A New Jersey resident is so thankful for Medicare, he’s written a song about it. Well, not really a song – more like a symphony in four movements for a full symphony orchestra. The name of the piece is, appropriately, Symphony No. 1, Medicare.
Speaking to the New Jersey press, N. H. Derwyn Holder, 74, said he wrote the piece to express his gratitude for the Medicare program and all the help it provided when he underwent numerous medical procedures.
“I’m filled with gratitude that the assistance that I’ve needed was made available for me through the Medicare program, from the AARP supplemental insurance, and by the fine medical people who have helped me to be here today,” Holder told the Hunterdon County Democrat. Describing the music, Holder says, “Through it I wish to ‘give back,’ not tell a story. The Medicare Symphony is the biggest thing I could do. It is intended to sound as beautiful as I could possibly make it.”
Holder is currently trying to arrange a first performance of his Medicare Symphony by enlisting the help of musical colleagues he has worked with during the years. I’ll keep you posted if I find and where and when it’s going to be performed.
In the meantime, I bet we’d be pressed to find someone who is willing to write a symphony for America’s health care system in general…
Lately, there have been a lot of crazy rumors about Medicare spreading like wildfire on the Internet. Like the rumor that Medicare premiums are going to jump to $247 in 2014 thanks to the Affordable Care Act, or that Medicare is going to refuse procedures for seniors over 75 unless an ethics panel (aka, death panel) reviews them—again, thanks to Obamacare.
But this rumor that I came across today on the Huffington Post Politics blog is by far the most absurd falsehood I have heard yet: Apparently, a Vietnam Vet and/or retired police officer started spreading a rumor via e-mail that Medicare regulations require doctors to ask you if you own a gun. “Be forewarned and aware,” the e-mails state. “The Obama administration has gone on record as considering veterans and gun owners potential terrorists.”
There’s a long and convoluted story behind this rumor, which you can read for yourself on Snopes, but just know that this rumor is wrong and belongs way out in left field (or maybe that should be right field in this case). Although doctors (particularly pediatricians) in most states can ask patients if they own guns if the question is relevant to the person’s medical care or safety, this question is most definitely not required by Medicare.
So as I stated in my last post, don’t believe everything you read or hear. If you want to sort through the rumors and get to the truth, do some searches on Google to find reputable sources, or check out these fact-finding sites: www.politifact.com or www.snopes.com or www.factcheck.org
This morning I read in Kaiser Health News that only 1 percent of Medicare beneficiaries living in Hawaii have taken advantage of the free annual wellness visit they are entitled to, courtesy of healthcare reform. I immediately sent a tweet via Twitter to my friend Claire Santos, RN, who is a nurse and health communicator and educator in Hawaii. Claire, I tweeted, you now have a mission to increase awareness of preventive services covered by Medicare in your home state.
According to the Centers for Medicare & Medicaid Services, only 890 beneficiaries in the Aloha State have had a free wellness exam this year, which is the lowest percent of any state. Even worse, the state with the highest percentage of seniors who have taken advantage of the wellness visit is Rhode Island — coming in at just 8 percent.
Nationally, only about 3.6 percent of beneficiaries, or 1.1 million seniors, have had a wellness visit since January. Jim Firman, CEO of the National Council on Aging (NCOA), a nonprofit advocacy group, theorizes that many seniors simply do not know what additional Medicare benefits are provided in the Affordable Care Act. Speaking at a White House event highlighting benefits to seniors in the health law, Firman said of the annual wellness visit, “This is a really good benefit, but you have to use it to maximize the opportunity.”
What exactly is the annual Medicare wellness visit?
It’s important to understand that the wellness visit is not a physical exam. It’s actually just a great opportunity to talk to your doctor and develop or update a personalized prevention plan based on your current health and risk factors. Anyone who has had Medicare Part B for longer than 12 months is eligible for this annual visit, which includes:
• A review of medical and family history
• A list of current providers and prescriptions
• Height, weight, blood pressure, and other routine measurements
• A screening schedule for appropriate preventive services
• A list of risk factors and treatment options for you
Other preventive services covered by Medicare
Thanks to the Affordable Care Act, numerous preventive services are now provided free under Medicare. These services include various exams, shots, lab tests, and screenings, plus counseling and education to help you take care of your own health. This year, only 43 percent of Medicare beneficiaries, or about 14 million people, have taken advantage of the free care this year. CMS put out a great guide to Medicare’s preventive services, which I highly recommend you check out if you are among those eligible who have not yet taken advantage of these services – especially if you are among the 99 percent of beneficiaries in Hawaii who have not yet had your wellness visit.
By the way, if you’re wondering what “ola lāhui” means: According to online sources, it is defined as, “So that the people will live and thrive.” The term is often used with health care services or professionals — like my friend Claire — to show intent to improve the health and being of the Hawaiian people.
As I mentioned in my last post, I’ve been writing a letter that invites my company’s Part D plan members to participate in Medicare’s Medication Therapy Management (MTM) program. The main feature of the Medicare MTM program is an annual comprehensive medication review, which includes a review of all medications, vitamins, and supplements with a pharmacist; a written summary and medication action plan to share with doctors; and a personal medication list.
The letter has been written and approved, but I still have my doubts that it is going to convince people to take advantage of this free program. For some reason—well, many reasons—seniors who take a lot of medications just don’t think they need an annual medication review, even if their health and safety is at risk.
Aging and multiple medications increase your health risks
But here’s the hard truth, plain and simple: If you take multiple medications, your chances of ending up in the hospital because of dangerous side effects or a harmful drug interaction are pretty high. To make matters worse, aging increases your risk for medication side effects.
If you take multiple medications, you’re not alone
The average older American uses 4-5 prescription drugs and 2 over-the-counter medications. The average nursing home resident uses at least 7-8 prescription drugs. Here are a few other facts to consider:
• The more medications you take, the more chance there is for those drugs to interact negatively with each other — or with vitamins, supplements, and even certain foods.
• You may think the symptoms of such harmful interactions are normal, such as an upset stomach or feeling tired. Or you may not notice any symptoms at all.
• If you are taking multiple drugs, there also is a greater risk of forgetting to take medications, taking them at the wrong time, or taking too much or too little.
• The more drugs you take, the more likely at least one of those drugs is not necessary.
The MTM comprehensive medication review is just what the doctor ordered
Let’s face it. It’s not always easy to keep track of your drugs or know how to use them safely. That’s why the Institute of Medicine encourages people to participate actively in the healthcare process to prevent medication-related problems. One of the things that doctors suggest is a medication review with a healthcare provider at least once a year.
So what are you waiting for?
I hope I have encouraged at least a few seniors to participate in their Medicare prescription drug plan’s MTM program. And I hope you say “yes” if your plan invites you to have a comprehensive medication review with a pharmacist. Your health and safety depend on it.
Like all Medicare prescription drug plans, the Part D plan that I write for offers a special health benefit called a Medication Therapy Management (MTM) program. MTM programs are designed to help Medicare beneficiaries ensure their medications are working safely and effectively for the best possible clinical outcomes.
My assignment this week was to write a letter to all our plan members who are eligible for MTM this year. Not just any letter, but a compelling letter that encourages seniors to say “yes” to a free service that even many doctors recommend for patients who are taking multiple medications.
Easier said than done.
The MTM comprehensive medication review
The standard Medicare MTM program includes an annual comprehensive medication review for the beneficiary, which includes a review of all medications, vitamins, and supplements with a pharmacist; a written summary of the consultation and medication action plan to share with doctors; and a personal medication list. All Medicare Part D sponsors are required to provide this service at no extra charge for members meeting the following MTM eligibility criteria:
• Have multiple chronic diseases
• Are taking multiple Part D covered drugs
• Are likely to spend more than a specific amount on Part D drugs during the year ($3,100 in 2012)
Although the people who concocted the Medicare Modernization Act of 2003 probably had good intentions when they set the guidelines for the MTM program, it appears that few seniors are actually taking advantage of the services the program provides.
Part of the reason why MTM participation is low is because the Centers for Medicare & Medicaid Services (CMS) places all the burden on the Part D sponsor: Plans must offer MTM services to all eligible beneficiaries each year, but participation is optional and must be sought out through letters or phone calls. Hence, my assignment to write a letter that makes members want to accept the free offer.
Low participation could also be due to neutral or even negative perceptions of the MTM program, and in particular, of comprehensive medication reviews (CMRs). In a 2011 focus group study conducted by the University of Iowa College of Pharmacy, the majority of participants said they were not interested in the CMR, even though they are taking multiple medications and have a high medication risk rating.
Here are some responses they gave when asked why they did not want a CMR:
• Although I have multiple doctors and multiple medications, I consider myself at a low risk for a medication-related problem.
• The counseling I receive from my pharmacist is adequate so I don’t need a comprehensive review.
• This would be a waste of time for me because my pharmacist already talks to me whenever I have a new medication.
• My doctor should do this; not my pharmacist.
• I wasn’t aware that my Part D program offered this.
My recommendation to CMS: If you really want to help Medicare beneficiaries ensure all their medications are working together safely and effectively, don’t put the onus on Part D sponsors. Make the MTM program truly mandatory: Everyone who is eligible for the program must show proof of active participation in order to receive the prescription drug benefit. If that’s not possible — and it probably is not — than at least help sponsors out with outreach on your own CMS letterhead. Maybe a letter or phone call from CMS will work better — it’s worth a try.
Then maybe I won’t have to write a compelling letter that gets, at best, 5% of our eligible members to participate in MTM.
In Part II next week, I’ll talk about why CMRs are just what the doctor ordered.
“Curing nonadherence could pay for the health care of 44.8 million Americans.” —Express Scripts 2011 Drug Trend Report
According to the Express Scripts 2011 Drug Trend Report, 30 percent of adults with high cholesterol do not take their medications as prescribed. For those with high blood pressure or heart disease, 31 percent do not adhere to their therapy. An even greater number of patients with diabetes—43 percent–are nonadherent.
These are very disturbing numbers, especially when Medicare is allegedly on the verge of bankruptcy.
Nonadherence—not taking drugs as prescribed by the doctor—is our nation’s most costly health condition. According to Express Scripts, in 2011, medication nonadherence cost the U.S. health care system over $317 billion in treating medical complications that could have been avoided if patients had taken their medication. This amount is actually higher than the total cost of treating diabetes, congestive heart failure, and cancer combined.
Patients who are nonadherent and do not take their medications the right way are more likely to experience:
• Long-term complications
• More emergency room visits
• Unnecessary hospital admissions
• Additional physician visits and lab tests, and
• Other related medical expenses
What you can do if you are not taking your drugs correctly
Most people are nonadherent because of behavioral factors, such as forgetfulness, inattentiveness, or procrastination. For example, based on findings in the 2011 Drug Trend Report, 39 percent of nonadherent patients said they just forgot to take their medication while 30 percent said they didn’t renew or refill their prescription.
If you find yourself in one of the categories above, you may want to consider asking your Medicare prescription drug plan if it offers refill reminder alerts (by cell phone or email) or automatic prescription renewal programs with mail order. If you have cut back or stopped taking certain medications because of high costs, ask your Part D plan about lower-cost medication alternatives or lower-cost pharmacy services such as home delivery. If you are eligible, you should also take advantage of your plan’s Medication Therapy Management (MTM) program, which I’ll talk more about next time.