Medicare Part D associated with reduction in nondrug medical spending

ScienceDaily (July 26, 2011) — Among elderly Medicare beneficiaries with limited prior drug coverage, implementation of Medicare Part D was associated with significant reductions in nondrug medical spending, such as for inpatient and skilled nursing facility care, according to a study in the July 27 issue of JAMA.See Also:Health & MedicinePharmacologyToday's HealthcareHealth PolicyPersonalized MedicineHIV and AIDSControlled SubstancesReferencePalliative carePharmaceutical companyDetoxClinical trial

"Implementation of the Medicare prescription drug benefit (Part D) in January 2006 was followed by increased medication use, reduced out-of-pocket costs, and improved adherence to essential medications for elderly persons. The effects of Part D on nondrug medical spending for Medicare beneficiaries have not been clearly defined," according to background information in the article.

J. Michael McWilliams, M.D., Ph.D., of Harvard Medical School and Brigham and Women's Hospital, Boston, and colleagues compared nondrug medical spending for traditional Medicare beneficiaries before and after the implementation of Part D. Nationally representative survey data and linked Medicare claims from 2004-2007 were used to compare nondrug medical spending before and after the implementation of Part D by self-reported generosity of prescription drug coverage (extent to which medications were mostly or completely covered) before 2006. Participants included 6,001 elderly Medicare beneficiaries from the Health and Retirement Study, including 2,538 with generous and 3,463 with limited drug coverage before 2006.

Adjusted total nondrug medical spending before implementation of Part D was consistently but not significantly higher for participants with limited drug coverage than for participants with generous drug coverage (7.6 percent relative difference). The researchers found that nondrug medical spending after Part D implementation was 3.9 percent lower for participants with limited prior drug coverage than for those with generous prior drug coverage, which was a significant differential

Health-care reform must involve psychologists, medical providers, educate patients, expert says

ScienceDaily (July 21, 2011) — While some members of the U.S. Congress and others are trying to repeal the healthcare reform law that was passed in 2010, known as the "Patient Protection and Affordable Care Act," medical providers have begun to implement requirements as the law slowly phases in over the next several years. For reform to be successful, one University of Missouri public health expert has determined that professional associations for psychologists and other medical providers need to be at the forefront of the planning stages, and that everyone, including providers and patients, will need to be educated on rights and responsibilities.See Also:Health & MedicineToday's HealthcareHealth PolicyMind & BrainMental HealthChild DevelopmentScience & SocietyPublic HealthPrivacy IssuesReferenceAthletic trainingPsychologistPhysical therapyPhysical trauma

"We looked at psychology departments here in the United States and in other countries to determine what worked best when implementing the policies outlined in healthcare reform," said Nancy Cheak-Zamora, assistant professor of health science in the MU School of Health Professions. "Many providers, especially psychologists, work independently, but the new healthcare law is encouraging providers to develop a medical team approach, one that can tackle many different aspects of a disease."

The new law encourages providers to bundle payment methods, study best practices, and develop accountable care organizations (ACO), which are formal groups or institutions that include teams of general practitioners and specialists taking a team approach to patient care. ACOs will have a financial stake in the outcomes of their patients. These changes could force a major shift in health care providers' practices, including those in psychology and rehabilitation. Physicians and psychologists, and specifically rehabilitation psychologists, need to move away from the traditional model of considering mental and behavioral health care services as separate from medical care, Cheak-Zamora said.

Cheak-Zamora said that large professional organizations, such as the American Psychological Association, should take the lead to help form expectations and policies for the team approach. Simultaneously, new psychologists should be trained to work in a team with other medical providers. Benefits of a medical team include reduced unnecessary procedures, less paperwork, better coordination with other providers and specialists, and better monitoring of prescriptions to discourage abuse or unintended drug interaction.

In her analysis, which is being published as a chapter in The Oxford Handbook of Rehabilitation Psychology by Oxford University Press, Cheak-Zamora also found that patients and providers need to be educated about the current system, how to access care, how to get questions addressed, and how to get the quality care patients deserve.

"With the implementation of healthcare reform, many patients might have been uninsured or underinsured for so long that they no longer know how the system is supposed to benefit them," Cheak-Zamora said. "They need to know how to access insurance information and utilize the system effectively."

Additionally, medical staff will need to be trained to handle requests through the new system, and how to work with individuals that do not have experience with insurance.

"Healthcare reform is an outline of what the government wants. Policymakers are working to develop policies, so now is the time to air any concerns and help shape a policy that works for everyone," she said.

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