PN LogoTop

Guiding your journey through illness and aging....

 

In This Issue
Clinical Cancer Advances in 2012
Health Care Reform Changes in 2013
Skilled Nursing Patients Win a Big Court Case

Quick Links

 

Visit our Blog   

Subscribe to our Free Navigator Notes

Join Our Mailing List

 

Facebook Icon
Twitter Icon
Patient Navigator specializes in:

Clinical Advocacy

Medical Research and Doctor Search

Insurance Resolution

Elder Transitions and Care Coordination

If you face obstacles in the healthcare system or aren't finding the help you need, call us for for a complimentary consultation.

Sometimes one call can make the difference.
 

Rainbow with green hills

Volume 4 Issue 1
Winter 2013 
Dear Readers,

Welcome to the Winter 2013 issue of "Patient Navigator Notes," a quarterly newsletter to inform our readers about important health topics.  If you are a new reader, we hope you'll take a look! 

We welcome feedback at Patient Navigator
or by email.

Elisabeth Schuler Russell
Founder and President
Patient Navigator, LLC  
  G
uiding your journey through illness and aging ....
Clinical Cancer Advances in 2012

We hear so much news about cancer research, drugs and treatments that it is easy to feel overwhelmed and confused. Fortunately, The American Society of Clinical Oncology (ASCO) publishes a yearly report which brings together all of this information in a useable, consumer-friendly way.

"Clinical Cancer Advances 2012: Annual Report on Progress Against Cancer" features 87 studies, 17 of which have been designated "major advances," meaning these advances are considered practice-changing and had to have been published in a peer-reviewed journal and/or report on a treatment that received FDA approval in the past year. 

Major advances in 2012 were achieved in the areas of: 

Overcoming treatment resistance: too often, certain cancers respond to initial treatment but eventually develop resistance and grow. Research reported in the past year brought new, effective options for several difficult types of tumors. 

 

Personalized Medicine: Oncology is rapidly transitioning to an era where patients receive treatment tailored to the unique genetic make-up of their tumors. Researchers now know that even subtle genetic differences can make one tumor responsive and another resistant to the same drug.  One example is the Cancer Genome Project.  

 

New results from this federally funded cancer research initiative revealed potential new drug targets in colorectal cancer, identified biological processes critical for cancer cell survival, and proposed innovative ways to predict whether chemotherapy would be effective in patients with ovarian cancer, based on tumor biology. 

 

Cancer Screening and Lifestyle:  About one-third of all cancer cases could be prevented, primarily through lifestyle and dietary changes, or by early detection through screening. This year, researchers gained important new insights into screening, especially for colorectal and lung cancers. 

 

New FDA Drug Approvals:   Based on encouraging results from large clinical trials, the U.S. Food and Drug Administration approved seven new anti-cancer drugs and expanded indications for five existing agents between October 2011 and October 2012.

 

The approvals bring new treatment options for patients with certain forms of myeloma; leukemia and lymphoma; breast cancer; skin cancer; prostate cancer; gastrointestinal stromal tumors; colorectal cancer; kidney cancer; and soft-tissue sarcoma.  

 

If you are interested in keeping up with cancer breakthroughs, I encourage you spend some time looking at the 2012 report or this summary.  The ASCO website is also a valuable and trusted source on cancer with information on many types of cancer, diagnoses, treatments and the constellation of issues related to a cancer journey.  

Back to Top  

 

 

 

Health Care Reform Changes in 2013

While many of the Patient Protection and Affordable Care Act of 2010 provisions have been implemented, there are some notable changes in 2013 that may affect you.  This year will be busy with States preparing to launch in 2014 either their own or a Federal health insurance exchange.

 

According to a useful Guide from Consumer Reports, here's what to expect this year.     

  

Standard disclosure forms.  Beginning in September 2012, all health plans had to use a standardized, consumer-friendly form to provide a uniform summary of benefits and coverage, including information on co-payments, deductibles, and out-of-pocket limits. This will make it easier for you to compare plans.  Insurers will also have to calculate and disclose a patient's typical out-of-pocket costs for two medical scenarios: having a baby and treating type 2 diabetes. See a sample form (PDF).  

  

Caps on Flexible Spending Accounts (FSAs). Employers could still set their own limits (usually $2,500 to $5,000) on FSAs in 2012. But in 2013, the most you can set aside tax-free for medical expenses not covered by insurance will be $2,500, with the cap increasing by the annual inflation rate in subsequent years.  Plus you can no longer use FSAs to pay for over-the-counter drugs unless you have a doctor's prescription. The cap takes effect January 1, 2013. For people with 2012-2013 health care plans that run on a fiscal (rather than calendar) year, the cap kicks in July 1, 2013. Read more about FSAs.   

  

New Medicare tax for high earners. Two Medicare-related taxes will impact high earners in 2013. Individuals earning over $200,000 (or $250,000 for couples who file jointly) will see their Medicare payroll tax rate increase from 1.45 percent to 2.35 percent. They'll also pay a new 3.8 percent Medicare tax on unearned income, including investments, interest, dividends, annuities, rent, royalties, certain capital gains and inactive businesses.  Read more about Medicare.     

   

According to the Kaiser Family Foundation, other changes in this timeline include:

 

Phasing-in federal subsidies for brand-name prescriptions filled in the Medicare Part D coverage gap (reducing coinsurance from 100% in 2010 to 25% in 2020, in addition to the 50% manufacturer brand-name discount).

 

Establishing a national Medicare pilot program to develop and evaluate making bundled payments. The law establishes a national pilot program to encourage hospitals, doctors, and other providers to work together to improve the coordination and quality of patient care.  Under payment "bundling," hospitals, doctors, and providers are paid a flat rate for an episode of care rather than the current fragmented system where each service or test or bundles of items or services are billed separately to Medicare.  

  

For example, instead of a surgical procedure generating multiple claims from multiple providers, the entire team is compensated with a "bundled" payment that provides incentives to deliver health care services more efficiently while maintaining or improving quality of care. It seeks to align the incentives of those delivering care, and savings are shared between providers and the Medicare program.for acute, inpatient hospital services, physician services, outpatient hospital services, and post-acute care services for an episode of care.

 

Increasing the threshold for the itemized deduction for unreimbursed medical expenses from 7.5% of adjusted gross income to 10% of adjusted gross income; waives the increase for individuals age 65 and older for tax years 2013 through 2016.

   

Increases payments to primary care doctors treating Medicaid patients and more funding for preventative services.  

 

For a full timeline of all the changes, click here. 

 

As always, you need to keep up with these ongoing changes.  Good sources are the  Government site and Kaiser Family Foundation.  

   

Back to Top 

 

 

Skilled Nursing Patients Win A Big Court Case 

In October 2012, in a settlement of a nationwide class-action lawsuit, Jimmo v. Sebelius, Medicare agreed to end a decades-old practice that required many beneficiaries to show a likelihood of medical or functional improvement before Medicare would pay for skilled nursing and therapy services.   

 

This "Improvement Standard" had suggested that Medicare coverage for physical therapy services in a skilled nursing facility, home health or outpatient services was dependent on a beneficiary improving.  

 

That policy raised an obvious question: how is a patient supposed to make progress if he or she is denied the physical therapy that is necessary to help them make progress?  

 

Under the settlement, which amounts to a significant change in Medicare coverage rules, Medicare will pay for such services if they are needed to "maintain the patient's current condition or prevent or slow further deterioration," regardless of whether the patient's condition is expected to improve.

 

Federal officials agreed to rewrite the Medicare manual to make clear that Medicare coverage of nursing and therapy services "does not turn on the presence or absence of an individual's potential for improvement," but is based on the beneficiary's need for skilled care.  

 

This is a major victory, especially for older and disabled Medicare beneficiaries who need skilled care to maintain their conditions (thereby preventing them from getting worse). It will make a tremendous difference for patients with chronic conditions such as multiple sclerosis and Parkinson's disease who need therapy to preserve the function they have. 

 

So if you are dealing with a parent, friend or relative in a skilled nursing facility whose physical therapy is being curtailed on the grounds of "insufficient progress," make sure to cite this court case.  It will take some time for Medicare providers, contractors and administrators to learn about and implement this new policy. And there is an appeals process available.     

 

The bottom line: skilled nursing facilities can no longer tell you that therapy is ending simply because your loved one is "not making enough progress and will not improve."  

 

For further reading:

 

"Settlement Eases Rules for Some Medicare Patients"