Industry shaker news on Medicare
You guys also might want to take a look at Titan Pharmaceuticals TTP 10k filing this weekend and check out what Novartis has found in their testing of titans iloperidone,, regarding dementia, very interesting. Also im wondering if you guys know of any other companies that might be affected by the billions that this press release below is indicating will be unleased for care.?
WASHINGTON, March 30 The Bush administration, in a major change, has authorized Medicare coverage for the treatment of Alzheimer's disease (news - web sites), which afflicts nearly four million Americans and is expected to grow to epidemic proportions with the aging of the population.
• In a First, Medicare Coverage Is Authorized for Alzheimer's
• TV Drama, Pentagon-Style: A Fictional Terror Tribunal
• For the latest breaking news, visit NYTimes.com
• Get DealBook, a daily email digest of corporate finance newsDealBook.
Search NYTimes.com:
Today'sNewsPast WeekPast30 DaysPast 90 DaysPastYearSince 1996
The new policy means that Medicare beneficiaries can no longer be denied reimbursement for the costs of mental health services, hospice care or home health care just because they have Alzheimer's.
In the past, many claims were automatically denied on the assumption that treatment was futile because people with Alzheimer's were incapable of any medical improvement. Now, federal officials say, new studies show that people with Alzheimer's can often benefit from psychotherapy, physical and occupational therapy and other services.
"This is great news for people with Alzheimer's disease and other dementias," said Stephen R. McConnell, chief executive of the Alzheimer's Association. "The new policy should eliminate a form of discrimination against millions of people."
Neither federal officials nor advocates for the elderly provided estimates of the cost of the new policy. Experts said the direct cost to Medicare could be several billion dollars a year. But, they said, some of the cost could be offset by savings elsewhere in Medicare and Medicaid, because the new services will enable patients to live longer on their own, with greater ability to function.
The policy is set forth in a memorandum sent late last year from the government to the companies that review and pay Medicare claims. These companies have just begun to put the change into practice.
The government gave no public notice of the new policy, but it has already made a difference in the lives of some people with Alzheimer's. Some patients have received benefits that were once denied, and some medical practitioners have secured payment for services that Medicare once refused to cover.
The companies that review claims for the government, under federal contracts, are known as Medicare carriers. Most of them had programmed their computers to reject claims for people with Alzheimer's and other types of dementia. The new policy bans such computer software instructions and says contractors cannot deny claims simply because a person has Alzheimer's.
"Throughout the course of their disease," the memorandum says, "patients with dementia may benefit from pharmacologic, physical, occupational, speech-language and other therapies."
Patients' advocates, including the Alzheimer's Association and the American Bar Association, had supplied the government with dozens of research studies providing scientific evidence that such therapies were effective.
The government said it changed its policy because doctors and psychologists can now often diagnose Alzheimer's in its early stages, when patients are most likely to derive significant benefits from treatment and therapy. While there is no cure for Alzheimer's, staving off its worst effects can prolong a relatively normal life and save money.
It is not clear why the government did not publicize the new policy. Some officials apparently did not want to acknowledge that the old policy was, in effect, biased against people with Alzheimer's. When asked, a Medicare official said the change was not announced because "we saw it mainly as a technical matter for Medicare carriers."
Mr. McConnell of the Alzheimer's Association estimated that 10 percent of people over 65 and nearly half of those over 85 had Alzheimer's, a brain disorder that causes loss of memory, changes in personality and behavior, and a decline in thinking abilities.
Under the policy, Medicare will pay for more therapy and outpatient services. Dr. Steven T. DeKosky, a neurologist who directs the Alzheimer's Disease Research Center at the University of Pittsburgh, said these services would "keep people out of nursing homes," avoiding costs that would otherwise be borne by the government, patients or their families.
Kim A. Warchol, an occupational therapist in Itasca, Ill., who specializes in the treatment of people with Alzheimer's, said the new policy had major implications for patients, their spouses and their children.
"People with Alzheimer's will be able to live at home longer and avoid institutionalization," Ms. Warchol said. "Caregivers often assume that people with Alzheimer's are helpless. But we focus on their remaining physical and mental abilities, the things they can still do, and we find that many patients can perform activities of daily living if we provide appropriate cues or reminders of how to get started. They can dress themselves or groom themselves if you lay out their clothing or grooming supplies."
Margaret P. Norris, an associate professor of psychology at Texas A&M University, said that while Alzheimer's was irreversible and incurable, patients with mild to moderate forms of the disease could benefit from psychotherapy to help them cope with loss of memory and with feelings of depression and anxiety.
"We encourage patients to keep a notebook full of important information, like the names of their grandchildren, which they might forget," Ms. Norris said. "In later stages of Alzheimer's disease, it's common for patients to yell and scream and become aggressive. That may be because the environment is too noisy and distracting. We can sometimes modify the patient's behavior by changing the environment."
The impact of the new policy is illustrated by the experience of Jenni Lee Robins, 58, of Winter Haven, Fla., who used it to get treatment for her father, Harry H. Baker.
Mr. Baker, 78, has had Alzheimer's for eight years. After he was hospitalized and admitted to a nursing home last year, he received physical therapy, but it was ended after the nursing home concluded that his condition would not improve. He was hospitalized this year for pneumonia.
After learning of the new policy from a local chapter of the Alzheimer's Association, Ms. Robins used it to ensure that her father got "all the appropriate therapies" physical, occupational and respiratory.
"Daddy has improved tremendously because of the therapies Medicare now covers," Ms. Robins said. "He is in better condition now than before he went into the hospital this year. After eight days in the hospital, he lost the ability to walk, forgot how to walk. But after nine weeks of physical therapy, he can walk again."
People with Alzheimer's live an average of 8 to 10 years after the condition is diagnosed.
Dr. Paula E. Hartman-Stein, a clinical psychologist and founder of the Center for Healthy Aging in Kent, Ohio, said: "Previously, in many parts of the country, if a person had a diagnosis of dementia, the Medicare carrier would just arbitrarily, as a blanket policy, not cover psychological services. The new policy breaks down one of the major barriers to providing mental health services to elderly people."
Christina A. Metzler, director of federal affairs at the American Occupational Therapy Association, said the new policy was "tremendously significant" for patients. "In the past," she said, "a diagnosis of Alzheimer's could prevent a patient from getting Medicare coverage for therapy to treat other conditions a broken hip, a broken wrist or a stroke."
The new policy was adopted after two years of lobbying by the Alzheimer's Association and the American Bar Association's Commission on Legal Problems of the Elderly.
Leslie B. Fried, a lawyer at the commission, used the Freedom of Information Act to get copies of the local rules used by Medicare carriers in deciding whether to pay claims. These documents, she said, showed that "people with Alzheimer's were often being denied medically necessary services." |
