Medical Device Daily Washington Editor

Last week's stalled authorization for Medicare funding promises to leave doctors with about 10% less money for their Part B business for the balance of the year, but the Centers for Medicare & Medicaid Services nonetheless published its proposed Part B fee schedule for calendar year 2009. That proposal includes another 5.4% reduction beyond the 10.6% already in play.

However, Mike Leavitt, the Secretary of Health and Human Services, has thrown Congress an offer of reprieve in the battle over Medicare Advantage plans, which Congress wants to trim back substantially in order to pay for the suspension of the cuts to Part B services.

Leavitt's offer is to hold all claims coming in the first 10 business days after June 30, which would slow down payments but which would also give Congress and the White House time to come to some agreement over the stand-off.

Two members of the Senate, however, claim that the 10-day hold is essentially meaningless, given that CMS is required to hold claims for 13 days in order to verify the legitimacy of the charges.

Sens. John Rockefeller (D-West Virginia) and Charles Schumer (D-New York) state in their June 30 letter that the administration "is misleading the public by claiming to provide a temporary hold on payment which is already authorized by law."

Whether Leavitt intended to say that CMS will hold invoices 10 days beyond the 13 days mentioned by Schumer and Rockefeller is unclear. CMS did not return calls for comment by press time yesterday.

The Senate came up short in a 58-40 vote last Friday to provide funds for Medicare over the next five years (Medical Device Daily, June 30, 2008), which is needed to avert the 10.6% reduction in Part B doc fees under SGR. According to CMS, the proposal would provide payouts "projected at $54 billion, down 5% from the $57 billion projected for 2008." The White House threatened to veto any bill that takes money away from Medicare Advantage plans.

Acting CMS administrator Kerry Weems said the fee schedule is part of the agency's efforts "to improve how Medicare pays for healthcare services for our nation's seniors," and "to ensure that beneficiaries continue to get the highest quality of health care at the greatest value."

Jim King, President of the American Academy of Family Physicians (AAFP; Washington), told Medical Device Daily that Congress "has to change this formula." He added, "we're hoping that they'll come back in and correct the 10% and give themselves 18 months" to find an alternate to SGR for keeping costs from overwhelming Medicare.

As for a recent GOP proposal to keep funding at current levels for a year and a half, King stated that Sen. Ted Kennedy (D-Massachusetts), the chairman of the Health, Education, Labor and Pensions committee, "was in favor of 18 months," and King said "we think its going to take at least a year to change the formula."

According to King, physician costs could be trimmed by consolidating into larger groups. "I see that happening, and we're watching it closely," he said, but added, "larger practices alone cannot fix the payment system we have."

RM alone not enough for hypertension

Controlling medical costs means dealing with chronic conditions more effectively and remote monitoring (RM) is one of the means by which docs can keep patients healthy. According to a report in the June 25 edition of the Journal of the American Medical Association, remote monitoring can be used to cut down on hypertension, but not by itself.

The paper, penned by a group of 10 led by Beverly Green, MD, of the Group Health Cooperative (Seattle, Washington), is based on a study of three groups of hypertensive patients totaling 778 over roughly two and a half years. The control group went through typical care scenarios whereas the other two groups reported their blood pressures via web monitoring. One of these latter two groups also consulted with a pharmacist regarding their drug regime via the Internet.

The patients on an RM regime recorded a drop in blood pressure (36% to 31%, RM-only and controls, respectively), but the drop was not deemed statistically significant. On the other hand, the article's abstract states that "adding a Web-based pharmacist care to home BP monitoring and web training significantly increased the percentage of patients with controlled BP," coming in at 56%.

The conclusion? "Pharmacist care management delivered through secure patient Web communications improved BP control in patients with hypertension."

Headband diagnoses Alzheimer's

Headbands are not just for sweaty professional athletes anymore.

According to a recent article in the journal Optics Letters, the use of pulsed near-infrared light shone onto the forehead of a patient can tell a doctor whether that patient's brain exhibits the kinds of morphological changes characteristic of Alzheimer's disease. As things stand, this can only be done after the disease kills the victim.

Eugene Hanlon, PhD, a researcher at the Veteran's Administration Medical Center in Bedford, Massachusetts and others have gone as far as small trials to prove the principal, and will soon begin trying the technique out on human subjects.

The problem with this approach is a familiar one to radiation technologists; how to get the signals past the skull and back out. This was the major impediment to x-radiation and led to the development imaging with magnetic resonance (MR), which is also on the short list of candidates to make the diagnosis of Alzheimer's.

The attraction behind this headband-based, near-infrared approach is that it would be much cheaper than an MR scan and positron-emission scanning. Both these modes can require the use of contrast dyes, which carry their own risks.