Module 7 Medicare Preventive Services

Transcription

1 2015 National Training Program Module 7 Medicare Preventive Services

2 Lesson 1 Introduction Medicare preventive services Find health problems early, when treatment works best Covered by Medicare Part B (Medical Insurance) Whether you get your coverage from Original Medicare Medicare Advantage Plan Other Medicare health plans Coverage for preventive services is based on age, gender, and medical history 05/01/2015 Medicare Preventive Services 2

3 Paying for Preventive Services in 2015 In Original Medicare you Pay nothing for most preventive services if your provider accepts assignment* May pay more if provider doesn t accept assignment May have a copayment If doctor performs other services not part of covered preventive benefits, or For certain preventive services *Assignment is an agreement by your doctor, provider, or supplier to be paid directly by Medicare, to accept the Medicare-approved amount as full payment for covered services and not to bill you for anymore than the Medicare deductible and coinsurance. 05/01/2015 3

4 Lesson 2 What is Covered? "Welcome to Medicare" preventive visit Yearly Wellness visit Abdominal aortic aneurysm screening Alcohol misuse screening and counseling Bone mass measurement Breast cancer screening (mammogram) Cardiovascular disease (CVD) Risk Reduction Visit Cardiovascular disease screenings Cervical and vaginal cancer screening Colorectal cancer screenings Screening fecal occult blood test Screening flexible sigmoidoscopy Screening colonoscopy Screening barium enema Multi-target stool DNA test Diabetes screenings Diabetes self-management training Flu shots (Vaccine) Glaucoma tests Hepatitis B shots (Vaccine) Hepatitis C screening test HIV screening Lung Cancer Screening Medical nutrition therapy services Obesity screening and counseling Pneumococcal shots Prostate cancer screening Sexually-transmitted infections screening and counseling Tobacco use cessation counseling Depression screening 05/01/2015 Medicare Preventive Services 4

5 Colorectal Cancer Screening Helps prevent or find cancer early Helps find pre-cancerous growths One or more of the following tests may be covered: Screening Fecal Occult Blood Test Screening Flexible Sigmoidoscopy Screening Colonoscopy Screening Barium Enema Multi-target stool DNA test (Cologuard ) 05/01/2015 5

6 Colorectal Cancer Screenings Screening Test Screening Fecal Occult Blood Test (50 or older) Screening Flexible Sigmoidoscopy (50 or older) Screening Colonoscopy (No minimum age) If Normal Risk Covered Once Every If High Risk, Covered Once Every You Pay 12 months 12 months No deductible or copayment for this test 4 years or 10 years after a previous screening colonoscopy 10 years (generally) or 4 years after a previous flexible sigmoidoscopy 4 years No deductible or copayment for this test 24 months (unless a screening flexible sigmoidoscopy is performed, then only every 4 years) No deductible or copayment for this test 05/01/2015 6

7 Colorectal Cancer Screenings Continued Screening Test Screening Barium Enema (50 or older) Multi-target Stool DNA test (Cologuard ) If Normal Risk Covered Once Every 4 years when used instead of a sigmoidoscopy or colonoscopy If High Risk, Covered Once Every 24 months (as an alternative to a covered screening colonoscopy) You Pay There is no deductible for this test. You pay 20% of the Medicare-approved amount for the doctor s services. In a hospital outpatient setting, you pay a copayment. 3 years 3 years There is no deductible or copayment for this test. 05/01/2015 7

8 Hepatitis C Screening Test Hepatitis C virus (HCV) is a serious disease (virus attacks the liver) Can cause chronic liver disease Cirrhosis (scarring of the liver) Liver cancer, liver failure, and even death Covered when ordered by primary care practitioner in a primary care setting Single, once-in-a-lifetime HCV screening test if born from 1945 to 1965 Annually, if high-risk person with prior negative HCV screening test No copayment or deductible with Original Medicare 05/01/2015 8

9 Lung Cancer Screening Medicare covers lung cancer screening with Low Dose Computed Tomography once per year for people with Medicare who meet all of these criteria: Are Are either a current smoker or have quit smoking within the last 15 years Have a tobacco smoking history of at least 30 pack years Get a written order from their doctor or qualified nondoctor practitioner 05/01/2015 9

10 Pneumococcal Shots UPDATE Effective 9/19/2014, Medicare covers An initial pneumococcal vaccine for all Medicare beneficiaries who ve never received the vaccine under Medicare Part B, and A different second pneumococcal vaccine 1 year after the first vaccine was administered (11 full months have passed following the month in which the last pneumococcal vaccine was administered) All people with Medicare are eligible No copayment or deductible for the vaccines with Original Medicare if the provider accepts assignment 05/01/

11 Your Guide to Medicare s Preventive Services CMS Product No /01/2015 Medicare Preventive Services 11

12 Preventive Services Checklist CMS Product No /01/

13 To view all available NTP training materials, or to subscribe to our list, visit CMS.gov/Outreach-and-Education/Training/ CMSNationalTrainingProgram/index.html For questions about training products

14 Home Health Compare and Dialysis Facility Compare Star Ratings CMS National Training Program April Alan Levitt, MD Division of Chronic and Post Acute Care Quality Measurement and Health Assessment Group Center for Clinical Standards and Quality

15 Why Star Ratings? The ACA calls for transparent, easily understood public reporting of quality of care information Star ratings are easy to understand Public reporting is a key driver for improving quality, supporting consumer choice, and incentivizing providers Already on Nursing Home Compare and Physician Compare In 2015 will add Dialysis Facility Compare, Hospital Compare, and Home Health Compare 15

16 Helping consumers use star ratings The star rating only uses quality information reported on the compare websites Star ratings measure the quality of clinical care, not patient satisfaction Star ratings provide a comparison of one facility/agency to others Star ratings should be used in combination with other information when selecting a facility/agency 16

17 Home Health Compare (HHC) Star Ratings: Quality Measures Used Process measures Timely Initiation of Care Drug Education on all Medications Provided to Patient/Caregiver Influenza Immunization Received for Current Flu Season Pneumococcal Vaccine Ever Received Outcome measures (risk adjusted) Improvement in Ambulation Improvement in Bed Transferring Improvement in Bathing Improvement in Pain Interfering With Activity Improvement in Shortness of Breath Acute Care Hospitalization 17

18 HHC Star Rating Calculation 1. For each measure, rank agencies based on score and assign into 10 equally sized groups 2. Ratings are adjusted if individual measure score is not statistically different from the overall median across all agencies 3. Calculate an overall score by averaging the adjusted ratings across all measures (at least five) and rounding to the nearest half star 4. Assign an overall final HHC Star Rating that ranges from 1 to 5 in half star increments. There are 9 star rating categories with a middle category of 3 stars 18

19 HHC Star Ratings: Questions and Comments Further reading and FAQs: Patient-Assessment- Instruments/HomeHealthQualityInits/HHQIHomeHeal thstarratings.html Questions or comments about HHC star ratings send to: Home Health Compare: 19

20 Dialysis Facility Compare (DFC) Star Ratings: Quality Measures Used Standardized Outcome Domain: Standardized Mortality Ratio (SMR) Standardized Hospitalization Ratio (SHR) Standardized Transfusion Ratio (STrR) Other Outcomes Domain 1: % patients receive treatment through AV fistula % patients catheter > 90 days Other Outcomes Domain 2: Dialysis Adequacy: 3 Kt/V (waste removal measures) combined % patients with hypercalcemia 20

21 DFC Star Ratings: Star Rating Calculation Each measure scored based on national ranks Average the measure scores within each domain into a domain score Average the domain scores to create a final score Assign star ratings based on the final score: Top 10% final scores = 5 stars Next 20% highest final scores = 4 stars Middle 40% final scores= 3 stars Next 20% lowest final scores = 2 stars Bottom 10% final scores = 1 star 21

22 DFC Star Ratings: Questions and Comments Further reading and FAQs: Disease/ESRDGeneralInformation/index.html Questions or comments about DFC star ratings send to: or by calling We also have a contact us form: Dialysis Facility Compare: 22

23 Learning How to Age Well: Creating an Aging-Friendly Community 2015 Aging in Texas Conference Austin, TX July 30, 2015 Janet L. Henning, Ph.D.

24 City of Denton, 1883

25 Denton Square 2015

26 Denton A-Train Transit Center

27 Selected Denton Demographics 62% White not Hispanic, 21% Hispanic, 10% African American, 4% Asian 37% Bachelor s degree or higher 46,000 housing units 48% home ownership rate $46,150 median household income ( ) 19.8% below poverty level ( ) Urban/suburban mix Two major universities

28 Population Comparisons 65+ Texas Denton City of , million 117, , million 123,099 Denton population projections: , ,334

29 Texas Median Age Median age: Texas is 2 nd youngest state in nation U.S. Texas

30 Texas Older Adults Texas has 2 nd highest number of adults age 65 and older U.S. Texas million 2 million million 4.3 million

31 Common Aging Ideals Active and engaged in communities Safe, self-sufficient and independent Physically, mentally and spiritually healthy Living in comfortable community-based settings Basic food, shelter, medical and safety needs are met

32 Emerging Aging Realities Increased need at state and community levels to prepare for: Aging in place Longevity Baby Boomer expectations Many communities have already started becoming aging-friendly Planning and capacity building

33 Aging Texas Well Created in 1997 to: Promote increased community preparedness for an aging Texas Identify and discuss aging policy issues Guide state agencies aging readiness Promote Texercise and Texas Healthy Lifestyles Resides within DADS Ongoing activities: biennial plan, state-level advisory committee, statewide survey every 4 years, website, toolkit

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35 Local Involvement Requires local community to identify specific goals Requires commitment Regardless of funding

36 Denton Sets Aging Friendly Goals 2010: formed Age Well/Live Well coalition Composed of local and regional planners, service providers and universities Adopted goals of expanding evidence-based programs and measuring the impact of existing community activities Continues to meet regularly to share progress and coordinate resources 2013: NCTAAA received ATW toolkit grant

37 The Community Assessment Toolkit Encourages communities to Identify features that define an aging-friendly community Assess their community s aging readiness and aging in place options Undertake planning and action steps to build a community with ATW attributes

38 Toolkit Process: A Practical Approach Toolkit worksheets provide 6 focus areas for communities to review Demographics: age distribution, income, disability, etc. Residential: housing options, affordability, accessibility, assistance, etc. Transportation: availability, cost, accessibility, etc.

39 Toolkit Worksheets con t Health care, mental health, and substance abuse: availability of hospitals, clinics, home health, preventive services, etc. Recreation & well-being: parks, rec centers, shopping, education, cultural and social events, etc. Community supports & services: websites, hotlines, home-delivered and group meals, intergenerational programs, etc.

40 Toolkit Process Worksheets guided community forums Forums helped formulate survey questions Toolkit available at: In left-hand column, click on Community Assessment Toolkit

41 Sample Forum Questions - Housing What type of housing are you currently in? Are you aware of people who can t find appropriate housing within your community? Tell us about experiences you ve had with financial assistance for home repairs, maintenance or improvements Any experience with property tax reduction for seniors? Tell us about any experiences with programs that assist with routine seasonal upkeep gutter cleaning, etc.

42 Sample Survey Questions Instructions: For each statement, check one box using the following scale: 1 = relatively unimportant compared to the rest 2 = somewhat important compared to the rest 3 = moderately important compared to the rest 4 = very important compared to the rest 5 = extremely important compared to the rest Transportation To successfully deliver transportation to the residents in the city of Denton in the next 2-5 years, we will need to: 1. Provide more education to potential riders on how to use transportation systems 2. Offer help from door to curb for older or disabled people 3. Provide transportation service in north Denton County 4. Provide same-day transportation for emergencies 5. Provide bus stops closer to entrances of destinations

43 Survey Distribution Paper copies MoW, senior centers, senior living facility Tax assistance at library, Black History Month event, Indian grocery, meditation center Parish picnic at Spanish-speaking church, storytelling festival Online version 551 surveys completed Online distribution increased returns

44 Selected Demographics Ethnicity of respondents 70% Caucasian 10% Hispanic 9% African American 8% Other/Unknown, 3% Multiracial Age of respondents 370 (67%) 50 and older 181 (33%) under 50

45 Survey Results Consumer theme across all topics Need for better communication Top two concerns Improving communication about and coordination of existing services Making transportation more accessible

46 Survey Results Recreation Under age 50 focused on activities Travel opportunities, dog parks, fitness centers, food trucks Over age 50 focused on facilities Sidewalks, lighting, shade, bathrooms, multi-generational programs

47 Survey Results Housing Issues for all ages: Increase housing for purchase below $100,000 Increase shelter space for the homeless Install emergency buttons in all homes Increase rentals $550-$900/month

48 Survey Results Housing Priorities for ages 50+: Homes specifically for seniors Housing that provides continuum of care Housing near shopping and services

49 Survey Results Transportation Priorities for ages 50+: Same day transportation for immediate needs Improved transportation from senior living communities to train and bus centers Better education to potential riders on how to use systems More transportation after 6 p.m. Curb-to-door help for older or disabled residents

50 Survey Results Health Care Issues for all ages: Coordination of existing services Financial assistance for basic health needs Increased communication Characterized by more education, neighborhood service outreach, and more bilingual provider staff

51 Community Role in Toolkit Process Project researcher spearheaded formation of Toolkit Action Committee composed of community stakeholders and consumers Community involvement was critical because of knowledge of community strengths knowledge of local resources community connections

52 Action Committee Role Discussed toolkit activities and progress Reviewed community survey responses Supported sharing of survey recommendations with Denton city officials and local advocacy groups

53 Lessons Learned It takes time to cultivate relationships Involve elected leadership Share ownership and responsibility Recognize good ideas shared by others Address territorial issues

54 Next Steps Present data to Denton City Council Post data on Age Well Live Well Denton website Use data in AWLW Denton grant applications Send data link to Denton s Healthy Community Coalition and other local groups