FOR BREAKING NEWS VISIT www.qns.com december 3, 2015 • HEALTH • The queens CourieR 3 ▶health Map tracks Medicare opioid prescription claims across America The Centers for Medicare & Medicaid Services (CMS) released an interactive online mapping tool that shows geographic comparisons at the state, county and ZIP code levels of de-identified Medicare Part D opioid prescription claims — prescriptions written and then submitted to be filled — within the United States. This new mapping tool allows the user to see both the number and percentage of opioid claims at the local level and better understand how this critical issue impacts communities nationwide. “The opioid epidemic impacts every state, county and municipality. To address this epidemic, while ensuring that individuals with pain receive effective treatment, we need accurate, timely information about where the problems are and to what extent they exist,” said CMS Acting Administrator Andy Slavitt. “This new mapping tool gives providers, local health officials and others the data to become knowledgeable about their community’s Medicare opioid prescription rate.” Deaths from drug overdose have risen steadily over the past two decades. In 2013, overdose from prescription opioid pain relievers claimed more than 16,000 lives, with more than 145,000 people dying from these overdoses in the last decade. Heroin deaths have also been climbing sharply, more than doubling between 2010 and 2013. The resulting health, social and economic consequences for communities across the country are enormous. “The opioid abuse and overdose epidemic continues to devastate American families,” said CDC Director Tom Frieden, M.D., M.P.H. “This mapping tool will help doctors, nurses and other health care providers assess opioid-prescribing habits while continuing to ensure patients have access to the most effective pain treatment. Informing prescribers can help reduce opioid use disorder among patients.” The data used in this mapping tool is from 2013 Medicare Part D prescription drug claims prescribed by health care providers and does not contain beneficiary information (https://www.cms.gov/Research- Statistics-Data-and-Systems/Statistics-Trends-and- Reports/Medicare-Provider-Charge-Data/Part-DPrescriber. html). The data set, which is privacyprotected, contains information from more than 1 million distinct providers who collectively prescribed approximately $103 billion in prescription drugs and supplies paid under the Part D program. The data characterizes the individual prescribing patterns of health providers that participate in Medicare Part D for over 3,000 distinct drug products. Of the 1.4 billion total Part D claims per year, there were approximately 80.7 million opioid claims for 116 distinct opioid products contributing to $3.7 billion of the total Part D prescription drug costs. By openly sharing data in a secure, broad and interactive way, CMS is supporting a better understanding of regional provider prescribing behavior variability and is adding insight to local health care delivery. The tool includes interactive maps that allow users to mouse over an area and see its data. The data for each geographic region includes percentage of opioid claims, state and national averages, total providers, total opioid claims and total claims. As part of this initiative, the Department of Health and Human Services (HHS) is working through the Centers for Disease Control and Prevention (CDC) to develop opioid prescribing guidelines and supporting training and tools for providers to make informed prescribing decisions. The Substance Abuse and Mental Health Services Administration (SAMHSA), Food and Drug Administration (FDA), National Institutes of Health-National Institute on Drug Abuse (NIHNIDA) and Office of the Assistant Secretary for Health (OASH) are active partners in implementing the administration’s opioid initiative. From the Centers for Medicare & Medicaid Services Selecting a Medicare Advantage Plan Americans over age 65 are increasingly choosing the Medicare Advantage option. If you’re interested in joining them, here are some tips on how. By Hany Abdelaal, DO, President of VNSNY CHOICE Health Plans Over the past decade, the number of older Americans enrolled in a Medicare Advantage plan at any given time has soared from 5 million to over 16 million. In fact, Medicare Advantage plans, which are administered by private health insurers rather than by the federal government, now account for about one-third of all Medicare recipients. It’s not surprising that these plans, also known as MA or Medicare Part C plans, are growing in popularity. MA plans are required by law to give the same benefits as standard Medicare, and most also include added benefits above what standard Medicare provides. Many people pay nothing for their MA plans beyond their usual Medicare B premium. Even the more expensive Medicare Advantage plans carry only a modest additional premium—often under $100 per month. Every MA plan also includes a maximum annual out-of-pocket cost of $6,700 per recipient, providing a certainty that ordinary Medicare can’t match. With plentiful plans to choose from—the average Medicare recipient has access to 18 different MA plans—and flexibility to switch to another Medicare offering if desired (any Medicare recipient can change plans during Medicare’s open enrollment period of October 15 through December 7), it’s easy to see why more and more people are choosing the MA option. Determining if Medicare Advantage Is Right for You If you’re interested in exploring the Medicare Advantage option, the first step is to determine your eligibility. Virtually everyone over age 65 who qualifies for coverage under Medicare Parts A and B is eligible for Medicare Advantage, unless they have end-stage renal disease (meaning they require regular dialysis treatments). The next step is to check whether you live in an area that has Medicare Advantage plans available. As noted above, most Americans live in areas where multiple MA plans are available. With our VNSNY CHOICE Medicare plans, for example, you can enroll if you are a Medicare-eligible New Yorker living in New York City, Long Island, Westchester County, or the four upstate New York counties of Albany, Rensselaer, Saratoga and Schenectady. A third essential thing to know is whether your primary care doctor participates in any Medicare Advantage plans. Most primary care physicians are part of one or more MA networks—but if your doctor isn’t, you might have to change primary care physicians if you want to join MA (which most people are understandably reluctant to do). Which MA Plan is Best for You? If your answer to all three questions above is “yes,” then the next step is to carefully review the benefits and cost of the available Medicare Advantage plans in your home area. I strongly advise that you reach out to the individual companies offering these various MA plans to learn all the details about their offerings. One question to ask is whether the plan requires a referral from your primary care physician before you can see a specialist. You should also look into the plan’s out-of-network benefits: While all Medicare Advantage plans typically have a network of providers whose services are fully covered by the plan, some also provide a certain amount of coverage for out-of-network providers as well. Before you contact a specific plan, be sure to have a good idea of your annual income, since this will determine what subsidies you might be eligible for. Many individual insurers offer a variety of Medicare Advantage plans, with costs and benefits that may vary somewhat. Most plans have representatives available by phone or online to walk you through their offerings. At VNSNY CHOICE, our Medicare benefit representatives can be reached at our toll-free number, 888-387-4167, from 8 a.m. to 8 p.m., seven days a week, to answer your questions and arrange an in-person consultation with a representative who is fully versed in our plans. There is also an option to chat online with expert consultants on our website, vnsnychoice.org. With a range of enhanced benefits, a cap on annual out-of-pocket costs, and the care coordination and health planning services of an experienced insurance provider, the appeal of Medicare Advantage is clear. If you’re a Medicare recipient, I recommend taking a few minutes to explore the MA plans in your area. This is one instance where there’s a healthy advantage in knowing exactly what all your Medicare options are.
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