Diagnostics & Imaging Week Washington Writers

Sen. Edward Kennedy's (D-Massachusetts) office said last week that the Senate Health, Education, Labor and Pensions Committee will hold a confirmation hearing today for Tom Daschle, President-elect Barack Obama's choice to head the Department of Health and Human Services (HHS).

The committee's hearing on Daschle will take place just two days after the 111th Congress convenes.

Kennedy, chairman of the committee, said Daschle's integrity, intelligence, experience and commitment to the American people have won him friends and admirers on both sides of the aisle.

Obama officially named Daschle as his pick to lead HHS on Dec. 11. However, rumors that the former South Dakota Democratic senator and former Senate majority leader was the president-elect's top choice for the HHS job had been circulating for several weeks prior to the announcement

Although not yet confirmed, Daschle already has been on the road for weeks touting the Obama administration's plans for reforming the nation's healthcare system. The HHS secretary-designate announced earlier in December at a summit in Denver that Obama's transition team would host so-called healthcare community discussions in homes across the nation to solicit recommendations and advice from the public for the president-elect's new health policy team.

The healthcare community discussions were modeled on platform committee meetings that the Obama campaign held throughout the U.S. last summer. Obama said the health forums were "a great way for the American people to have a direct say in our health care reform efforts."

The president-elect's transition team provided moderators and materials for anyone who enlisted on Obama's change.gov web site to host a meeting. More than 8,500 such community meetings reportedly were planned, with many held over the last two weeks of 2008.

Daschle attended one of the community forums last week at a home in Dublin, Indiana, which hosted about 35 local residents who talked about the difficulties they have had in obtaining health insurance for their families or paying for expensive medications, according to information posted on Obama's transition website.

Medicare is aiding in long-term care need

A new book released by the SCAN Foundation (Long Beach, California) suggests that the Medicare system, which does not cover long-term care, may actually be filling a need for long-term care among the nation's elderly by paying for post-acute-care services that are similar to long-term care.

The book notes that in 2007 long-term care accounted for nearly one-third of the $312 billion in overall Medicaid spending, with an additional $350 billion in unpaid care being provided by families and other private sources.

Joint reform efforts that address the full spectrum of acute and long-term care needs could produce innovative financing and delivery systems that result in more efficient and higher quality care. The study was conducted by Avalere Health (Washington), an advisory company focused on business strategy and public policy.

"The Avalere chart book indicates that although Medicare was never designed to address long-term care, which is an integral and growing factor of any healthcare reform proposal, there is still a need for long-term care services among the Medicare population," said Dr. Bruce Chernof, president/CEO of the SCAN Foundation.

He added, "We may have sufficient funding in the system now, but we are not using it efficiently. Families, nonprofits, and state agencies are taking the lead in developing new ways to provide and pay for services, but they are hobbled by Medicare models designed to pay for acute and post-acute care and lack of integration between Medicare and Medicaid."

Maintaining that long-term care that combines healthcare and social services, with the goal of helping seniors remain independent longer, advocates have argued that a continuum of care produces better health outcomes.

The SCAN Foundation said the long-term healthcare revolution "is being driven by the surging growth and longevity of America's senior population." The 65 and over population is expected to increase from about 40 million to 70 million between 2010 and 2040. Seniors over age 85 utilize more long-term care, and by 2050 their numbers are expected to account for the largest percentage increase in the senior population.

The independent nonprofit foundation is dedicated to advancing the development of a sustainable continuum of quality care for seniors that integrates medical treatment and human services in the settings most appropriate to their needs and with the greatest likelihood of a healthy, independent life.

It was created through a contribution by SCAN Health Plan, a nonprofit Medicare Advantage organization based in Long Beach.

CMS memo for apnea diagnostic

The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed decision memo for diagnosis of obstructive sleep apnea (OSA) after receiving a request in 2008 from Itamar Medical (Caesarea, Israel) for clarification on the means by which OSA is measured. At least one observer of the world of OSA thinks that the memo will help providers separate the winners from the wanna-bes.

CMS noted that it had addressed the coverage of continuous positive airway pressure devices in three earlier decisions, but that "we have not, at a national level, specifically addressed coverage of the tests themselves," leaving the issue "to local contractor discretion."

CMS proposes to cover polysomnography only in sleep labs, but will cover other modalities in home and clinical settings, including tests of airflow, pulse oximetry and actigraphy, which measures gross motor movement.

Edward Grandi, executive director of the American Sleep Apnea Association (Washington) told Diagnostics & Imaging Week that the decision memo "clarifies the role of the non-traditional devices" used to diagnose OSA and that "there was some confusion after the last memo."

Grandi said that the difficulty for CMS is that "there is no gold standard" for diagnosing OSA, not even polysomnography, which measures a wide range of physiological behaviors. He said the memo "gives equal weight to all these diagnostic devices," which he depicted as a good development to the extent that "they'll now be able to compete" and the poorer performers will be weeded out of the market.