Category Archives: Medicare

Think Twice about Medicare Advantage

It is that time of year again. The time of the year when many people are choosing their health insurance plan for the next year. People really need to pay attention to more than just the medicare-dis-advantage-780x490premium rates.

“I’m seeing more and more patients in my clinic with Medicare Advantage insurance plans. They’re stunned when they find out it’s not the same as traditional Medicare. Not all procedures and medicines are covered,” says Dr. Edward Hughes, Medical Director of First Dayton Cancer Care. Dr. Hughes’ experience is not the exception. Medicare Advantage plans have doubled in the past 9 years and now cover over 15 million seniors.

Medicare Advantage is run by private companies, unlike traditional Medicare, which is run by the federal government.

A recent study by the Wharton School of the University of Pennsylvania asked the question and was titled, “Who benefits When the Government Pays More? Pass-through in the Medicare Advantage Program.” Mark Duggan, a Wharton professor and co-author of the study, said “We’re talking about billions of dollars in additional government spending … I was somewhat surprised to see so little benefit passing through to consumers in the form of better benefits. We see more people enroll and we see more advertising expenditures. But we actually don’t see much better quality when you pay plans more.”

Rather than respond with a Congressional hearing, Congress instead gave Medicare Advantage a 0.4% increase in lieu of a planned 1.9% cut.

What’s the senior to do? Dr. Hughes recommends that “before you sign up for Medicare Advantage, look carefully and read your policy’s coverage for major illnesses that are likely to happen to seniors, like diabetes, heart disease, cancer, and COPD. Your quality of life and financial health depend on it.”

Why is Medicare trying to Destroy Free Standing Practices?

Dr. Hughes is actively involved in working with Ohio politicians to ensure that you have access to the healthcare that you deserve. Here is a letter that Dr. Hughes sent to our Congressman, Senators and local representatives. If you would like to help in this fight for better quality healthcare at a fair price, we recommend that you contact your representatives as well.

In sum and substance, CMS (Medicare) continues to undervalue payment to freestanding radiation oncology centers. I call your attention to a letter from the American College of Radiation Oncology that was sent to Mr. Andrew Slavitt, the acting administrator of CMS.

The most egregious finding is that CMS facility-based payments to freestanding cancer centers have declined 24.2% between 2005 and 2016, while facility-based payments to hospitals have increased 16.7%. The data are found on page 3 of the letter. The differential is enormous-40.9%

I am sure you are familiar with the legal term “Qui Bono?” I understand from my reading of a legal dictionary that the Latin words mean “As a Benefit to Whom?”

So permit me to ask you, who benefits from the proposed further reduction of CMS payments to freestanding oncology centers?

1). Certainly not Medicare patients who will pay more out of pocket for exactly the same services delivered by the exactly same equipment in the hospital verses freestanding centers.

2). Certainly not CMS and ultimately the taxpayers who will pay more for exactly the same services delivered in the hospital versus in freestanding centers.

So why single out freestanding cancer centers for continued dramatic reductions in payments? After all, freestanding radiation oncology centers now represent only a small fraction of CMS payments for radiation oncology services across the country. In fact, in the state of Ohio, only 5 freestanding cancer centers are left. The vast majority have been acquired at bargain basement prices or from bankruptcies over the past several years. So why try to drive us out of business?

Let me propose that it’s the Big Hospitals who benefit most from further reduction in payments to freestanding oncology centers. The proposed CMS reduction will be the death knell for the 5 remaining freestanding oncology centers in Ohio.

With the only competition eliminated, Big Hospitals will be emboldened to charge more for their services, especially from private carriers. CMS will have no alternative. Prices will rise, access will be limited and quality care will decrease.

RECOMMENDATION:   I urge you to call Mr. Slavitt and recommend against further reduction in CMS payment to freestanding radiation oncology centers. I would request that you at least put us on par with the payment to hospitals.

 

Medicare Has Good News About Lung Cancer

Medicare now covers lung cancer screenings.

MEDICARE NOW COVERS                     LUNG CANCER SCREENINGS

The good news is that CMS (Medicare) has finally appreciated the results of the 2012 National Lung Screening Trial. Medicare has now approved payment for low dose CT scan screening of Americans, ages 55-70, who currently have smoked at least one pack per day for the past 30 years, 2 packs a day for 15 years or those who stopped smoking within the past 15 years and smoked these quantities.  The results from the National Lung Screening Trial were dramatic: 25,000-30,000 Americans will be saved each and every year from the ravages of lung cancer when it is detected early.

The better news is that more and more patients will be discovered with early stage lung cancer when the disease is highly curable.  Does that necessarily mean surgery?  Maybe or maybe not.  I believe that the days of a surgeon making unilateral decisions for patients are over.  The diagnosis of early stage lung cancer is not an emergency.  Patients and their families have time to make informed choices.  Patients need to be actively involved in their treatment decisions.

There are 2 key facts for patients and their families to consider in a shared medical decision.  Firstly, prospective patients need to be told about a major study that was first reported in the Journal of the AMA Surgery http://archsurg.jamanetwork.com/article.aspx?articleid=1915585in late 2014.  Over 9,000 early stage lung cancer patients were analyzed in the SEER-Medicare database.  The research showed that open surgery with lobectomy was superior to wedge resection.  The remarkable finding was that patients who were treated with stereotactic ablative body radiotherapy, like that delivered with CyberKnife, had results equivalent to those patients who underwent lobectomy.  And better than wedge resection surgery. That is to say, 3-5 treatments with state-of-the-art radiation produced the same results as lung surgery, but without pain, without an incision, without a prolonged hospital stay, and few complications.  Secondly, the risks of lobectomy operative mortality, death within 30 days of an open operation, is 1-2% at major institutions who performed the procedure on a routine basis.  But the death rate from surgery at community hospitals may be many times greater. The risk increases with an inexperienced surgeon.

So what’s a patient to do?  I think the smart choice is to get a second opinion, especially from a physician who specializes in stereotactic ablative radiotherapy.  I know firsthand that the diagnosis of lung cancer is terrifying.  But what you don’t know may even kill you. Find out more for yourself.

 

Local Doctor Says Think Twice About Medicare Advantage

“I’m seeing more and more patients in my clinic with Medicare Advantage insurance plans. They’re stunned when they find out it’s not the same as traditional Medicare. Not all procedures and medicines are covered,” says Dr. Edward Hughes, Medical Director of First Dayton Cancer Care. Dr. Hughes’ experience is not the exception. Medicare Advantage plans have doubled in the past 9 years and now cover over 15 million seniors.

Medicare Advantage is run by private companies, unlike traditional Medicare, which is run by the federal government.

A recent study by the Wharton School of the University of Pennsylvania asked the question and was titled, “Who benefits When the Government Pays More? Pass-through in the Medicare Advantage Program.” Mark Duggan, a Wharton professor and co-author of the study, said “We’re talking about billions of dollars in additional government spending … I was somewhat surprised to see so little benefit passing through to consumers in the form of better benefits. We see more people enroll and we see more advertising expenditures. But we actually don’t see much better quality when you pay plans more.”

Rather than respond with a Congressional hearing, Congress instead gave Medicare Advantage a 0.4% increase in lieu of a planned 1.9% cut.

What’s the senior to do? Dr. Hughes recommends that “before you sign up for Medicare Advantage, look carefully and read your policy’s coverage for major illnesses that are likely to happen to seniors, like diabetes, heart disease, cancer, and COPD. Your quality of life and financial health depend on it.”