Washington Update - February 2006

New Report on Nation’s Health Status Highlights Adults Age 55-64

Life expectancy in the U.S. increased to a record 77.6 years in 2003, according to a new report from the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics. However, half of Americans age 55-64 years have high blood pressure—a major risk factor for heart disease and stroke—and two in five are obese, the report notes.

Health, United States, 2005, the Government’s annual report to the President and Congress on the health of all Americans, features an in-depth look at the 55-64 age group, which includes the oldest of the baby boomers. In 2011, the eldest baby boomers will be eligible for Medicare, and by 2014, the ranks of Americans age 55-64 will swell to 40 million, from 29 million in 2004.

“Controlling high blood pressure and obesity is crucial for health, particularly for baby boomers as they grow older,” said Mike Leavitt, Secretary of the U.S. Department of Health and Human Services. “It’s time to act against both conditions so more Americans can live longer, healthier lives.”

The report also notes that 11% of Americans age 55-64 years lack health insurance. Roughly 16.5% of Americans age 65 and under have no health insurance.

The U.S. spent $1.7 trillion—15% of gross domestic product —on health care in 2003, or an average of $5,671 per resident, the report estimates. Much of this spending was for care, medications, and procedures to control or reduce the impact of chronic diseases and conditions, such as heart disease, affecting an aging population. In 2003, more than one-third of personal health care expenditures were for hospital care; one-quarter for physician care; one-eighth for prescription drugs; 8% for nursing home care; and the remaining one-fifth for ‘‘other’’ personal health care, including visits to nonphysician medical providers, medical supplies, and other health services.

Medicare to Expand Coverage for Cardiac Rehabilitation Services

The Centers for Medicare & Medicaid Services (CMS) is proposing to expand coverage for cardiac rehabilitation services to additional groups of patients.

“The evidence is adequate to conclude that cardiac rehabilitation is reasonable and necessary following acute myocardial infarction (AMI), coronary artery bypass graft (CABG), stable angina pectoris, heart valve repair/replacement, percutaneous transluminal coronary angioplasty (PTCA), and heart or heart-lung transplant,” CMS stated in a proposed decision posted on its website on December 22.

“With this proposed coverage decision, CMS seeks to expand coverage to a greater number of beneficiaries with cardiac illness,” added CMS Administrator Mark B. McClellan, MD, PhD, in a January 4 announcement.“But just as important, we hope that our proposed decision will raise the public’s awareness regarding cardiac rehabilitation services in general.”

CMS also proposed that cardiac rehabilitation programs be comprehensive and include a medical evaluation, a program to modify cardiac risk factors (eg, nutritional counseling), prescribed exercise, education, and counseling. Evaluation of the current medical evidence found a greater benefit to patients when services were provided in such a comprehensive manner, CMS reported.Under the proposal, services provided in connection with a cardiac rehabilitation exercise program may be considered reasonable and necessary for up to 36 sessions without individual review by a contractor’s medical consultant.

CMS determined that the evidence is not adequate to conclude that cardiac rehabilitation is reasonable and necessary for congestive heart failure, however, and therefore will not cover these services for this condition. CMS will issue a final decision in the spring.

CMS Makes Awards to Medicare Administrative Contractors

CMS recently awarded contracts to four specialty contractors who will be responsible for handling claim administration for durable medical equipment, prosthetics, and orthotics. The new Durable Medical Equipment Medicare Administrative Contractors (DME MACs), selected through a competitive bidding process, will replace the current Durable Medical Equipment Regional Carriers (DMERCs). The four contractors are National Heritage Insurance Company, AdminaStar Federal, Palmetto Government Benefits Administrator, and Noridian Administrative Services.

Under the current system, fiscal intermediaries process claims for Part A providers such as hospitals, skilled nursing facilities, and other institutional providers. Carriers process claims for physicians, laboratories, and other suppliers under Medicare Part B. Under the Medicare Modernization Act, these fiscal intermediaries and carriers will eventually be replaced by Medicare Administrative Contractors who will be responsible for both Part A and Part B claims. For beneficiaries and providers, the new structure will mean that they each have a single point of contact with the Medicare program, CMS reported.

VA Issues Final Rule on Advance Directives

The Department of Veterans Affairs has issued a final rule regarding the use of written advance directives (ie, a VA living will, a VA durable power of attorney for health care, and a state-authorized advance directive). The rule also sets forth a protocol for honoring verbal or nonverbal instructions from a critically ill patient who is admitted for care when loss of capacity may be imminent, and when the patient is not physically able to sign an advance directive form, or the appropriate form is not readily available.

The final rule states that a patient who has decision-making capacity may revoke an advance directive or instructions in a critical situation at any time by using any means to express the intent to revoke. In addition, the final rule emphasizes the obligation of any surrogate—including a health care agent named in an advance directive—to make decisions on behalf of a patient who lacks decision-making capacity. These decisions must be in accord with the patient’s clearly expressed wishes.

The final rule appeared in the November 30, 2005 Federal Register and was effective December 30, 2005.