Medicare

March 13, 2008
Heart Scans Still Covered by Medicare
By REED ABELSON
Reversing a proposed decision issued in December, the federal government said Wednesday it would continue to cover the use of an increasingly popular procedure to detect heart disease.
The Centers for Medicare and Medicaid Services said it would continue to cover the scanning procedure, despite its earlier misgivings over whether there was enough evidence to justify paying for the tests under Medicare.
The agency said Wednesday that it would continue to leave payments for the scans up to the local insurance carriers it employs to oversee medical claims. Most local carriers have been covering the test, a form of CT scan that can cost $600 or more.
“We found that the evidence is not black and white either way,” said Dr. Barry Straube, chief medical officer for the Centers for Medicare and Medicaid Services. Given the overwhelming criticism of the preliminary decision, the agency decided it did not have enough reason to override local carriers’ decision to cover the tests as medically necessary.
“Before we make a significant change in policy, we need more evidence,” said Dr. Straube, who indicated the agency would still like studies testing whether the scans are medically effective.
But much of medicine, including treatments Medicare pays for, is similarly unproven. “There are a lot of technologies, services and treatments that have not been unequivocally shown to improve health outcomes in a definitive manner,” Dr. Straube said.
Medicare paid for roughly 70,000 of the heart scans in 2006, according to the agency, at a cost of $40 million to $50 million. For people not yet eligible for Medicare, thousands of other such scans were paid for by commercial insurers or from patients’ own pockets, at prices sometimes close to $1,000. As many as 1,500 centers around the country are estimated to be offering the scans, with some centers advertising their services.
The agency’s decision to continue paying for scans means their use is likely to continue to climb, according to doctors and insurers. Private insurers often follow Medicare’s lead on what medical procedures they will pay for.
The scans are now widely promoted as a noninvasive alternative to tests like angiography, which requires the insertion of a catheter into the blood vessels and can cost thousands of dollars. But conventional angiography is typically done only on patients with cardiac symptoms. There is growing concern that the CT scans are being done increasingly on those who show no signs of heart disease, subjecting them needlessly to radiation risks.
“Before it enters widespread use, it needs to be critically examined, and it has not been,” said Dr. Mark Grant, a senior scientist for the Blue Cross and Blue Shield Association, which told the agency it favored further study.
In December, the Centers for Medicare and Medicaid Services had said it would not pay for the scans unless patients were enrolled in a study to test the technology’s effectiveness. The Blue Cross group said Wednesday that without a Medicare mandate for such research, there might be little likelihood now that doctors or equipment makers would do it.
The proposal to curtail payments met with fierce resistance from doctors who perform these scans and companies that make the equipment. They strongly defended the scans as an important alternative to conventional angiography and said patients who could not enroll in a study of the scans would be unfairly denied access to the technology.
“I think this is great news for patients,” Dr. Constantino S. Peña, the director of vascular imaging at the Baptist Cardiac and Vascular Institute in Miami, said of Wednesday’s ruling.
Among the organizations advocating Medicare coverage were professional societies representing doctors who do scans, including the American College of Cardiology and the North American Society for Cardiac Imaging.
“The biggest role we played is educating” the Medicare agency, said Dr. Pamela K. Woodard, the society’s president.
Proponents argue that many studies are being done. “Within one year, there will be 10 times as much evidence of the effectiveness” of the heart scans, said Dr. Daniel S. Berman, president-elect of the Society of Cardiovascular Computed Tomography, who said his group and others presented the agency significant evidence of the scans’ usefulness.
But the Centers for Medicare and Medicaid Services, in the final decision, said there remained “uncertainty regarding any potential health benefits” from the scans and described the existing evidence as of “overall limited quality and limited applicability.”
Given the amount of resistance, the agency was not able to justify scaling back coverage, said Dr. Sean Tunis, a former Medicare official who is director of a nonprofit group, the Center for Medical Technology Policy, aimed at evaluating new technology. “Without new evidence that something is either ineffective or harmful,” he said, “it’s very hard for Medicare to narrow existing coverage.”
And yet, Dr. Tunis said, Wednesday’s decision indicates the agency “continues to feel there are important unanswered questions.” His group had been in discussions with health insurers and equipment makers to consider conducting the studies that the agency originally envisioned, as a way to show whether the technology was, in fact, better than existing tests and improved patients’ health.
Without the Medicare agency’s insisting upon them, such studies would probably now be more difficult to organize, he acknowledged, although he said he planned to reach out to members of the working group to determine what steps might be taken.
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Social Security

Notch
The Senior Citizens League members and supporters tend to be older, less affluent seniors. They are also, to a large extent, Notch babies - those individuals who receive lower Social Security benefits because they were born in the years 1917 and immediately thereafter. TSCL feels that this is an inequity that was brought about because of the Social Security Act Amendments enacted and signed into law in 1977. Just years before they were set to retire, these individuals discovered they would have significantly lower benefits than originally anticipated. And the problem only grew and compounded with the inflation that occurred in the early 1980s. Thus, in order to make the Social Security program more equitable in general, and to correct a wrong done to Notch babies, we believe that some recompense for that injustice should be provided.
TSCL strongly supported legislation introduced in the 109th Congress that would have provided either a lump-sum payment or an increased monthly benefit calculation to Notch babies. We were pleased to see that Congressman Ralph HallТs legislation, H.R. 615, got 118 co-sponsors in the last session - more than in any other session of Congress since the lump-sum proposal has been before Congress. We will continue to educate new Members of the House and Senate about the Notch and to work with past supporters of the Notch. With an increasing number of Notch co-sponsors during each of the last three sessions of Congress, we are hopeful that some type of Notch reform will take place in the 110th Congress.

Stimulus Package

Q: I normally don't need to file a tax return. How do I know if I'm one of those people who may be eligible to receive an economic stimulus payment?A: This group includes some recipients of Social Security, Railroad Retirement or veterans' benefits as well as taxpayers who do not make enough money to normally have to file a 2007 tax return. For example, this can include low-income workers, those who receive Social Security benefits or veterans’ disability compensation, pension or survivors’ benefits from the Department of Veterans Affairs in 2007. These people will be eligible to receive a payment of $300 ($600 on a joint return) if they had at least $3,000 of qualifying income.Qualifying income includes Social Security benefits, certain Railroad Retirement benefits, certain veterans’ benefits and earned income, such as income from wages, salaries, tips and self-employment. For people filing joint tax returns, only a total of $3,000 of qualifying income from both spouses is required to be eligible for a payment.




Special Guidelines for Recipients of Certain Social Security, Veterans and Railroad BenefitsCertain people who normally are not required to file but who are eligible for the stimulus payment will have to file a 2007 tax return. This includes low-income workers or those who receive Social Security benefits or veterans’ disability compensation, pension or survivors’ benefits from the Department of Veterans Affairs in 2007. These taxpayers will be eligible to receive a payment of $300 ($600 on a joint return) if they had at least $3,000 of qualifying income.Qualifying income includes Social Security benefits, certain Railroad Retirement benefits, certain veterans’ benefits and earned income, such as income from wages, salaries, tips and self-employment. For taxpayers filing joint tax returns, only a total of $3,000 of qualifying income from both spouses is required to be eligible for a payment.The special version of the Form 1040A unveiled today on IRS.gov shows taxpayers in these groups the specific sections of the form they need to fill out to qualify for the stimulus payment. The mock-up is designed to be used as a guide for filling out an actual Form 1040A."People who don’t normally need to file have a roadmap on how to fill out the Form 1040A quickly and easily," Stiff said. "We encourage recipients of Social Security and veterans’ benefits who don’t normally need to file a tax return to use this mock-up of the form as a guide to help them get their stimulus payment."The Form 1040A illustration on IRS.gov shows the limited number of lines that will need to be filled out for recipients of Social Security, certain Railroad Retirement and certain veterans’ benefits. A key line is reporting their 2007 benefits on Line 14a of Form 1040A. The IRS reminds taxpayers they can also use Line 20a on Form 1040 to report these same benefits.In addition, taxpayers in these groups should write the words "Stimulus Payment" at the top of the 1040A or 1040.For now, taxpayers in this group filing a tax return can only file a paper copy of the Form 1040 or Form 1040A. The IRS is working to update its systems to accept electronic versions of these limited-information returns for taxpayers who otherwise have no need to file a tax return. The IRS is also working with the software community to handle these returns electronically at a future date.The IRS also reminded taxpayers with Social Security, Railroad Retirement or veterans’ benefits who have already filed but did not report their qualifying benefits on either Line 14a of Form 1040A or Line 20a of Form 1040 that they may need to file an amended return in some situations to receive a larger stimulus payment.Taxpayers who already have filed but did not report these benefits can file an amended return by using Form 1040X, which can only be filed with a paper form.The IRS reminded taxpayers who don’t have any other requirement to file a tax return that submitting a tax return to qualify for the economic stimulus payments does not create any additional tax or trigger a tax bill. In addition, the stimulus payments will not have any effect on eligibility for federal benefits.The IRS is working with the Social Security Administration and Department of Veterans Affairs and other organizations to ensure that recipients are aware of the need to file a tax return to receive their stimulus payment in 2008.

File 1040 A stimulas package

On Wednesday President Bush signed into law H.R. 5140, the economic stimulus package. Treasury Secretary Henry Paulson said that rebate checks could be in the mail as early as May. Individuals will receive $600, couples will receive $1200, and an additional $300 will be given for each child under 17. Individuals and couples earning over $75,000 and $150,000, respectively, will have their eligibility phased out. Individuals who earn $3,000, receive Social Security or are disabled veterans will receive $300.

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PUSH CONGRESS TO PASS LEGISLATION
LOWER RX COSTS We need to legalize the importation of safe less expensive presciption drug from other countries. Also, Medicare should be allowed to negotiate lower drug prices with manufacturers. Under Current law, even though large employers can negotiate prices for their employees, Medicare is barred from doing the same. This must be stopped.
MODERNIZE THE HEALTH CARE SYSTEM: Technology can be used to improve the quality of health care we receive and lower costs. Health care information should be standardized and readily available to your health care professionals. For example, emergency rooms should be able to wuickly access your medical records from all your physicians. Technology can be to reduce administrative costs and better inform the patient. Also, health care professionals and institutions that provide the best care most efficiently should be rewarded--we must stop subsidizing and encouraging the least efficient and least effective care.
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PUSH CONGRESS TO ENACT SIGNIFICANT CHANGE TO IMPROVE HEALTH CARE FOR AMERICA'S SENIORS.