Americans Support Minor Reductions in Medicare Spending

The June 2011 tracking poll conducted by the Henry J. Kaiser Family Foundation examined the opinions of seniors and the general public on the debate over how to deal with the federal budget deficit and the related discussions about the financial future of Medicare. Overall, the public favors reductions in spending over tax increases as the approach to deficit reduction. Forty-seven percent say the deficit should be reduced through reductions in spending on government programs and services, while only 16% prefer tax increases as a solution. Approximately 20% say a combination of approaches would be best. When survey respondents were asked about which programs should be addressed in a spending reduction effort, agreement was harder to find. The majority of respondents indicated they would not accept any reductions in spending on Social Security, Medicare, or Medicaid. However, when asked about reductions in Medicare spending as a way to ensure the financial future of that program, 42% say they would support “minor” reductions to current spending in order to “prevent the program from going bankrupt.” The House Budget Plan includes a proposal to change Medicare to a system in which the government pays a fixed amount of money towards private insurance plans for Medicare beneficiaries (referred to as a voucher or premium support system). Americans were roughly divided on this proposal: 45% said they would support such a system and 49% said they preferred to keep the current system. Adults <65 years of age were evenly split on the plan; those ≥65 years of age were opposed by a large margin (only 32% were in favor of the change). Finally, the June poll results again found the American public divided in their assessments of the Affordable Care Act: 42% hold a favorable view and 46% view it unfavorably. Strong partisan divisions continue. Blood Pressure Control Is Beneficial in Elderly Patients Preliminary data reported at the American College of Cardiology meeting on the effects of reducing systolic blood pressure to the 130s in the elderly demonstrated that for patients >70 years of age, a reduction in blood pressure is associated with a reduction in mortality. Among the study participants, the lowest mortality rate during an 8-year period was found in those whose systolic blood pressure was between 130 and 139 mm Hg. According to an article in Medpage Today, clinicians have had concerns about aggressively treating hypertension in older patients due to a lack of data on outcomes and possible adverse effects from adding additional medications to lower a patient’s blood pressure. During the study reported at the meeting, the rates of blood pressure control improved from 45% to 73%, a rate of improvement consistent across age groups. In addition, there were no additional side effects seen in older patients, the article noted. Infants Benefit from Vaccines A new study has found that if pregnant women receive influenza vaccine, their babies will be protected. Babies under 6 months of age are too young to be vaccinated; infants that age have the highest rates of hospitalization for pediatric influenza. The study, reported in the June issue of the American Journal of Obstetrics and Gynecology, found that babies whose mothers were given influenza vaccine were 45% less likely to contract the virus during their first flu season, compared with babies whose mothers were not vaccinated. In another vaccine-related study, researchers examined the effect of routine rotavirus vaccination for infants. The study, reported in Clinical Infectious Diseases, found that hospitalizations for rotavirus decreased as vaccination rates increased among infants 6 to 11 months of age. The hospital stays decreased by 88% in 2009 from the 2006 baseline rate when the vaccine became available. Among children too old to be vaccinated, hospitalizations also decreased, most likely because widespread vaccination impeded the spread of the virus, the researchers said. New Model for ACOs The Department of Health and Human Services has announced a Pioneer Accountable Care Organization (ACO) model designed to “provide a faster path for mature ACOs” and save Medicare as much as $430 million over 3 years. According to an article in Kaiser Health News, the Pioneer model offers an incentive to hospitals and physicians: the opportunity to pocket more of the expected savings in exchange for taking on greater financial risk. The model will allow existing integrated-care organizations such as Geisinger Health System, the Cleveland Clinic, and Intermountain Healthcare will launch ACOs as early as this summer. For less mature health systems, the Centers for Medicare & Medicaid Services also announced it is considering helping cash-strapped provider groups form ACOs by giving them some of their share of anticipated savings upfront, the article said. Physician Acceptance of Insurance In a study reported in Archives of Internal Medicine, researchers found that physician acceptance of new patients covered by Medicare dropped from 95.5% in 2005 to 92.9% in 2008 (P=.01). Physicians in private practice were responsible for the largest decline in accepting new Medicare patients (95.5% in 2005 vs 93.0% in 2008; P=.01). There was a more pronounced decrease in acceptance of new patients covered by private noncapitated insurance (93.5% in 2005 vs 87.8% in 2008; P=.01). During the study period, a smaller percentage of adult primary care physicians accepted private noncapitated patients (97.3% in 2005 vs 89.9% in 2008; P<.001). Further, the study found that rates of acceptance of new patients covered by Medicaid and private capitated insurance were lower than Medicare and private noncapitated insurance; those rates also showed a decline. In all years, acceptance of self-paying patients was 96%, with no significant change during the study period. Drugs for Prostate Cancer In the past 15 months, the FDA has approved 3 new drugs that extended the lives of men with prostate cancer in clinical trials and several others are in the pipeline, according to an article in the New York Times. Prior to those approvals, only 1 FDA-approved drug—docetaxel—had been shown to improve survival. However, the cost of the new drugs is raising concerns about the cost of care among providers, patients, and insurers, the Times article continued. Medicare has completed a yearlong study into whether to pay for Provenge, which costs $93,000 for a course of treatment. The final decision from the Centers for Medicare & Medicaid Services was to pay for the drug when it is used according to the label. According to physicians and patient advocates, private insurers are following suit, paying for the drug only when it is used according to the label. Provenge was approved in April 2010 for late-stage cancer patients with few symptoms. Breast Cancer Screening A 3-decade study in Sweden has found that mammography reduces deaths from breast cancer by at least 30%. Previous studies projected that 1 breast cancer death could be prevented for every 1000 to 1500 women screened; the new study’s results showed that mammography can prevent 1 breast cancer death for every 414 to 519 women screened. In an article in the Los Angeles Times, Dr. Loretta Lawrence, chief of breast imaging at North Shore University Hospital in Manhasset, New York, described the findings as “a really big deal.” She added that a “30% reduction in mortality translates to 15,000 to 20,000 lives saved by mammography screening each year.” The new study does not address issues such as when women should begin to have regular screening or how frequently the screening should occur.