Medicare Part D is a wonderful program that protects the health of our deserving seniors in Florida and throughout the nation. Recent proposed changes would be detrimental to seniors who rely on Part D for the medications they desperately need. We need to preserve it for current enrollees and those it will help in the future. Since enacted, the program has exceeded cost-saving expectations and is widely loved by seniors. This outstanding program delivers needed treatments at a far lower cost than projected by the Congressional Budget Office. Part D costs are 45 percent lower than projected for the initial 2004-2013 forecast period, and CBO has continued reducing its cost projection. Spending estimates have been reduced by more than $100 billion each of the past three years, proving that seniors are getting tremendous value in a program that is consistently affordable. Additionally, average premiums for enrollees this year are far below original projections at about $30 monthly, which is less than the original estimates of $61. Most Medicare enrollees cannot afford an extra $50 or $100 in additional monthly expenses, so it is fortunate that the premiums for Part D remain low, ensuring their medicines are affordable.

Not only is the program costing less than expected, but studies have shown that Part D decreases medical spending in Medicare. CBO estimates that a 1 percent increase in the number of prescriptions filled by enrollees would cause Medicare’s spending on services to fall by about one-fifth of 1 percent. Additionally, a study in the Journal of the American Medical Association found that the Medicare prescription drug program was followed by a $1,200 annual decrease in non-drug medical spending among those who previously had limited drug coverage. This reduction saved taxpayers $13.4 billion overall during the first full year of Part D. Some have suggested this extremely successful and important program be changed to lower costs. However, any modifications to this program would not lower costs for seniors; instead, it would inhibit the program. When Part D was enacted, it included a non-interference clause that allows for the free market to negotiate the price of medications. It is for this reason that costs remain low. According to the nonpartisan CBO, if we allow the secretary of Health and Human Services to interfere in the private price negotiations between Medicare Part D plans and drug manufacturers and pharmacies in the program, we will not see cost savings. CBO also says that striking the non-interference clause will not yield significant savings unless the government also restricts access or fixes prices.

Some also argue that the benefit should be changed to work like Veterans Affairs’ prescription drug benefit. However, many VA beneficiaries prefer to use other coverage for their medicines rather than rely on VA coverage because of its restrictive formulary. A recent study on the subject, conducted by the Lewin Group, found that of the most routinely prescribed drugs for seniors, 93 percent were covered by both of the two most popular Part D plans — compared to only 67 percent covered by the VA formulary. Additionally, the proposed Independent Payment Advisory Board would be detrimental to the program, dictating arbitrary budget cuts. The proposed board is not accountable to anyone, and it would function independently of any control by elected officials in violation of the principle of the democratic process. Any change to the Part D program that could result in cost increases for enrollees would be detrimental. If seniors are unable to pay for the critical medications they need, many will suffer. We need to protect the critically important program that saves the lives of so many here in our Sunshine State. Austin R. Curry is the executive director of Elder Care Advocacy of Florida.

Medicare Part D needs to be preserved for seniors

By AUSTIN R. CURRY | Special To The Tampa TribunePublished: March 26, 2013

Written by:Deepak A. Kapoor, M.D. Recently, investigative reports have shed light on a serious yet underreported problem: hospitals’ role in perpetuating spiraling health-care costs. Differential reimbursement policies have enabled hospitals to acquire thousands of physi-cian practices nationwide, consolidating their market control in many communi-ties. For example, the American College of Cardiology reports that since 2007, the number of hospital employed cardiolo-gists has more than tripled, while the number in private practice has fallen 23 percent. This trend extends to physician recruitment: recent surveys indicate that hospital employment is now preferred by new graduates over traditional private practice. Historically, hospitals are the least ef-ficient, most expensive site of service for medical care. Unfortunately, hospitals are rewarded for this inefficiency by being reimbursed at higher rates than physi-cians’ offices for providing exactly the same service. These increased costs are passed to patients and employers through higher insurance premiums; these costs also strain the solvency of state and fed-eral health-care programs. It has been reported that Medicare is pay-ing more than a billion dollars annually for the same services because hospitals can charge more when doctors work for them. Whether for diagnostic imaging, surgical services, chemotherapy or thera-peutic radiation, hospital reimbursement for outpatient services are often multiple times that for physician offices or ambu-latory surgery centers. In fact, the Deficit

Reduction Act capped reimbursement for medical imaging procedures in the physi-cian office at the outpatient hospital rate — thus, all such procedures cost the same or less at physicians’ offices than hospi-tals. Unfortunately, no such constraints exist on bloated hospital charges. Those advocating hospital takeover of community practitioners argue that this improves efficiency and outcomes, but such unrestrained acquisition can result in dangerous hospital monopolies. Reports indicate that some physicians working for Health Management Associates were pressured to increase revenues both by di-recting patient referrals to doctors work-ing for the same hospital and by meeting emergency room admittance quotas. HMA, the fourth largest for-profit hospi-tal chain in the U.S., with nearly half of its revenues coming from Medicare and Medicaid programs, was accused of set-ting arbitrary benchmarks for physicians admitting patients in order to increase profits, regardless of medical need. This unethical behavior puts ill patients at direct risk for hospital acquired infections and other complications, further reducing access and increasing costs. Technological advances have enabled community-based physicians to of-fer integrated care in the independent practice setting — which allows patients to be diagnosed and treated by different specialists under one roof or organized electronically into virtual groups — pro-viding patients with efficient, accessible, high-quality services. These integrated physician groups are able to improve ac-cess and control costs while maintaining traditional doctor-patient relationships.

These groups serve the added benefit of effectively counterbalancing hospital healthcare monopolies, providing patients with an important community alternative to monolithic healthcare conglomerates. If the disproportionate payment sys-tem presently in effect continues, such groups will have no choice other than to close their doors or sell their practices to hospitals; ultimately forcing patients into more expensive, less convenient sites of service. Fundamental to the American ideal of fair play is the notion of equal pay for equal work. Indeed, the Medicare Payment Ad-visory Commission has embraced this by recommending fee parity for outpatient evaluation and management visits in both hospitals and physicians’ offices. The future of healthcare depends on control-ling costs while preserving access and improving outcomes regardless of site of service; leveling the reimbursement playing field is an important first step in this direction.

Deepak A. Kapoor, M.D. is president of the Large Urology Group Practice Association, Schaumburg, IL., as well as chairman and CEO of Integrated Medical Professionals,

PLLC, the largest independent urology group practice in the United States.

Patients deserve high-quality care without excessive costs

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Published on January 29, 2013

New study confirms PSA screening saves lives

By Deepak A. Kapoor, M.D., president, Large Urology Group Practice Association

03/20/12 11:34 AM ET

For the past two decades (the PSA screening era), we have seen a nearly 40 percent decrease in deaths from prostate

cancer although there has been no increase in incidence during this interval. This month, a follow-up of the European

Randomized Study of Screening for Prostate Cancer (ERSPC) was published in the New England Journal of Medicine. It

confirmed what urologists and other health care providers have known for years: PSA screening is a valuable life-saving

tool. The study, “Prostate-Cancer Mortality at 11 Years of Follow-up,” showed that the statistical significance of prostate

screening for all age groups has improved, with an overall survival advantage of 21 percent. More importantly, for

patients followed for more than 10 years, this advantage increased to 38 percent.

Nearly six months ago, U.S. Preventive Services Task Force (USPSTF) recommended healthy men no longer receive PSA

tests as part of routine cancer screening. Ironically, this decision against routine PSA screening was made by a panel that

does not include urologists or oncologists. The same task force tried unsuccessfully to eliminate mammograms for women

ages 40-49 and recommended against teaching women to do breast self-exams. The panel made the PSA recommendation

based on contradictory information from studies with serious design flaws. Based on USPSTF recommendations, the

Government Accountability Office (GAO) singled out PSA tests as a screening that would require patient co-pays,

potentially discouraging men to have testing that could identify cancer in its earliest, most curable stage.

What is particularly disturbing about all this discussion is that PSA screening itself is not treatment, but is merely a simple

blood test. There are essentially no risks to screening, and with screening results, patients have the information they need

to make better informed decisions about their health. Particularly in need of this information are those at greatest risk for

prostate cancer: African-American men and those with a family history of prostate cancer. Opponents to prostate cancer

screening are not concerned about the risks or costs of screening (both of which are negligible) but rather that patients, in

consultation with their own doctor, may not make the “right” treatment decision. This paternalistic interference by the

government with the one of the most private decisions in any man’s life is inconsistent with the values we hold most dear.

It is simply indefensible.

The revised ERSPC data highlights the problems with the USPSTF process. Under the Affordable Care Act, this taxpayer-

funded agency has been given great power to determine what screening tests must be provided. Despite this authority, the

USPSTF does complies with neither the Federal Advisory Committee Act, (FACA) nor the Administrative Procedures

Act (APA) which were enacted to ensure that those that ultimately work for American citizens conduct their business in

an objective, transparent fashion. We as a country deserve to know who is making health policy decisions by what

criteria, as well as if there is an inherent bias or potential conflict of interest that those with that decision-making power

may have.

Ultimately, the decision on how to screen and treat prostate cancer should stay where it has always been: between patients

and their doctors. This landmark research on the benefits of PSA screening is critical not only for men’s health, but also

serves to illustrate the severe flaws in our existing process. Enactment of the USPSTF recommendations will cause the

needless deaths of thousands of men, and not only must this recommendation be modified, but the entire process revised

to ensure such missteps do not occur in the future.

Deepak A. Kapoor, M.D. is president of the Large Urology Group Practice Association, representing more than 1,800

urologists nationwide, as well as chairman and CEO of Integrated Medical Professionals, PLLC, the largest independent

urology group practice in the United States.