Help Your Medicare Patients “Bite into a Healthy Lifestyle”

Help Your Medicare Patients “Bite into a Healthy Lifestyle”

i Mar 11th No Comments by

CMS reminds health care professionals that March is National Nutrition Month®- a time to “Bite into a Healthy Lifestyle” with informed food choices now and throughout the year. This year’s theme encourages consumers to adopt a healthy lifestyle that is focused on consuming fewer calories, making informed food choices, and getting daily exercise in order to achieve and maintain a healthy weight, reduce the risk of chronic disease, and promote overall health.

Nutrition related health conditions are prevalent within the Medicare population. Twenty-eight percent of Medicare beneficiaries have diabetes and fifteen percent have chronic kidney disease. More than one-third of American men and women are obese, and adult obesity is associated with a number of serious health conditions, including heart disease, hypertension, diabetes, and some cancers.

Registered dietitians and nutrition professionals are key providers of nutrition services. They can play a critical role in helping your Medicare patients put together a comprehensive and achievable lifestyle-based eating plan based on their health history, food preferences and routine that can help improve their health and prevent and manage many health conditions.

Medicare provides coverage for the following nutrition-related health services:

  • Medical Nutrition Therapy (MNT)

Medicare provides coverage of MNT for certain beneficiaries diagnosed with diabetes and/or renal disease*, when referred by the treating physician and provided by a registered dietitian or nutrition professional.

  • Diabetes Self-Management Training (DSMT)

Medicare provides coverage of DSMT services for beneficiaries who have been diagnosed with diabetes. DSMT services are intended to educate beneficiaries in the successful self-management of diabetes. A qualified DSMT program includes among other services education about nutrition, diet, and exercise.

  • Intensive Behavioral Therapy (IBT) for Obesity

Medicare provides coverage of Intensive Behavioral Therapy for Obesity for qualifying beneficiaries whose body mass index (BMI) is equal or greater than 30 kg/m2. This coverage includes Screening for obesity in adults using measurement of BMI, a Dietary (nutritional) assessment, and intensive behavioral counseling and behavioral therapy to promote sustained weight loss through high intensity interventions on diet and exercise. This coverage includes one face-to-face visit every week for the first month, one face-to-face visit every other week for months 2-6, and one face-to-face visit every month for months 7-12, if the beneficiary meets the 3kg (6.6 lbs) weight loss requirement during the first 6 months.

  • Intensive Behavioral Therapy for Cardiovascular Disease

Medicare provides coverage of IBT for cardiovascular disease (referred to as a CVD risk reduction visit). The visit consists of the following three components:

  • Encouraging aspirin use for the primary prevention of cardiovascular disease when the benefits outweigh the risks for men age 45-79 years and women 55-79 years;
  • Screening for high blood pressure in adults age 18 years and older; and
  • Intensive behavioral counseling to promote a healthy diet for adults with hyperlipidemia, hypertension, advancing age, and other known risk factors for cardiovascular and diet-related chronic disease.
  • Annual Wellness Visit

The Annual Wellness Visit is a visit focused on prevention and provides health professionals the opportunity to provide eligible Medicare beneficiaries with personalized health advice, a written screening schedule (such as a checklist) and referrals, as appropriate, to health education, preventive counseling services, and community-based lifestyle interventions, focusing on reducing health risks and promoting self-management and wellness, including weight loss, physical activity, smoking cessation, fall prevention, and nutrition.

Your Help is Needed

As a health care professional who provides care to people with Medicare, you can help your Medicare patients live healthier lives in 2015 by encouraging the appropriate use of the above Medicare-covered services. These services present excellent opportunities to begin a dialogue with your Medicare patients about how their eating habits may affect their health, and make recommendations for preventive services that can help them reach their nutrition and dietary goals. Remember to provide any appropriate written referrals, such as referrals to registered dietitians or nutrition professionals for MNT services.

For More Information

* Note that, for the purpose of this benefit, renal disease means chronic renal insufficiency or the medical condition of a beneficiary who has been discharged from the hospital after a successful renal transplant for up to 36 months post-transplant. Chronic renal insufficiency means a reduction in renal function not severe enough to require dialysis or transplantation [Glomerular Filtration Rate (GFR) 13-50 ml/min/1.73m2].

Since 2010, 9.4 million people with Medicare have saved over $15 billion on prescription drugs

i Mar 5th No Comments by

The Department of Health and Human Services released today new information that shows that millions of seniors and people with disabilities with Medicare continued to enjoy prescription drug savings and improved benefits in 2014 as a result of the Affordable Care Act.

Since the enactment of the Affordable Care Act, 9.4 million seniors and people with disabilities have saved over $15 billion on prescription drugs, an average of $1,598 per beneficiary. In 2014 alone, nearly 5.1 million seniors and people with disabilities saved $4.8 billion or an average of $941 per beneficiary. These figures are higher than in 2013, when 4.3 million saved $3.9 billion, for an average of $911 per beneficiary.

Use of preventive services has also expanded among people with Medicare. An estimated 39 million people with Medicare (including those enrolled in Medicare Advantage) took advantage of at least one preventive service with no cost sharing in 2014. In contrast, in 2013, an estimated 37.2 million people with Medicare received one or more preventive benefits with no cost sharing. In 2014, nearly 4.8 million people with traditional Medicare took advantage of the Annual Wellness Exam, which exceeds the comparable figure from 2013, in which over 4 million took advantage of the exam.

“Thanks to the Affordable Care Act, seniors and people with disabilities have saved over $15 billion on prescription drugs, and these savings will only increase over time as we close the Medicare coverage gap known as the donut hole,” said HHS Secretary Sylvia M. Burwell. “By providing access to affordable prescription drugs and preventive services with no cost sharing, the Affordable Care Act is working for seniors to help keep them healthier.”

As part of the Department’s “better care, smarter spending, healthier people” approach to improving health delivery, providing affordable prescription drugs and certain preventive services with no-cost sharing are some of the many initiatives advanced by the Affordable Care Act. To achieve better care, smarter spending and healthier people, HHS is focused on three key areas: (1) linking payment to quality of care, (2) improving and innovating in care delivery, and (3) sharing information more broadly to providers, consumers, and others to support better decisions while maintaining privacy. Today’s news comes on the heels of Secretary Burwell’s recent announcement that HHS is setting measurable goals and a timeline to move Medicare toward paying providers based on the quality, rather than the quantity of care they give patients.

Closing the prescription drug “donut hole”

The Affordable Care Act makes Medicare prescription drug coverage more affordable by gradually closing the gap in coverage where beneficiaries had to pay the full cost of their prescriptions out of pocket, before catastrophic coverage for prescriptions took effect. The gap is known as the donut hole. The donut hole will be closed by 2020, marking 2015 as the halfway point.

Because of the health care law, in 2010, anyone with a Medicare prescription drug plan who reached the prescription drug donut hole received a $250 rebate. In 2011, beneficiaries in the donut hole began receiving discounts on covered brand-name drugs and savings on generic drugs.

People with Medicare Part D who fall into the donut hole in 2015 will receive discounts and savings of 55 percent on the cost of brand name drugs and 35 percent on the cost of generic drugs.

For state-by-state information on discounts in the donut hole, go to: http://downloads.cms.gov/files/Part-D-donut-hole-by-state-2014-YTD.pdf.

For more information about Medicare prescription drug benefits, go to: http://www.medicare.gov/part-d/.

Medicare preventive services

The Affordable Care Act eliminated coinsurance and the Part B deductible for recommended preventive services covered by Medicare, including many cancer screenings and other important benefits. By making certain preventive services available with no cost sharing, the Affordable Care Act is helping Americans take charge of their own health. By removing barriers to prevention, Americans and health care professionals can better prevent illness, detect problems early when treatment works best, and monitor health conditions.

For state-by-state information on utilization of preventive services at no cost to Medicare beneficiaries, please visit: http://downloads.cms.gov/files/Beneificiaries-Utilizing-Free-Preventive-Services-by-State-YTD-2014.pdf.

CMS Strengthens Five Star Quality Rating System for Nursing Homes

i Mar 4th No Comments by

The Centers for Medicare & Medicaid Services (CMS) today strengthened the Five Star Quality Rating System for Nursing Homes on the Nursing Home Compare website to give families more precise and meaningful information on quality when they consider facilities for themselves or a loved one. Today’s announcement also marks an important milestone to achieving the goal of implementing further improvements to the Five Star system in 2015, as the Administration announced last October.

Star ratings allow users to see important differences in quality among nursing homes to help them make better care decisions. CMS rates nursing homes on three categories: results from onsite inspections by trained surveyors, performance on certain quality measures, and levels of staffing. CMS uses these three categories to offer an overall star rating, but consumers can see and focus on any of the three individual categories.

Beginning today, nursing home star ratings will:

  • Include use of antipsychotics in calculation of the star ratings. These medications are often used for diagnoses that do not warrant them. The two existing quality measures – for short stay and long stay patients – will now be part of the calculation for the quality measures star rating.
  • Have improved calculations for staffing levels. Research indicates that staffing is important to overall quality in a nursing home.
  • Reflect higher standards for nursing homes to achieve a high rating on the quality measure dimension on the website.

“CMS is committed to improving Nursing Home Compare and the Five Star Quality Rating System to ensure they are the most trusted and easy-to-use resources we can provide,” said Patrick Conway, M.D., CMS Deputy Administrator for Innovation and Quality and Chief Medical Officer for CMS. “Consumers can feel confident that Nursing Home Compare’s star ratings include measures that matter most to nursing home residents and their families and challenge nursing homes to continuously improve care.”

Since CMS standards for performance on quality measures are increasing, many nursing homes will see a decline in their quality measures star rating.  By making this change, Nursing Home Compare will include more meaningful distinctions in performance for consumers and focus nursing homes on continuously improving care focused on residents, families, and their caregivers. About two thirds of nursing homes will see a decline in their quality measures rating and about one third of nursing homes will experience a decline in their Overall Five Star Rating.

For example, before the recalibration, about 80 percent of nursing homes received either a 4 or 5-star rating on their quality measures. Now, about 49 percent of nursing homes will receive a 4 or 5 stars on their quality measure rating. Also, the number of nursing homes receiving one star for their quality measures has increased from 8.5 percent to 13 percent after the recalibration.

CMS is also focusing changes in areas identified by consumers and other stakeholders as important. For example, by the end of 2013 nursing homes achieved a 15 percent reduction in the use of anti-psychotics compared to 2011 levels. As part of the National Partnership to Improve Dementia Care, CMS is working with the nursing home community, patients, families and other important stakeholders to achieve a 30 percent reduction by the end of CY2016.

The Nursing Home Compare website was launched in 1998, and CMS added the Five Star Quality Rating System (“NH Compare 2.0”) in 2008.  Nursing Home Compare gets approximately 1.4 million visits per year and users report high satisfaction with the site. More than 85 percent of users have indicated that they found the information they were seeking. CMS recommends that consumers rely on multiple factors – including star ratings, visits and community reputation — when selecting a nursing home.

To achieve better care, smarter spending and healthier people, the Department of Health and Human Services is focused on sharing information more broadly to providers, consumers, and others to support better decisions while enforcing patient privacy. The Five Star Quality Rating System for Nursing Homes is part of an administration-wide effort to increase the availability and accessibility of information on quality, utilization and costs for effective, informed decision-making by consumers.


To read a fact sheet on Nursing Home Compare 3.0, visit http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-02-12-2.html.

To search for nursing homes in local areas, visit Medicare.gov/nursinghomecompare/search.html.

For more information on the national partnership, visit CMS.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-14-19.pdf.

For more information on the Advancing Excellence campaign, visit nhqualitycampaign.org/news.aspx#17.