News in brief - Dec. 11, 2000

HCFA urges flu shot standing orders for nursing home residents - HCFA expands Medicare Web site - Medicare to pay HMOs extra for patients with congestive heart failure - Dr. Shalala going to Florida school - Medicare prescription drug proposals would not help many seniors

HCFA urges flu shot standing orders for nursing home residents

The Health Care Financing Administration in November asked states to encourage Medicaid-accepting nursing facilities to place standing orders in seniors' medical charts that authorize flu and pneumonia immunizations.

The standing orders will ensure that nursing home residents are reminded each fall to get the necessary immunizations. The flu shot then can be administered on the spot without the need for a physician to write a new order.

"Research tells us that standing orders work, and nursing homes are the places to start, because they have vulnerable senior populations at high risk for contagious diseases, such as flu and pneumonia," said Timothy Westmoreland, the director of HCFA's Center for Medicaid and State Operations.

A flu shot is recommended annually for those age 65 and older, while one pneumonia immunization typically lasts a lifetime. Between 20,000 and 40,000 deaths are attributed to flu and pneumonia in the United States each year, and more than 90% of the deaths occur in people age 65 and older.

HCFA expands Medicare Web site

HCFA has added a directory of physicians to its Medicare Web site (http://www.medicare.gov/). The new feature is a response to frequent requests from seniors for help finding a doctor participating in Medicare.

The directory will enable users to search by specialty and location among the 90% of all U.S. physicians who accept Medicare payment rates and charge beneficiaries only the standard 20% coinsurance rate.

The agency also launched a Web site feature called Prescription Drug Assistance Program. It includes information for beneficiaries on how to apply for drug assistance programs provided by pharmaceutical companies, states and community-based programs. Beneficiaries also may search for drug coverage benefits offered by Medicare managed care and Medigap plans in their communities.

HCFA also has expanded the Nursing Home Compare Web feature to include the last three surveys of each of the 16,500 nursing homes participating in Medicare and Medicaid.

An estimated 21% of Americans over 65 have Internet access, and seniors are among the fastest growing Web-using demographic groups, HCFA reports.

Medicare to pay HMOs extra for patients with congestive heart failure

HCFA announced in November that Medicare+Choice organizations will receive extra payments beginning in 2002 for the outpatient care of seniors with congestive heart failure.

The agency already adjusts insurers' Medicare payments using hospital inpatient data to gauge an enrollee's health status. The extra payments are aimed at ensuring that Medicare+Choice organizations get paid more for providing high-quality outpatient care, HCFA officials said.

To get payments, Medicare+Choice plans must fulfill two quality indicators. They are: ensuring that at least 75% of congestive heart failure enrollees received evaluation of left ventricular function and appropriately prescribing an ACE inhibitor to at least 80% of enrollees with left ventricular systolic dysfunction.

Medicare enrollees account for more than 80% of the 3 million Americans currently diagnosed with congestive heart failure.

Dr. Shalala going to Florida school

The University of Miami has named Dept. of Health and Human Services Secretary Donna E. Shalala, PhD, as its president, effective June 1, 2001.

Dr. Shalala, the longest serving HHS secretary, presided over the implementation of the Balanced Budget Act's Medicare cuts, the creation of the Medicare+Choice managed care program, welfare reform, the creation of the State Children's Health Insurance Program, implementation of the Health Insurance Portability and Accountability Act's reforms, a stepped-up Medicare fraud fighting campaign, and an expansion of National Institutes of Health funding of almost 75%.

Her term at HHS ends with the Clinton administration in January. Prior to overseeing the agency, she served as chancellor for the University of Wisconsin, Madison.

Medicare prescription drug proposals would not help many seniors

Most Medicare beneficiaries would not qualify for prescription drug coverage if annual income alone determined eligibility, says a new Commonwealth Fund study. Many current Medicare prescription drug proposals would cover only those beneficiaries with incomes at or slightly above the poverty level -- leaving most without coverage. Eligibility should be broadened to include people with high drug expenditures, chronic illnesses and lack of stable drug coverage, the report concluded.