Health Headlines - January 23

Poor Planning Doomed Medicare Drug Plan Launch, Critics Charge

Earlier this month, a Medicaid recipient on four different heart medications was denied coverage for her life-saving prescriptions by her pharmacy in New York City.

Ideally, the woman should have been automatically transitioned from Medicaid-based coverage to Medicare's new drug benefit plan, which launched Jan. 1. Instead, her pharmacist told her he could no longer find any record of her in the system.

Desperate, she contacted the Medicare Rights Center, a nonprofit group that advocates on behalf of seniors and the disabled covered by the plan.

"There's literally hundreds of cases like just this in our office, right now," said Robert Hayes, the group's president.

Contacting Medicare's regional office in lower Manhattan, Hayes struggled to untangle the bureaucratic logjams that are preventing this patient and hundreds like her from getting the drugs they need.

"The response I got was, 'Well, give us their names,' " Hayes said. "But, they had had those names for eight or nine days."

A worker at the center said the outcome of the heart patient's case remains uncertain.

Tens of thousands of Medicare and Medicaid patients across the country have been encountering scenes like these ever since the roll-out of Medicare's Part D drug benefit, which was designed to provide cash-strapped seniors with low-cost medications through link ups with private insurers.

The biggest glitch? "Dual eligibles" -- Medicaid recipients like the woman above who also qualify for the new drug benefit -- were auto-enrolled by the agency into a private Part D plan. But some also went ahead and chose another plan in the run-up to the Jan. 1 deadline. The result? Data regarding their choice of a private plan made it into the system, but information as to their ongoing status as an eligible Medicaid/Medicare recipient did not.

Another problem: Beneficiaries switched to a new plan only to realize that it did not cover a brand-name drug they were taking. Under Part D rules, the new plan was required to cover the drug for a 30-day period, but this didn't always happen.

Scrambling, officials in 20 states passed short-term, emergency measures to pay pharmacists with state funds so that locked-out enrollees could get their drugs. And on Jan. 15, the White House ordered insurers to supply all beneficiaries in need with a 30-day supply of medications, no matter what. That measure might be extended if deemed necessary, federal officials said.

Medicare's critics say it just didn't have to be this way.

"It didn't have to be such a hassle," said Bill Vaughan, a health lobbyist and senior policy analyst at Washington, D.C.-based Consumers Union, which publishes Consumer Reports. He criticized the federal government for what he called its "breathtaking arrogance" in rushing the plan to the public.

Vaughan pointed to a 2004 study from the government's own Medicare Payment Advisory Commission, which found that transferring large numbers of patient files from one large insurer to another can take an average of six months.

"But here you have people in Part D signing up beginning on Nov. 15th for a program that starts Jan. 1 -- with some people even signing up Dec. 31st. And you expect them to get a prescription by January 2nd? It just won't work," Vaughan said.

A Medicare spokesman said that his agency was hamstrung by the law that created Part D. "You have to remember that Congress created the Part D program to begin January 1, 2006," Peter Ashkenaz said from his Washington, D.C. office. "So we put all the contingencies in place to handle as much as we did."

And he added that enrollment in the new plan has been high.

"Enrollment numbers issued earlier this week showed that we've got about 24 million people who are now receiving Part D drug coverage," Ashkenaz said in an interview Friday. "Roughly 20 million of them are receiving them through Part D plans -- stand alone plans, Medicare advantage plans or employer programs. We saw enrollment rise from a million the first couple of weeks to 3.6 million as of the 13th of January."

According to Ashkenaz, the biggest modification of Medicare in its 40-year history was bound to encounter a bump or two, and he said that millions of beneficiaries are getting their drugs just as easily as before.

He also noted that the new system does have a built-in "safety net."

"If a beneficiary is found not to be in a plan, the pharmacist has the ability to sign that 'dual-eligible' up to a plan right there at the counter -- it's a plan offered by Wellpoint, the only national plan that's authorized to receive auto-enrollments from low-income beneficiaries," he said.

Still, Hayes believes more could have been done. He said he personally warned Mark McClellan, Administrator of the federal Centers for Medicare and Medicaid Services, that the launch as planned couldn't go smoothly. Early last year, he said, "I was sitting in McClellan's office and I said, 'Look, even if you get this transition 99 percent right for the people losing Medicaid coverage, you're still going to have 64,000 people without drug coverage come Jan. 1.' And [McClellan] said 'No, we have everything under control.' "

The emergency relief now offered by the states provides beneficiaries with some form of safety net, Hayes said, though it's "a little late, and a little chaotic."

Ashkenaz' response: "Look, we are concerned if even a single beneficiary doesn't get the drugs they need. But we have the fallback system with Wellpoint, and we're working through the data systems to ensure that beneficiaries are able to get those drugs."

Others contend the system could have been designed better. New York City-based "information designer" Leslie Smolan works with big business to smooth out complex logistical bottlenecks.

She blamed the current Medicare problems on the fact that patient information remains split among the agency, doctors, pharmacies and insurance plans -- each with its own computer system and "language."

Better, centralized design that allowed every player in the process to share the same codes, programming and language would have prevented a lot of pain for the public, Smolan said. So would have more "beta testing" of the plan itself. "It's what any business creating any kind of product would do -- make sure it works, then roll it out," she said. "Now, it's just damage control."

But Ashkenaz said most of its partners have worked hard to merge their systems with Medicare's. "I talked to a 500-bed nursing home yesterday that said, 'We began preparing for Part D a year ago. We made sure then that our pharmacy was going to be able to talk to all of the plans.' "

Experts on both sides stressed that most of those who've enrolled have managed to get their medications without a problem, and Vaughan noted that the country has seen these types of first-year jitters during other major program launches.

In 1974, he noted, the federal government merged welfare programs for the aged, disabled and blind into what is now Social Security.

"In the first couple weeks, the system was so screwed up, The New York Times ran pictures of mounted police defending Social Security offices from people throwing bricks at the windows," he said.

"So, we've been here before," Vaughan noted. "This will get better and the system will shake out."

Heart Tests, Treatments May Be Overused

Doctors are using more and more tests and procedures to help detect and treat heart disease, even though the incidence of the illness isn't rising all that much, new studies show.

"I do believe that some of it is being done needlessly," said F. Lee Lucas, associate director of the Maine Medical Center's Outcomes Research and Evaluation, and lead author of a report in the Jan. 24 issue of Circulation.

Looking at Medicare records, Lucas and her colleagues found that from 1993 to 2001, U.S. doctors charted a nearly three-fold increase in the number of imaging stress tests ordered and more than a seven-fold increase in the use of coronary stents, the flexible tubes used to open narrow blood vessels in the heart.

"However, heart attack, by contrast, has not been increasing in any dramatic way," Lucas said. "So, we do not believe that the large increase in cardiac procedures reflects an underlying increase in coronary heart disease."

A report in the same journal on a study led by physicians at the University of Toronto found that annual costs for cardiac tests and bypass surgery nearly doubled in Canada between 1992 and 2001, outstripping "both demographic shifts and changes in the prevalence of coronary artery disease."

"The proliferation of cardiac testing challenges the sustainability of Medicare in Canada, especially given uncertainty as to whether the accompanying incremental rise in total expenditures translates into significant outcome benefits in the population," the researchers wrote.

In the United States, there has been a slight decrease in bypass surgery, Lucas said. "The rate has leveled off and will stay leveled off," she said.

But other procedures -- such as the insertion of catheters, flexible tubes used to open arteries, and stents, metal tubes designed to keep arteries open -- are being done more often, Lucas said.

"My basic feeling is that the rate of catheterization and coronary procedures such as stenting continues to increase," she said. "Some analyses show more than a linear increase. The trend is accelerating. Although this paper doesn't say so, I don't expect to see any leveling off based on what we see in the data."

The belief that many procedures are being done needlessly comes from a related study by the Maine group, Lucas said. "What we were able to show was that in areas where the rate is higher, the extra procedures are not targeted at the people who need them most," she said. "People get them equally, despite their risk."

The American Heart Association and the American College of Cardiology have separated patients into several classes, Lucas noted. "Class three includes those in whom the procedures are contraindicated, such as the terminally ill, who do not derive benefit from the procedure," she said. "What we showed is that the rate at which cardiac catherizations are being given is higher among all the subgroups, including those for whom it is contraindicated."

However, these two studies don't show whether the procedures are overused or done on patients who don't really need them, said Dr. Sidney C. Smith Jr., professor of medicine at the University of North Carolina and a spokesman for the American Heart Association.

"Nothing in either paper deals directly with appropriateness," Smith said, adding, "We need to be sure that we use these procedures appropriately and that all who might benefit from them receive them."

Until further studies are done to determine whether too many procedures are being done, prevention still should be key, he said.

"Cardiovascular disease is largely preventable," Smith said. "The issue can be resolved by better and increased use of preventive measures -- exercise, control of blood pressure, control of lipid abnormalities, weight loss when necessary. We wouldn't have to worry about the need for extensive procedures if these measures were taken by more people."

FDA Panel Approves OTC Weight-Loss Pill

A Food and Drug Administration panel of doctors and scientists voted Monday to recommend that the regulatory agency approve over-the-counter sales of a weight-loss pill now sold only with a prescription.

GlaxoSmithKline Consumer Healthcare still needs final FDA approval before it can sell the nonprescription version of orlistat, a drug already marketed in prescription form as Xenical, to overweight adults as use as a weight-loss aid. The FDA approved the prescription version of the fat-blocking pill made by Roche in 1999.

A joint FDA advisory committee voted 11-3 to recommend approval late Monday following a daylong hearing. The agency usually follows the recommendations of its outside panels of experts. Currently, the FDA has not approved any nonprescription weight-loss drugs for sale.

In six-month clinical trials, obese people who took orlistat lost on average 5.3 pounds to 6.2 pounds more than did those who were given dummy pills. Glaxo wants people to use it for only six months at a time, but as an over-the-counter item, its use could not be policed.

However, the pill's effect ends once its use is stopped, said Dr. Julie Golden, a medical officer in the FDA's division of metabolism and endocrinology products. A previous study showed a progressive weight gain in patients after they discontinued use of orlistat, Golden said.

Black Currants May Help Thwart Alzheimer's

Compounds in black currants may help protect against Alzheimer's disease, according to a study in the current issue of Chemistry & Industry magazine.

Researchers found that these compounds -- anthocyanins and polyphenolics -- had a strong protective effect in cultured neuronal cells. Darker black currants contain more anthocyanins and are likely to be more potent.

"These compounds also work in hippocampal cells taken straight from the brain," researcher James Joseph of Tufts University said in a prepared statement. He said these protective effects will likely be reproduced in the human body and that these compounds may prevent or significantly delay the onset of Alzheimer's.

While previous research found that compounds in black currants acted as antioxidants, this is the first study to demonstrate that they may help protect brain cells. Exactly how they do this remains unclear, the study said.

"We have evidence that the compounds protect against Alzheimer's by influencing the early gene expression in learning and memory, which influences cell signaling pathways that help neuronal cells communicate with each other," Joseph said.

Health Tip: Using a Nebulizer

For some people with respiratory problems, nebulizers are as essential as breathing.

In fact, these devices are used to treat asthma and other conditions that make it difficult to breathe. They deliver a stream of medicated air through a mask or tube to help open the airways to the lungs.

Different medications are used in nebulizers. Many have side effects such as headache, dizziness or even chest pain, but all of them are designed to help breathing.

According the National Library of Medicine, nebulizer medicines should be stored in a safe place, at room temperature, and away from children. Some medications should not be exposed to light until they're actually used.

If asthma symptoms become worse and the nebulizer medication becomes less effective, it's important to call a doctor because the patient's condition may be getting worse.

Health Tip: Keeping the Kids Safe Around the Car

Most people worry about their children's safety in cars.

But another critical place to be concerned about safety is around cars, according to a study by the U.S. Centers for Disease Control and Prevention.

A CDC reports concludes that children left unattended in or around motor vehicles can be injured or killed by slow-moving cars, cars rolling backward in driveways and parking lots, cars set in motion by the child, and children getting trapped in the car's trunk.

Some automobile companies are now equipping cars with sensors that can detect some of these unseen obstacles.

The best advice: When the kids are involved, be alert.

Food Fact:
Guac shock.

Think avocados are too lush and buttery to be good for you? Think again. Yes, avocados are high in fat, but it's the heart-healthy kind. Even "good" fat is highly caloric, so you have to keep portions under control, but in moderation as part of a diet low in saturated fat, avocados can help reduce bad cholesterol. To determine ripeness, press gently on the avocado's skin. If the flesh yields slightly, the avocado is ready to eat that day. Store avocados at room temperature, never in the refrigerator.

Fitness Tip of the day:
Dyna-band on the run.

Next time you head out on a business trip, pack a Dyna-band and a jump rope -- small items with big rewards. When time or the weather doesn't permit a gym visit or running, you can work up a sweat in your room with resistance training and cardio exercise using these two compact helpers. Nothing boosts your energy, creativity and effectiveness on the road like a workout.

FAQ of the day:
What exactly is considered "red" meat?

Contrary to what some advertisements may dub "the other white meat," scientists define red meat as the meat from land mammals such as cattle, pigs and lamb. That means beef, lamb and, yes, pork.