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WASHINGTON, DC – January 1, 2023 – Medicare provides health insurance for older Americans, disabled people and persons with certain chronic diseases. If you are eligible for Medicare, then you must decide between government-run traditional Medicare or a Medicare Advantage (MA) plan managed by private-health insurance companies. Traditional Medicare consists of Part A (for in-hospital care), Part B (for outpatient care including doctor visits) and Part D (for prescription drugs). Medicare Part C, also known as MA, usually covers Part A, B & D. Almost one-half of all Medicare enrollees have Part C this year.

Many traditional Medicare beneficiaries may be unaware that they are receiving services from a provider using direct contracting, similar to MA, unless the provider notifies them. In 2019, during the Trump administration, the Centers for Medicare & Medicaid Services (CMS) entered in a direct contracting (DC) model with clinics, health systems, health plans and commercial health insurance. They are paid by the federal Medicare program to cover each beneficiary’s care like in the MA program. However, the DC only includes Part B like traditional Medicare and does not include Part D or other benefits offered by a MA plan. With the start of the New Year, under the Biden administration, CMS has modified the original DC model with the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) model to provide stricter oversight and a stronger focus on health equity.

Traditional Medicare beneficiaries in ACO REACH may be subject to the same disadvantages of MA. The MA plans restrict networks of doctors and hospitals, mandate authorization for some services (like imaging studies) and require referrals to specialists. The Office of the Inspector General found that MA plans routinely rejected claims that should have been paid and denied services that physician reviewers found to be medically necessary. Persons requiring medical care while away from home may not have their health care covered because the local providers are out-of-network. Brown University researchers found that many high medical needs patients were more likely to switch from MA plans to traditional Medicare.

Senator Elizabeth Warren, Representative Pramila Jayapal, and 19 other members of Congress recently sent a letter to Chiquita Brooks-LaSure, the CMS Administrator, complaining that the ACO REACH “model provides an opportunity for health care insurers with a history of defrauding and abusing Medicare and ripping off taxpayers to further encroach on the Medicare system.” They have asked CMS to protect patients by “halting participation by any organizations that have committed health care fraud.”

 

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Contact: Dr. Dick Needleman, Health reporter, 103.3 AshevilleFM, [email protected]

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WASHINGTON, DC – December 29, 2022 –  On December 29^th, President Joe Biden signed an end-of-year government appropriations bill that includes the bipartisan Mainstreaming Addiction Treatment (MAT) Act. The FDA-approved medicine for opioid use disorder (OUD), called buprenorphine, will become easier for people to obtain who seek treatment. One of the main medicines used to treat OUD is Suboxone. It is the brand name combination medicine that includes buprenorphine with naloxone, the latter is used to reverse opioid overdoses. Buprenorphine has been shown to be effective in reducing overdose deaths, curb the use of illegal drugs, and help people from dropping out of treatment. MAT has been proven to be the most effective treatment for OUD.

The MAT Act eliminates the following barriers to care:

• Health-care provider prescribing. Any DEA-registered prescriber of controlled substances will be able to treat OUD patients with buprenorphine. Providers will no longer require additional training and certification to obtain a special DEA waiver to prescribe this medicine. Therefore, more providers will be able to prescribe it. Patients won’t have to search for a physician who can prescribe buprenorphine and travel long distances to get treatment. Taking time off from work and spending money on gas are major factors in reducing patients access to care.
• Disparities by geography and race. Underserved communities of color and rural populations have difficulty with access to buprenorphine. Having more health care providers able to prescribe the medicine should reduce these disparities.
• Stigma in treating OUD. The Substance Abuse and Mental Health Services Administration is encouraging providers to treat patients with OUD by eliminating barriers to prescribing the controlled medicine.

More than 100 thousand Americans died from drug overdoses in 2021 and 75% were due to opioids. Over the past 20 years, more than one million Americans died from drug overdoses. However, in 2020 only 11% of people with this condition received medicine-assisted treatment. Therefore, federal legislators from both political parties are optimistic that the newly signed MAT Act will be a great step towards reducing the treatment gap. Health-care providers will be able to take care of patients with OUD (a disease of the brain) just as they take care of heart disease, diabetes and lung disease.

 

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Contact: Dick Needleman, Health reporter, 103.3 AshevilleFM, [email protected]

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ASHEVILLE, NC – February 1, 2022 – There is a trend downward to the pre-holiday season COVID-19 community levels. The CDC reports that the community level for Buncombe County is low for the week ending January 23rd. Almost one-half of the counties in North Carolina are low. More than two-thirds of the counties in the U.S. are at a low level with less than 4% of the counties at a high level.

The Buncombe County COVID-19 metrics are on the North Carolina COVID Dashboard. Data from the week ending on January 21st indicate:
• Last week’s total cases are down 24% from the previous week.
• 68% of the total population have received their initial vaccination series.
• 31% of people with their initial vaccination series have had the updated booster.
• The seven-day daily average of COVID-19 hospitalizations has decreased 29% since last week, and of ICU patients has decreased by 36% from the previous week.

An updated COVID-19 booster is now available for eligible persons 6 months and older. It is more effective at protecting against severe illness and death from the new variants. Eligible persons must have the initial vaccination series and be at least 2 months after any prior COVID-19 shots. The CDC advises delaying the booster 3 months for people who recently had COVID or after a positive COVID test if they were asymptomatic.

The Department of Health and Human Services recommends:
• Stay up-to-date with COVID-19 vaccines and the updated booster.
• People with any COVID symptoms should get tested
• People who are positive for COVID-19 or do not feel well should stay home

For a county at a low community level, like Buncombe County, the CDC recommends:
• If you are at high risk for getting sick, wear a high-quality mask in a public indoors space and take additional precautions.
• If you plan on being with someone at high risk for getting sick, consider self-testing for COVID-19 infection and wear a high-quality mask when indoors with them.

Vaccination sites and testing sites can be located through the North Carolina and Buncombe County Department of Health and Human Services.

The updated booster shot is available at the Department of Public Health Coxe Avenue vaccination clinic, pharmacies, community health centers and rural health clinics.

 

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Contact: Dr. Dick Needleman, Health reporter, 103.3 AshevilleFM, [email protected]

More Posts for Show: Asheville FM News Hour