Prevention Matters

Partnership for Prevention is proud to be one of six groups telling Centers for Medicare and Medicaid Services (CMS), “Medicaid should cover the full range of proven and effective treatment options so that pregnant women can find the particular service or combination of services that will best help them to quit using tobacco and not relapse.” Partnership made these comments in a letter yesterday to CMS on our views on the implementation of Section 4107 of the Patient Protection and Affordable Care Act (PPACA).

This section of the PPACA will be implemented October 1st of this year and will require state Medicaid programs to cover comprehensive tobacco cessation services, including “diagnostic, therapy, and counseling services and pharmacotherapy (including the coverage of prescription and non-prescription tobacco cessation agents approved by the Food and Drug Administration)”, for pregnant women. While this is certainly an improvement to the Social Security Act, Partnership urges CMS to clarify exactly what states must do to comply with Section 4107.

In its current state, the PPACA does not specify the type of counseling or the amount and duration of counseling sessions that pregnant women should receive. The Public Health Service’s Treating Tobacco Use and Dependence clinical practice guideline (PHS Guideline) found that proactive telephone counseling (quitlines, call-back counseling), individual counseling, and group counseling formats are all effective in reducing tobacco use. The PHS Guideline also confirmed that there is a strong dose-response relationship between the frequency and length of the counseling sessions and successful quit attempts. Furthermore, the PHS Guideline found that an effective strategy for producing high, long-term abstinence rates is “relatively intense cessation counseling (e.g., four or more sessions that are 10 minutes or more in length each)” and recommends that, if possible, clinicians should strive to meet with individuals four or more times.

Based on these guidelines, Partnership feels that the PPACA should require states to cover all three counseling formats: individual, group, and telephone-based. They should also cover a minimum of four counseling sessions per quit attempt and should be strongly encouraged to cover more sessions since accumulating evidence suggests that states cover a minimum of two quit attempts per year.

In terms of cessation medications, the current PHS Guideline does not make recommendations. In the event that a subsequent PHS Guideline does recommend use of cessation medications during pregnancy or if new evidence emerges that cessation medications can be used safely and effectively by pregnant women, Partnership encourages CMS to inform states that they must cover those medications in their Medicaid programs with no cost-sharing requirement.

Partnership for Prevention believes that effective implementation of this new policy will result in fewer health risks and save lives and money.

The Centers for Medicare and Medicaid Services (CMS) has proposed a new measure, which is still preliminary, that would expand coverage for evidence-based tobacco cessation counseling for all Medicare recipients. Current Medicare language limits reimbursement for tobacco cessation counseling to patients who have a tobacco-related disease.

The CMS has set a period of time for Public Comments on the proposed determination, after which they will issue a final decision. This period ends June 27, 2010. Partnership for Prevention urges you to offer your own public comment in support of tobacco cessation counseling for Medicare beneficiaries. It’s easy to do – just click on this link, then click on the orange “Comment” button at the top. Type in the box whatever you see fit to communicate about this matter.

As an example, here’s what I wrote in my message to the CMS this morning:

I am writing to express my strong support for the Centers for Medicare and Medicaid Services proposed decision to extend tobacco cessation counseling to all Medicare beneficiaries. It is Partnership for Prevention's position that this policy will help many tobacco users break free from a deadly behavior, people who otherwise would have been unable to do so. Undoubtedly, many lives will be extended and much money saved if this decision is enacted.

Not only is tobacco cessation counseling a Grade A rated recommendation by the U.S. Preventive Services Task Force, it is also received the highest ranking by Partnership for Prevention's National Commission on Prevention Priorities. In that review, physician tobacco cessation counseling was one of only three clinical preventive services to receive the highest score for cost and prevention effectiveness.

I urge the CMS to move forward with this critical public health measure when the public comment period has concluded. The entire Medicare community deserves to benefit from this service, not only those who have been diagnosed with a tobacco related illness. After all, that's what prevention is all about.

It is important that the CMS hears from constituents who support disease prevention, health promotion, and tobacco cessation. If enacted, this measure represents a lifesaving advance in our capacity to guarantee that all tobacco users have access to evidence-based tobacco cessation counseling. A significant public health benefit will be realized.

David Zauche
Senior Program Officer
Partnership for Prevention

The Department of Health and Human Services’ Office of Inspector General (IG) has just released a new report (OEI-05-08-00520) concluding that “Most children in nine selected States are not fully benefiting from Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) comprehensive screening services.”

For anyone concerned about the importance of expanding coverage for clinical preventive services under health reform, this report is a reminder that coverage alone isn’t enough to assure access.

The EPSDT program provides “a comprehensive and preventive child health program for children under the age of 21. Every State Medicaid program must offer the EPSDT benefit…In 2007, 31.5 million children were eligible for EPSDT…Services provided under the EPSDT benefit are intended to screen, diagnose, and treat children eligible for EPSDT services at early, regular intervals to avoid or minimize childhood illness. The EPSDT services cover four health-related areas: medical, vision, hearing, and dental. This study focused on medical, vision, and hearing screenings. Only medical screenings have components specifically required by the statute. Complete medical screenings under the EPSDT benefit must include the following five age-appropriate components: a comprehensive health and developmental history, a comprehensive unclothed physical examination, appropriate immunizations according to age and health history, appropriate laboratory tests, and health education.

States selected for the review included Arkansas, Florida, Idaho, Illinois, Missouri, North Carolina, Texas, Vermont and West Virginia.

The IG found that two primary factors contributed to children not receiving required screenings.

First, children did not receive the correct number of each type of screening. Second, when children received medical screenings, the screenings were often incomplete. These two factors taken together indicate that very few children received the correct number of complete screenings required by law.

Seventy-six percent of children, or 2.7 million children, in the States selected for the review did not receive all of the required number of medical, vision, and hearing screenings. Forty-one percent of children did not receive any required medical screenings. In addition, more than half of children did not receive any required vision or hearing screenings.

Fifty-five percent of children in the nine States received a medical screening during the study period. Of these children, 59 percent lacked at least one component of a complete medical screening. The component that children were missing most often was appropriate laboratory tests.

Officials from all nine selected States identified strategies to improve participation in the EPSDT and the completeness of medical screenings. The disconnection between States’ efforts to improve the EPSDT program and the low number of children receiving required screenings is difficult to account for, but it indicates that additional efforts are required.

Based on these findings, the IG recommended that CMS: (1) require States to report vision and hearing screenings, (2) collaborate with States and providers to develop effective strategies to encourage beneficiary participation in EPSDT screenings, (3) collaborate with States and providers to develop education and incentives for providers to encourage complete medical screenings, and (4) identify and disseminate promising State practices for increasing children’s participation in EPSDT screenings and providers’ delivery of complete medical screenings.

New requirements under Health Reform will require expanded coverage of clinical prevention services under Medicare and new individual and group private plans. To realize the benefits of these services it is essential the Administration require that new coverage be accompanied by effective strategies and resources to encourage participation.

E Ripley Forbes
Director, Government Affairs
Partnership for Prevention

A project that links Medicare payments to quality of hospital care has led to the prevention of 4,700 heart attack deaths in four years, according to an analysis by the contractor, Premier Financial Services.

The Centers for Medicare and Medicaid Services (CMS) announced fourth-year data from its hospital quality improvement project as well as data from two demonstration projects in which physician groups improved outcomes by following quality measures.

The new CMS data provides support for what President Obama and others have proposed -- paying for improvements in patient health, rather than for the number of services received during a hospital stay. Proponents of the so-called value-based purchasing concept say the plan could help save major money in the Medicare system.

The Centers for Medicare and Medicaid Services (CMS) has forecast that the share of the economy devoted to health spending will jump a full percentage point this year. The jump from 16.6% to 17.6% would mark the biggest one-year increase recorded since the government began tracking the data in 1960.

Hopefully, this will put to rest the notion that we can't afford to do health reform right away. There are signs that people are getting this message:

New York Times: "While some people have predicted that Mr. Obama would have to shelve his priorities given rising deficits, his determination to proceed, especially on health care, reflects his economic advisers' conviction that the government cannot control its finances without reforming health care."

Long Island Newsday: "Whenever this tsunami of acute economic problems finally ebbs, the chronic problem of out-of-control medical costs will take center stage as an impediment to a healthy future," and while "it may take broad reform to fashion an affordable, sustainable health care system ... the effort has to start now," a Newsday editorial states.

Joe Conason, Salon: Neither the fiscal responsibility summit "nor any other serious discussion of fiscal problems can be confined to entitlement programs -- because the underlying issue is health care costs."