These checks are sent automatically to seniors when 2010 prescription costs reach the coverage gap.

It is not necessary to apply for the check!

But scam artists are already at work, contacting  seniors and other Medicare beneficiaries asking for social security numbers, bank accounts, and pretending to help them apply for the $250 rebates.

The Centers for Medicare and Medicaid Services has begun a national education campaign to help consumers protect themselves against rebate check fraud.  It includes radio, television, and print advertising along with outreach efforts.

CMS Acting Administrator Marilynn Tavenner told the press,

Since early April, we have learned of seniors across the country who are being asked for personal information to help them get a rebate check,” Beneficiaries who reach the donut hole will get a check mailed to the same address Medicare uses to send them information now without doing anything special. Seniors should be on the look-out for scams where people they don’t know ask them for their personal information in order to get their checks. This is not how the process will work. Checks will come directly to beneficiaries who qualify for this benefit under the Affordable Care Act. Seniors or family members should contact us at 1-800-MEDICARE to report any of these types of calls or go to www.stopmedicarefraud.gov to learn more about efforts to fight scams like these.

Rebate checks are part of the Affordable Care Act which will continue to provide discounts for prescription drugs until the coverage gap is finally closed in 2020.

If someone acts you for personal information over the phone, especially if they ask for social security numbers or bank accounts, HANG UP.

And then let Medicare know.

Reviewing published medical literature, a task group from the National Colorectal Cancer Roundtable found research identifying both barriers to screening and factors that made it easier.

The most frequently mentioned barrier related to healthcare providers was lack of a doctor’s recommendation.  Having a usual source of health care facilitated getting screened.

Other barriers included:

• Low level of education
• African American race
• Hispanic ethnicity
• female gender

Being married or living with a partner was the most frequent personal faciliator.

Lack of health insurance or dual coverage with Medicare and Medicaid were most frequently reported insurance barriers to getting screened, while Medicare coverage was consistently reported as facilitating it.

Idris Guessous led the study team from the National Colorectal Cancer Roundtable Screening Among the 65 Plus Task Group.

SOURCE: Guessous et al., Preventive Medicine, Volume 50, Issues 1-2, pages 3-10, January-February 2010.

• The Colorectal Cancer Association of Canada is sponsoring a contest for print and video ads that raise awareness of colorectal cancer.
• Clinical trials at the NIH Clinical Center in Bethesda, MD are an option for cutting-edge treatment at no cost.
• When co-pays are raised for Medicare, the elderly make fewer outpatient visits but are hospitalized more often and stay in the hospital longer.

Raise CRC awareness with an ad or video and win!

Your print or video public service announcement to raise awareness of colorectal cancer and its prevention could be a winner.

The Colorectal Cancer Association of Canada will award $2,500 for the best video and $1,000 for the best print ad that reduces colorectal cancer by encouraging:

• Prevention= health lifestyles, diet and exercise, screening
• Awareness= signs, symptoms, stats
• Education= knowledge about treatments
• Support= cancer coaching and psychosocial aspects
• Advocacy = access to diagnostics and medicine

Entries must be submitted online and be received by March 31, 2010.

Cancer clinical trials at the National Institutes of Health in Bethesda

The National Cancer Institute Center for Cancer Research in Bethesda, MD, just outside of Washington D.C., conducts cancer clinical trials, including trials for colon and rectal cancer.

There is no cost to participate in a clinical trial at the NIH Clinical Center.  In addition, transportation expenses are paid and there is a per diem to cover meals and lodging for outpatients.

Higher co-pays for Medicare end up costing more

When Medicare co-pays are raised for ambulatory visits, plan members make fewer out-patient visits, but are hospitalized more often and for more days.

In plans that raised co-pays, there were 20 fewer out-patient visits per 100 enrollees each year, but 2 more hospitalizations and 13 more days in the hospital compared to plans that kept co-pays stable.

For every 100 patients in plans that raised co-pays, the plan got $5,950 in extra money from co-pays and saved $1,200 from fewer outpatient visits for a net savings to the insurance plan of $7,150.  However, with an average cost of $11,o65 for each hospitalization of a patient 65 to 84, the increase in hospitalization cost $24,000 for each 100 plan enrollees.

Increased co-pays hit low-income, black, and less-educated patients particularly hard, decreasing numbers of visits and increasing hospitalizations.

Writing in the January 28, 2010 issue of the New England Journal of Medicine, lead author Amal N. Trivedi, MD, MPH and team concluded,

Increasing copayments for ambulatory care reduced the use of outpatient care among elderly enrollees in managed-care plans, but this decline was offset by an increase in hospitalizations, particularly among enrollees with low socioeconomic status and those with chronic disease. Increasing copayments for ambulatory care among elderly patients may have adverse health consequences and may increase spending for health care

On Thursday afternoon, Senate Majority Leader Reid (NV) set the procedural wheels in motion for a vote on the Patient Protection and Affordable Care Act.

The first procedural vote is expected around 8pm on Saturday.  It will be a cloture vote on the motion to proceed.  Majority Leader Reid is working to line up the 60 votes needed to pass the cloture motion (a cloture motion must be approved by three-fifths of the Senate).

Continue reading for more information on the upcoming Senate vote as well as a summary of some of the provisions included in the Senate bill that C3 thinks are important for people living with colorectal cancer.

Typically, a cloture vote will be followed by a second procedural vote – a vote on the motion to proceed.  This vote requires a simple majority vote to pass.  However, Senate Republicans have agreed to waive this second procedural vote and forego reading the bill on the Senate floor in exchange for an all-day debate on the bill on Saturday (without this agreement, the Senate rules would have only required one hour of debate before the cloture vote).

The New York Times reports that Democratic Sens. Ben Nelson (NE), Mary Landrieu (LA), and Blanche Lincoln (AR) “are proving tough sells” on health care reform, “raising the prospect that one or perhaps all three of them could scuttle the bill before the fight over it even begins on the Senate floor.”  Should the cloture vote fail, Democrats may be forced “to regroup and redraw the measure or even switch to a more contentious procedural shortcut around the need for a 60-vote majority.”  Politico has a good article on the fast track options for moving the legislation forward.

Be sure to tune in and watch the debate and vote on Saturday.  You can watch the vote on C-Span’s website.

The $849 billion Patient Protection and Affordable Care Act includes a public option that will extend health insurance coverage to 31 million Americans.  The reimbursement rates for the public plan will not be tied to Medicare, and co-ops will still be offered.  The bill will create an insurance exchange where people can compare and purchase health insurance, it expands Medicaid coverage to those earning 133 percent of the federal poverty level, and it offers subsidies to help those without employer sponsored insurance purchase health insurance.

Increasing the number of Americans with health insurance will help reduce mortality rates from colorectal cancer.  Many studies show that people who are uninsured are substantially less likely to be screened for colorectal cancer.  In addition, insurance status strongly influences survival among those diagnosed with colorectal cancer – individuals with private insurance who are diagnosed with Stage II colorectal cancer have better survival outcomes than individuals who are uninsured and are diagnosed with Stage I colorectal cancer.

Like the House health reform bill, the Senate bill eliminates pre-existing condition exclusions.  Eliminating pre-existing conditions exclusions is very important for cancer patients.  Pre-existing condition exclusions lock the millions of Americans with at least one chronic illness (nearly one third of the population) into existing plans and employment.

The bill will eliminate cost-sharing requirements for all preventive services (including colorectal cancer screening) that have a United States Preventive Services Task Force (USPSTF) A/B rating, and require coverage of these tests by private insurance.

It also has a section regarding community preventive screenings, and specifically lists cancer screenings as one of the community interventions needed to improve public health.

The bill establishes a prevention and public health fund to be administered through the Office of the Secretary at the Department of Health and Human Services to provide for an expanded and sustained national investment in prevention and public health programs.  This new fund will support public health activities including prevention research and health screenings.

Many colorectal cancer patients face a lifetime of cancer treatment.  Caps on insurance result in very difficult decisions about the care they will receive and how they are going to pay for it.  The Patient Protection and Affordable Care Act eliminates “unreasonable annual benefits” and lifetime limits on the dollar value of benefits for any participant or beneficiary for all group health plans and health insurance coverage required to provide “essential health benefits” (i.e., any insurance company or plan that participates in the new health insurance exchange).

Senate Democrats have complied a section-by-section summary of the bill along with a timeline for implementation of the various provisions in the bill.  In addition, the Congressional Budget Office (CBO) has reviewed the legislation.  CBO’s analysis and cost estimate of the bill is available online.

The cloture vote on Saturday is an important step in getting a final health reform bill sent to the President, but there is still a long road ahead for health reform and many areas where the pending bills could be improved.

C3 has been closely following the various health reform proposals introduced in Congress, and will continue to work with legislators to advocate for the access to care that is critical to preventing, treating and beating colorectal cancer.  Please feel free to share your thoughts with us by leaving comments below.

If you can’t have a loved one with you during a painful procedure, just looking at your partner’s picture may make it hurt less.

The American Society for Radiation Oncology has a new website for patients, and open enrollment for Medicare plan coverage begins on November 15 and extends through the end of the year.

Research News

• African Americans were more likely to die of colorectal cancer in a study of over 13,000 patients.  They were more likely to have stage IV disease when diagnosed and less likely to have surgery.   But after late stage and lack of surgery were taken into account, racial differences in survival disappeared.  Writing in the November 2009 issue of the Journal of the American College of Surgeons, Dr. Timothy L. Fitzgerald and team said, “These data suggest that improvements in screening and rates of operation may reduce differences in colorectal cancer outcomes between African-American and Caucasian patients.”
• Canadian women were more likely than men to be diagnosed with an early colorectal cancer in the three years after a negative colonoscopy.  Researchers in Manitoba studied billing records for nearly 46,000 patients who had a clear colonoscopy and found that women with a negative colonoscopy were about as likely as women in the general population to develop colon cancer during the first three years after their test.  Then their risk dropped to about 40 to 50 percent lower.  The men’s  risk was 40 to 50 percent lower throughout the follow-up period.  Older women and those whose colonoscopy wasn’t done by a gastroenterologist were the most likely to have a missed or early colorectal cancer.   Harminder Singh MD, MPH and his team at the University of Manitoba reported their results in the American Journal of Gastroenterology online November 10, 2009.
• Looking at the picture of a loved one or holding your boyfriend’s hand reduces painful feelings, according to a study done by psychologists at UCLA. Women reported less pain when heat was applied to their forearm if they were holding their partner’s hand rather than a stranger’s hand or a ball during the experiment.  Just looking at a picture of their loved one also reduced the amount of pain they said they had.  Sarah Master PhD led the study.

Other Headlines

• The American Society for Radiation Oncology (ASTRO) has launched a newly designed patient website RT Answers. The new site is easier to navigate and includes more pictures.  The front page helps patients search for a radiation oncologist and provides a gateway to treatment information.
• Medicare beneficiaries can make new coverage choices during the annual open enrollment period from November 15 through December 31.   Online comparisons of original Medicare, Medicare Advantage, and supplemental Medigap policies are available from CMS.  Also changes in Part D Prescription Drug coverage plans can be made during open enrollment.

Catherine Knowles is C3′s new Director of Policy

The health care reform debate continues.  Last week, the Senate Finance Committee discussed Senator Baucus’s proposal and considered hundreds of amendments.  The Committee will hold a final vote on the proposed bill later this week.  This will allow the Congressional Budget Office (CBO) time to complete its analysis of the bill and provide a final cost estimate.  After the Finance Committee has approved the bill, it will be combined with the bill from the Senate Health, Education, Labor and Pensions Committee before it is scheduled for a vote on the floor by the full Senate.

C3 has been closely following the various health reform proposals introduced in Congress, because access to care is critical to preventing, treating and beating colorectal cancer.  Please feel free to share your thoughts with us by leaving comments below.

Continue reading for more information on some of the amendments adopted by the Senate Finance Committee that C3 thinks are important for people living with colorectal cancer.

C3 was pleased to see that the Senate Finance Committee made significant changes to the health reform overhaul package it considered that will make health care more affordable and accessible.

Sen. Cantwell (D-WA) sponsored an amendment that will let states create low-cost health insurance plans for low-income families.  The amendment is designed to encourage states to enact a program mirroring the Washington State Basic Health plan.  It will allow states to put people making more than 133 percent of the federal poverty level (the upper threshold for Medicaid in the mark) and less than 200 percent of the federal poverty level (approximately $44,000 for a family of four) in a state-based government plan.  The amendment provides a federally funded, non-Medicaid, state plan which combines the innovation and quality of private sector competition with the purchasing power of the states.  It passed 12-11.  This amendment would help expand coverage to people who currently cannot afford insurance.  And without insurance, people are less likely to be screened, let alone able to be treated for colorectal cancer.

The committee also adopted along party lines an amendment sponsored by Senate Finance Health Subcommittee Chairman Rockefeller (D-WV) regarding so-called “Cadillac” insurance policies – expensive policies with low deductibles, limited co-pays and extensive benefits.  Senator Baucus proposed taxing the insurers for plans that cost over $8,000 anually ($21,000 for a family) in order to help offset costs of coverage for the uninsured.  In addition, there is an underlying assumption that “Cadillac” policies encourage inappropriate over-use of medical care – and taxing these policies could help make them less attractive.   However, some of the committee were concerned that some consumers – people in high-risk jobs, or older Americans – have to spend that much for “Chevrolet” coverage.  They felt that the costs should be increased.  Under the Rockefeller amendment, the cost of the plans for retirees older than 55 and those in high-risk professions must total $9,850 for individuals and $26,000 for families before they are considered “Cadillac” and therefore taxable.  The threshold tops the amounts in the underlying proposed bill by $1,100 for individuals and $3,000 for families.

Colorectal cancer patients tend to be older – most people are diagnosed over age 50.  And the cost of insurance policies increases significantly as people age.  The Rockefeller amendment will increase affordability to policies for retirees over age 55.

The Rockefeller amendment also guarantees that the independent commission set up to find savings in Medicare cannot propose increases to Medicare premiums.  This will reassure Medicare recipients who are concerned about cuts in benefits accompanied by increases in premiums.

The Committee also addressed comparative effectiveness research.  Comparative effectiveness research (CER) compares treatments – for example, does ibuprofen, aspirin or acetaminophen work better for a headache?  Senator Baucus proposed the formation of a Patient-Centered Outcomes Research Institute (PCORI) which would be responsible for coordinating CER data and communicating results with health care providers and the public.  Comparative effectiveness will help determine what therapies can be used to effectively treat those with colorectal cancer.  Any provisions related to comparative effectiveness research should be conducted through an open and transparent process involving all stakeholders, starting from the research planning stage.  During the Senate Finance Committee markup, Sen. Grassley (R-IA) sponsored an amendment designed to improve the PCORI governance of patient-centered outcomes research institute.  The amendment would not allow the Secretary of Department of Health and Human Services, the National Institutes of Health, and other high-ranking officials, including elected officials and appointees, from being board members of the institute.   It was agreed to by voice vote.  Ensuring that patient voices are represented and that politics is kept out of comparative effectiveness research is extremely important to ensuring that patients continue to have access to innovative and life-saving medical treatments.

You can read the entire text of the Senate Finance Committee bill as amended online.

Risk of dying during that first year was 50 to 90 percent higher among the uninsured.  They were more likely to diagnosed at an advanced stage and live in poor neighborhoods.

Other illness (comorbidities) was lowest in privately insured patients and highest in patients under 65 on Medicare, who were likely to have Medicare because of a disability.

Trying to track down reasons for why uninsured colorectal cancer patients have poorer survival, researchers at the American Cancer Society in Atlanta analyzed information for nearly 65,000 patients with colorectal cancer in the National Cancer Data Base in years 2003 through 2005.  In addition to cancer information, they studied comorbidities to see if they were contributing to increased deaths.

After adjusting statistics for factors known to affect survival including age, stage at diagnosis, where patients were treated, and neighborhood education level and income, risk of dying was significantly higher for all patients without private insurance—78% higher for uninsured patients, 64% higher for those insured by Medicaid, and 86% higher for those insured by Medicare.

However, although patients who were uninsured or who had Medicaid or Medicare had more comorbidities than patients with private insurance, that difference didn’t have an impact once insurance status was figured in.

Anthony S. Robbins, MD, PhD and his colleagues in the Department of Surveillance and Health Policy Research at theAmerican Cancer Society in  Atlanta concluded,

Thus, using data from more than 64,000 colorectal cancer patients in a large national database, we found substantial differences in comorbidity level by insurance status, but these differences did not explain the poorer survival of patients without private insurance. Even after adjustment for age, stage, facility type, neighborhood education level and income, and number of comorbid conditions, whites and blacks without private insurance had 40% to 80% higher risk of death during the first year after diagnosis. These higher death rates translated into large reductions in 1-year survival for patients without private insurance and those with higher comorbidity levels.

SOURCE: Robbins et al.,Journal of Clinical Oncology,Volume 27, Number 22, August 1, 2009.

In other headlines, the Caterpillar company works with Peoria hospitals and doctors to ensure quality colonoscopy for their employees and a Swiss laboratory will be the first to offer a blood screening test for colorectal cancer.

In research, MRI colonography is useful for patients who can’t have a full colonoscopy before surgery, screening colonoscopies are increasing for Medicare enrollees, and scientists have found factors in tumors that make nerves more sensitive to pain.

Research Reports

• Magnetic resonance colonography was successful before surgery for patients with colon or rectal cancer who hadn’t yet had a complete colonography.  Done either the night before in surgery in the hospital or a week before as an outpatient procedure, it revealed lesions, both cancers and polyps, in 4 out of 47 patients tested, changing the surgical strategy for 3 of them.  One flat adenoma and 5 small polyps were missed and found later on colonoscopy. Although bowel cleansing is necessary, there is no radiation or sedation.  Michael P. Achiam and his team in Copenhagen report on the feasibility and potential benefits of MRC in the July 2009 issue of Academic Radiology.
• Since 1998 when Medicare first began paying for colonoscopy, its use has increased each year for Medicare enrollees, and use of other screening tests including FOBT, flexible sigmoidoscopy, and barium enema has decreased.  Percentage of people on Medicare who have been screened for colorectal cancer has increased each year, but still less than half (47 percent) had been tested in 2005.  Only a third of people 50 to 64 who are covered by Medicare because of a disability had an appropriate screening test.  Anna Schenk in North Carolina and a team at the National Cancer Institute report findings in the American Journal of Prevention Medicine, July 2009.
• Working with mice, German scientists have discovered two substances secreted by tumors that make nerve fibers more sensitive to pain, increase nerve endings in the skin, and cause the growth of tumors.  Blocking the signals of granulocyte- and granulocyte-macrophage colony-stimulating factors (G-CSF and GM-CSF) may lead to a more effective way of controlling cancer pain.  Matthias Schweizerhof discusses the research in a letter to Nature Medicine published online June 7, 2009. Science Daily had an article about the studies on June 25.

Other Headlines

• The Caterpillar company, headquartered in Peoria, IL, provides free cervical, breast, prostate, and colorectal cancer screening to its 45,000 US employees.  To manage costs and ensure quality, they met with hospital and doctors in their area and proposed a program for Caterpillar employees that caps costs for colonoscopy at $1,000 and also grades doctors on how many of eight colonoscopy quality-indicators  they meet. That information is shared with the program doctors.  All doctors who do colonoscopies in the Peoria region are now part of the program.  Health reporter Julie Steenhuysen covers the story for Reuters Health.
• Voillier, a private Swiss testing lab will be the first in Europe to offer a blood test for colorectal cancer based changes in DNA. The test looks for methylation of DNA in the SEPT9 gene which ordinarily keeps tumors from developing.  Cancer cells shed this altered DNA into the bloodstream.  The test was developed by German molecular diagnostics firm Epigenomics, which plans to offer the test in the United States later this year.  Currently a study is underway with 7,500 people who who will have the blood test done before their colonoscopy to find out if changes in blood DNA are reflected in colonoscopy results.

Information comes from an analysis of the Commonwealth Fund 2007 Biennial Health Insurance Survey, a nationally representative telephone survey of 3,501 adults age nineteen and older living in United States.   Even counting those who refused to participate and those who could not be reached by phone, the survey’s response rate was almost 50 percent.

While 37 percent of Medicare patients said their overall medical care in the past year was “excellent”, only 20 percent of people with employer insurance said the same.  On the other hand, 18 percent of those employer-covered people said that their care was “fair to poor” while only 8 percent of Medicare-covered patients felt that their care was fair or poor.The survey found poorer health among elderly Medicare patients.

Compared to people with employer sponsored insurance:

• More than twice as many rated their health fair to poor (28 percent vs 14 percent)
• Almost four times as many had multiple health problem (38 percent vs 11 percent)
• More than half had incomes below 200 percent of poverty compared to about a quarter of those with insurance.
• One in four (25 percent) had annual income less than $20,000 compared to one in ten (9 percent) of people with insurance.

Medicare enrollees reported better access to care and fewer problems with that care:

• 32 percent said they had one or more negative experiences with coverage for care compared to 44 percent of employer-covered patients.
• 10 percent said that a doctor refused to take them as a patient compared to 17 percent of those employer-covered.
• 14 percent of Medicare patients had a problem paying a bill or with bill collection compared to 35 percent of employer-covered insured.

Since a similar study in 2001, Medicare patients do report more problems with access to care and paying bills, but the gap between their concerns and the greater problems experienced by patients with employer-coverage has grown.

Despite an overwhelming number of comments urging that CMS overturn their provisional determination not to cover the test, the agency remained unconvinced that there was sufficient evidence to conclude that CT colonography was appropriate to screen for colorectal cancer.

Almost 95 percent of 357 comments supported CT colonography screening, including comments from the American Cancer Society and C3:Colorectal Cancer Coalition.

Briefly,

The Centers for Medicare and Medicaid Services (CMS) concludes the following:

The evidence is inadequate to conclude that CT colonography is an appropriate colorectal cancer screening test under § 1861(pp)(1) of the Social Security Act.  CT colonography for colorectal cancer screening remains noncovered.