Center explains The Medicare Trustees Report
The trustees of Medicare, four government officials and two private
citizens, issue detailed annual reports on the current and projected
finances of the Medicare health insurance program for the elderly and
disabled. The report, which looks 75 years into the future, incorporates the
latest thinking of actuaries on trends in Medicare spending.
What's new in the July 2015 report? Not much in the near term. The Trustees
did make some technical adjustments to their long-run model that lowered
projected Medicare spending, but these adjustments only affect the
projections from 2041 on. By 2088, this adjustment amounts to a bit less
than 1 percent of GDP.
Medicare spending is projected to rise from 3.5 percent of GDP in 2014 to
4.3 percent in 2024, with the increase mostly attributable to increased
enrollment as the baby boom generation turns 65.
Adjusted for inflation, spending per beneficiary rises an average of just 2%
per yearâ€”about the same pace as per capita GDP growthâ€”as reimbursement cuts
under the Affordable Care Act (ACA) continue to restrain spending.
In the longer run, the Trustees project Medicare spending to increase
sharply as a share of the economy, rising from 3.5 percent of GDP in 2014 to
6 percent by 2089. The rise in spending between 2014 and 2035 is largely
driven by increased enrollment. From 2036 to 2089, spending is projected to
rise primarily due to growing per-beneficiary costs.
The Trustees have dramatically lowered their projections of long-run
Medicare expenditure growth. In 2009, for example, the Trustees projected
that Medicare spending would reach 11.2 percent of GDP by 2080â€”compared with
just 6 percent in this year's report. The change in the spending outlook is
attributable to the effects of the ACA on provider reimbursements and a much
slower rate of increase in actual Medicare expenditures since 2009. Excess
cost growth in Medicareâ€”the difference in the growth rates of per
beneficiary spending and per capita GDPâ€”is now expected to be quite low
relative to historical averages.
The Trustees believe that, unless the healthcare sector manages to become
much more productive over time, these payments will be too low to ensure
that Medicare beneficiaries continue to have good access to healthcare
providers. As a result, they hypothesize that future Congresses might choose
to override them. Under this alternative, Medicare spending rises to 9.6%
percent of GDP, about 50% higher than in the baseline scenario.
The Trustees and CBO have similar projections for spending over the next ten
years, but they have very different methodologies for projecting Medicare
spending growth in the long run. In particular, the Trustees assume that
Medicare spending will rise more slowly than private health expenditures,
while CBO assumes that Medicare spending will rise more rapidly. As a
result, their projections diverge sharply as the horizon is extended, with
CBO projecting Medicare expenditures to be more than twice as high as a
share of GDP by 2089.
Visit Brookings for the report.
chemotherapy near the end can actually make life worse
A new study finds that, at least in cancer, there's a very real medical
reason to consider giving less treatment at the end of life: chemotherapy
doesn't improve dying patients' quality of life. In fact, for those terminal
cancer patients who were doing the best at the beginning of the study and
were least disabled by their cancer, receiving chemotherapy was associated
with worse quality of life near death.
"For oncologists, the default seems to be if a patient can tolerate
another chemotherapy regimen, thereâ€™s a perception or the conventional
wisdom is there is no harm in trying," said Holly Prigerson, director of the
Center for Research on End-of-Life Care at Weill Cornell Medical College.
"The power of this analysis is it's one of the first, I believe, to
demonstrate there are harms."
The study, published in JAMA Oncology, examined the cases of 312
people with progressive cancers that had spread and followed them until
their deaths. The chemotherapy administered at this stage was
palliative, and the study did not find any difference in survival.
Researchers found that half of the patients were receiving chemotherapies at
the beginning of the study, on average within four months of dying. Their
quality of life in their last week was assessed by a caregiver. Most
striking, for the nine patients who were doing well, asymptomatic at the
start of the study, all received chemotherapy, and most had a lower quality
of life in their last days.
The American Society for Clinical Oncology guidelines recommend palliative
chemotherapy only for patients with solid tumors who are performing well,
not disabled by their cancer.
In an accompanying editorial, two physicians from the Oregon Health and
Science University wrote that there are only two reasons to give a patient
chemotherapy, which can be time-consuming, expensive, and have side effects:
it should either extend their lives or make their lives better. The new
study, they write, brings "troubling" data to one of the most difficult
problems in cancer treatment. It also challenges one of the biggest
prevailing ideas about cancer: the analogy to a battle.
The study suggests "that equating treatment with hope is inappropriate,"
Charles Blanke and Erik Fromme wrote. "Even when oncologists communicate
clearly about prognosis and are honest about the limitations of treatment,
many patients feel immense pressure to continue treatment. Patients with
end-stage cancer are encouraged by friends and family to keep fighting, but
the battle analogy itself can portray the dying patient as a loser and
should be discouraged."
Visit the Washington Post for the article.
expansion of diagnostic test oversight
At a time when physicians are complaining about the coming "tsunami" of
regulations they'll have to follow for quality reporting and electronic
health records, federal officials are considering increasing regulations in
another area: laboratory-developed tests.
LDTs, as they are known, refer to tests that are developed and used only at
a specific laboratory -- for example, a test for erythrocyte sedimentation
rate that a hospital lab might use. And in a growing number of cases, LDT's
also involve genetic tests that purport to predict, say, a woman's risk of
getting breast or ovarian cancer -- tests that are used only by the company
marketing them and that are not sent out to independent labs or consumers as
However, the regulations have met with considerable opposition, including
from the American Medical Association (AMA) as well as from purveyors of
Currently, LDTs are regulated by the Centers for Medicare and Medicaid
Services (CMS) under a law known as the Clinical Laboratory Improvement
Amendments of 1988, or CLIA. CLIA regulates the tests' "analytic validity,"
Rachel Sachs, JD, an academic fellow at Harvard Law School in Boston,
explained at the school's "Health Law Year in P/Review" conference last
"The basic question is whether the test finds what it's supposed to find,"
Sachs explained. "If you have a BRCA test, and [the test manufacturer] says,
'Our diagnostic test detects the presence or absence of the following 50
mutations,' CLIA ensures that statement is accurate."
However, she continued, "CLIA provides essentially no information about
clinical validity, which is about the relationship between the test's target
and the presence or absence of a clinical condition. So a woman might know
she has a mutation in BRCA gene, but CLIA doesn't tell her how much that
mutation changes her risk of developing breast cancer."
CLIA uses recognized accrediting bodies such as the College of American
Pathologists (CAP) to accredit the labs, explained Lakshman Ramamurthy, PhD,
a director at Avalere, a healthcare consulting firm in Washington. "The way
CAP does it, it asks a lab to send them one or two proficiency testing
samples every year. If a proficiency test comes up as erroneous, [the lab]
gets a do-over." It's a much less rigorous process than the one FDA uses to
approve a test, he said.
The FDA's role in regulating LDTs, however, is unclear. Since the passage of
the Medical Device Amendments in 1976, that agency has been exercising
"discretionary authority" over LDTs -- meaning that although it has the
right to regulate them, for the most part it has left them alone.
But that may be changing. Last October, the agency issued a draft framework
for regulating LDTs. In the framework, the agency said it was concerned that
although CLIA regulation helps ensure "that laboratories and their personnel
maintain standards of high quality, FDA is concerned that compliance with
CLIA regulations alone does not ensure that the diagnostic devices
themselves are safe and effective."
The agency said it was also concerned "that under the current policy of
enforcement discretion, there is no post-market safety monitoring of serious
adverse events associated with the use of LDTs," and that "LDTs that have
not undergone rigorous analytical or clinical review are used without the
knowledge of the patient or the treating physician that the device being
used is not FDA cleared or approved."
Under the draft framework, the FDA would provide a low level of oversight
for LDTs that are considered Class I -- those that have the lowest risk for
problems. Makers of those LDTs would be required to register and list them
with the FDA, and report any adverse events. LDTs for rare diseases and
those that meet unmet medical needs -- cases where no FDA-approved test is
available -- would also fall into this category.
High-risk tests -- such as tests for determining the safety or efficacy of
blood products -- would, on the other hand, be subject to premarket FDA
review in addition to registration and adverse event reporting.
Moderate-risk devices also would have premarket review, but that requirement
wouldn't kick in for 5 years after the guidance is finalized. Also, while
the FDA itself would review high-risk tests, it would contract with third
parties to conduct the reviews for moderate-risk tests.
The AMA is also not a fan of the FDA's proposal. The group "hold[s] that the
FDA proposed guidance to regulate laboratory developed testing services is
not authorized by law," the association wrote in a June 19th letter to
members of the House Energy and Commerce Committee, which was considering
adding laboratory regulation provisions to the 21st Century Cures Act.
The FDA's proposed guidance "is based on the misunderstanding that physician
services and procedures rendered in a single laboratory to a specific
patient are equivalent to the use of commercial packaged kits engineered and
manufactured by a company for a standard patient and shipped around the
nation," the AMA's letter continued. "Services provided to a patient by a
physician do not share the same risks as a commercial kit."
The College of American Pathologists, on the other hand, seems to take a
more nuanced approach. In its own proposal for regulating LDTs, the college
suggests "A tiered risk-based regulation that would focus FDA oversight to
the tests that currently have the least transparency and highest potential
The proposal also suggests "Definition of a regulatory process for modified
LDTs with significant modifications to report high-risk tests to the FDA and
for moderate- or low-risk to CMS."
Visit MedPage Today for the article.
decry high cost of cancer drugs
"High cancer-drug prices are affecting the care of patients with cancer and
our health care system," Dr. Ayalew Tefferi, a hematologist at Mayo Clinic
in Rochester, MN, said in a Mayo news release.
Tefferi and his colleagues made a number of recommendations on how to
address the problem in a commentary published in the Mayo Clinic
Allowing Medicare to negotiate drug prices is one of the suggestions the
team of 118 leading cancer experts offered as a possible solution. Along
with their recommendations, the group also expressed support for a
patient-based grassroots movement on change.org that is demanding action on
"The average gross household income in the U.S. is about $52,000 per year.
For an insured patient with cancer who needs a drug that costs $120,000 per
year, the out-of-pocket expenses could be as much as $25,000 to $30,000 --
more than half their average household income," Tefferi explained in the
A study published earlier this year in the Journal of Economic
Perspectives found that cancer drug prices have increased an average of
$8,500 a year over the past 15 years.
The changes the commentary called for included:
Create a review mechanism after a drug has been approved by the U.S. Food
and Drug Administration that would propose a fair price for new cancer drugs
that is based on the value to patients and healthcare.
Allow the Patient-Centered Outcomes Research Institute -- established under
the Affordable Care Act -- to evaluate the benefits of new cancer therapies,
and let similar organizations include drug prices in their assessments of a
Permit patients to import cancer drugs from other countries. For example,
prices in Canada are about half that of prices in the United States, the
Pass legislation to prevent drug companies from delaying the introduction of
generic drugs, and reform the patent system to make it more difficult to
unnecessarily extend patent protection of a drug.
Encourage groups that represent cancer specialists and patients to consider
the overall value of drugs and treatments when developing their treatment
The group wrote that "it should be possible to focus the attention of
pharmaceutical companies on this problem and to encourage our elected
representatives to more effectively advocate for the interests of their most
important constituents among the stakeholders in cancer -- American cancer
Visit NIH for the study.
mortality risk can be reduced by 2 generic drugs
Two generic drugs can help cut the rate of breast cancer deaths in
postmenopausal women, according to two studies published in the Lancet
journal. The researchers also said that these drugs, aromatase inhibitors
and bisphosphonates, can be used together to enhance their benefits and
reduce certain side effects.
Aromatase inhibitors (AIs) are hormone-suppressing drugs prescribed to women
with postmenopausal breast and ovarian cancer, while bisphosphonates are
used to treat osteoporosis.
The results of the two studies were announced by the Early Breast Cancer
Trialists' Collaborative Group, a worldwide collaboration formed by the
University of Oxford in England to collect the findings of randomized trials
of early breast cancer treatment.
The first study conducted by the Institute of Cancer Research, UK, and the
Royal Marsden NHS Foundation Trust in England analyzed data from 30,000
post-menopausal women who participated in nine randomized trials.
The findings showed that intake of AIs for five years reduced the risk of
the cancer recurring by about a third, and the risk of dying from breast
cancer by about 15 percent through the decade after the start of the
treatment. The researchers stated that mortality rates associated with
breast cancer would reduce by 40 percent over 10 years after beginning the
The second study, also conducted by the Institute of Cancer Research, found
that bisphosphonates increased chances of survival among breast cancer
patients if taken for two years to five years after the onset of the
disease. For the study, researchers combined data from 18,766 women from 26
clinical trials. The study team stated that as breast cancer mostly spreads
to the bone, following a bisphosphonates treatment could result in a 17
percent reduction in the recurrence of cancer.
According to the researchers, among post-menopausal women, bisphosphonate
treatment showed an 18 percent decline in breast cancer deaths in the first
decade after diagnosis. The researchers, however, noted that bisphosphonate
has little effect in premenopausal women.
Visit the International Business Times for the article.
to benefit from new agreement with Medline for adult incontinence products
ST LOUIS â€“ Amerinet Inc. announces a new agreement for adult incontinence products with
Medline Industries, Inc.
Through this agreement, Amerinet member hospitals will receive negotiated
pricing on Medlineâ€™s incontinence products, including the FitRight line of
protective underwear, briefs and guards. Medline is committed to offering a
wide range of products made in the U.S. that promote individualized care and
This contract is currently effective through April 30, 2018.
Medline is a global manufacturer and distributor serving the healthcare
industry with medical supplies and clinical solutions that help customers
achieve both clinical and financial success. Headquartered in Mundelein, IL,
the company offers 350,000+ medical devices and support services through
more than 1,200 direct sales representatives who are dedicated points of
contact for customers across the continuum of care. For more information on
Medline, go to
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