, MD, MPH

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No abstract available.

Comparative Effectiveness of Different Treatment Pathways for Opioid Use Disorder

John Bayhi — Fri, 07 Feb 2020 13:59:45 +0000

Date Added:

February 7, 2020

Journal/Publication:

JAMA Network Open

Publisher:

American Medical Association

Publication Date:

February 5, 2020

Issue:

Volume:

Pages:

e1920622

URL:

Comparative Effectiveness of Different Treatment Pathways for Opioid Use Disorder

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamanetworkopen.2019.20622

Keywords

PMID (1):

32022884

MeSH

retrospective studies

Inpatients

outpatients

Comparative Effectiveness Research

opioid-related disorders

If the goal is to reduce overdoses and ED visits, the best treatment options appear to include buprenorphine or methadone. James W. Mold, MD, MPH

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IMPORTANCE:

Although clinical trials demonstrate the superior effectiveness of medication for opioid use disorder (MOUD) compared with nonpharmacologic treatment, national data on the comparative effectiveness of real-world treatment pathways are lacking.

OBJECTIVE:

To examine associations between opioid use disorder (OUD) treatment pathways and overdose and opioid-related acute care use as proxies for OUD recurrence.

DESIGN, SETTING, AND PARTICIPANTS:

This retrospective comparative effectiveness research study assessed deidentified claims from the OptumLabs Data Warehouse from individuals aged 16 years or older with OUD and commercial or Medicare Advantage coverage. Opioid use disorder was identified based on 1 or more inpatient or 2 or more outpatient claims for OUD diagnosis codes within 3 months of each other; 1 or more claims for OUD plus diagnosis codes for opioid-related overdose, injection-related infection, or inpatient detoxification or residential services; or MOUD claims between January 1, 2015, and September 30, 2017. Data analysis was performed from April 1, 2018, to June 30, 2019.

EXPOSURES:

One of 6 mutually exclusive treatment pathways, including (1) no treatment, (2) inpatient detoxification or residential services, (3) intensive behavioral health, (4) buprenorphine or methadone, (5) naltrexone, and (6) nonintensive behavioral health.

MAIN OUTCOMES AND MEASURES:

Opioid-related overdose or serious acute care use during 3 and 12 months after initial treatment.

RESULTS:

A total of 40 885 individuals with OUD (mean [SD] age, 47.73 [17.25] years; 22 172 [54.2%] male; 30 332 [74.2%] white) were identified. For OUD treatment, 24 258 (59.3%) received nonintensive behavioral health, 6455 (15.8%) received inpatient detoxification or residential services, 5123 (12.5%) received MOUD treatment with buprenorphine or methadone, 1970 (4.8%) received intensive behavioral health, and 963 (2.4%) received MOUD treatment with naltrexone. During 3-month follow-up, 707 participants (1.7%) experienced an overdose, and 773 (1.9%) had serious opioid-related acute care use. Only treatment with buprenorphine or methadone was associated with a reduced risk of overdose during 3-month (adjusted hazard ratio [AHR], 0.24; 95% CI, 0.14-0.41) and 12-month (AHR, 0.41; 95% CI, 0.31-0.55) follow-up. Treatment with buprenorphine or methadone was also associated with reduction in serious opioid-related acute care use during 3-month (AHR, 0.68; 95% CI, 0.47-0.99) and 12-month (AHR, 0.74; 95% CI, 0.58-0.95) follow-up.

CONCLUSIONS AND RELEVANCE:

Treatment with buprenorphine or methadone was associated with reductions in overdose and serious opioid-related acute care use compared with other treatments. Strategies to address the underuse of MOUD are needed.

Author/s:

Wakeman, SE, Larochelle, MR, Ameli, O, Chaisson, CE, McPheeters, JT, Crown, WH, Azocar, F, Sanghavi, DM

Patients Over Paperwork

Brian Desmarais — Wed, 12 Jun 2019 19:04:56 +0000

Date Added:

June 12, 2019

Publisher:

Centers for Medicare and Medicaid Services

URL:

Patients Over Paperwork

Type:

Notifications and Opportunities

Format:

Web Page

Keywords

MeSH

Here’s your chance to make suggestions to CMS about how to put patients over paperwork and to see what others have suggested. James W. Mold, MD, MPH

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Patients Over Paperwork

We’re putting patients first by reviewing and streamlining our regulations so we can:

Reduce unnecessary burden
Increase efficiencies
Improve the beneficiary experience

Legal Advocacy To Improve Care For Older Adults With Complex Needs

Brian Desmarais — Mon, 20 May 2019 05:00:00 +0000

Date Added:

May 20, 2019

Journal/Publication:

Health Affairs

Publication Date:

May 17, 2019

URL:

Legal Advocacy To Improve Care For Older Adults With Complex Needs

Type:

Public Health Announcements

Format:

Web Page

Keywords

MeSH

A review of the important underappreciated role of legal advocates in supporting health care-related needs of older adults. James W. Mold, MD, MPH

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Legal advocacy is a recognized strategy to address social factors that influence the health of populations with complex care needs. Such advocacy can improve housing stability, increase access to public benefits that support a host of social needs, assure that medical and financial proxy decision makers are in place, and reduce psychosocial distress.

Author/s:

Hooper, Sarah, Parekh, Ami, Fabiny, Anne, Teitelbaum, Joel

Lung Cancer Screening: A Clinician’s Checklist

Jeffrey Wilson — Mon, 22 Oct 2018 16:17:09 +0000

Date Added:

October 22, 2018

Publisher:

Agency for Healthcare Research and Quality

Publication Date:

March 1, 2016

Issue:

URL:

Lung Cancer Screening: A Clinician’s Checklist

Type:

Clinical Decision Aids

Format:

Web Page

Keywords

MeSH

This is a checklist for use when helping smokers decide whether to be screened for lung cancer with low-dose CT.

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This checklist was developed to help clinicians meet the Centers for Medicare & Medicaid Services (CMS) criteria for a lung cancer screening counseling and shared decisionmaking visit. All of the criteria listed below must be met for the screening to be covered as a preventive service benefit under Medicare.

Lung cancer screening with low-dose computed tomography (LDCT) reduces mortality from lung cancer. There are also potential harms associated with lung cancer screening, including a high-false positive rate and the associated need for diagnostic followup, known and unknown risks of additional testing associated with incidental findings, cumulative radiation exposure, and overdiagnosis. Shared decisionmaking is a collaborative patient-centered process in which patients and clinicians make decisions together, within the context of the best evidence and recommendations and based on the patient’s values and preferences.

Medical-Legal Partnership

Tracy Ashby — Thu, 11 Oct 2018 05:00:00 +0000

Date Added:

October 11, 2018

Type:

Notifications and Opportunities

Keywords

MeSH

delivery of health care

poverty

This is an opportunity to collaborate with Legal Aid of OK to connect patients to legal services when appropriate

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In Oklahoma, 1 in 5 people live in poverty and also have at least one health-harming civil legal need. Creating a system to screen for these legal needs will allow us to address problems not otherwise attended to, reducing patient stressors and saving health care partner’s money in terms of reducing illness, increasing
adjustment rate payments and reimbursement potential. The Medical-Legal Partnership (MLP) model integrates civil legal aid attorneys in health care teams to address health-harming legal needs for low-income populations.

Author/s:

Legal Aid Services of Oklahoma, Inc.

Short- and Long-Term Outcomes after Bariatric Surgery in the Medicare Population

Jeffrey Wilson — Mon, 10 Sep 2018 13:05:36 +0000

Date Added:

September 26, 2018

Journal/Publication:

Technology Assessment Program

Publisher:

Agency for Healthcare Research and Quality

Publication Date:

January 7, 2018

Issue:

OBST0816

URL:

Short- and Long-Term Outcomes after Bariatric Surgery in the Medicare Population

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

Keywords

MeSH

technology assessment, biomedical

bariatric surgery

In Medicare-eligible patients, bariatric surgery overall leads to improvements in weight loss outcomes beyond one year after surgery. Roux-en-Y gastric bypass performs better compared to sleeve gastrectomy or adjustable gastric banding for weight loss, metabolic, cardiovascular outcomes, renal function outcomes and postoperative complications.

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Introduction. We conducted a technology assessment to summarize and appraise the current evidence regarding the effectiveness and safety of bariatric surgery in the Medicare-eligible population.

Data Sources. We searched six bibliographic databases and the reference lists of published clinical practice guidelines, relevant narrative and systematic reviews, and scientific information packages from manufacturers and other stakeholders on the outcomes and prediction models of different bariatric procedures studied in the Medicare-eligible population.

Results. Of 126 eligible studies, 83 described outcomes after bariatric therapy and 43 described predictors of body weight loss or absolute body weight after bariatric therapy. We did not identify any randomized clinical trials in the Medicare-eligible population. Studies examined surgical modalities. There were no studies on endoscopically-performed bariatric procedures. Only 15 studies had a design and/or analytical approach that allowed inferences for causal treatment effects on weight loss outcomes, adverse events/complications, or other non-weightloss outcomes. Bariatric surgery in the Medicare-eligible population leads to improvements in weight loss and non-weight-loss outcomes, particularly mortality, metabolic, cardiovascular, respiratory, and musculoskeletal outcomes, and polypharmacy but the strength of evidence is low to moderate. There is moderate evidence that Roux-en-Y gastric bypass performs better compared to sleeve gastrectomy or adjustable gastric banding for metabolic, cardiovascular, and renal function outcomes and for postoperative complications. Finally, no models to predict weight loss have undergone internal or external validation.

Conclusions. Relatively few nonrandomized studies examine the comparative effectiveness and safety of bariatric therapies in the Medicare population. Large gaps remain in regard to comparisons of individual bariatric surgical procedures to each other, and very limited evidence exists in regard to patient-centered outcomes such as quality of life after surgery.

Author/s:

Orestis, A. Panagiotou, Markozannes, Georgios, Kowalski, Rishi, Di, Mengyang, Bond, Dale S., Ryder, Beth A., Adam, Gaelen P., Trikalinos, Thomas A.