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HOME ► Physician Office Quality ► More Task Information
More Task Information
| Breast Cancer Screening: |
- The percentage of women aged 52-69 that receive at least one mammogram in two years was about 59 percent for Medicare beneficiaries enrolled in fee-for-service (FFS) payment plans in 2004.
- Coverage:
- Medicare covers one baseline mammogram for women with Medicare between ages 35 to 39.
- All women with Medicare age 40 and older are covered for a screening mammogram every 12 months (20 percent co-pay but no deductible)
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| Colorectal Cancer (CRC) Screening: |
- About 91 percent of new cases occur in individuals older than 50, and the incidence rate of CRC is more than 50 times greater in persons aged 60-79 than in those younger than 40.
- Coverage - current Medicare coverage for people aged 50 and older includes:
- Fecal Occult Blood Test (FOBT) - once every 12 months
- Flexible Sigmoidoscopy - once every 48 months
- Screening Colonoscopy
- High risk - once every 24 months
- Not at high risk - once every 10 years, but not within 48 months of a screening sigmoidoscopy (if at high risk)
- Barium Enema
- High risk - covered every 24 months
- Not at high risk - every 48 months
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| Influenza Immunization: |
- Benefits:
- Vaccine can be effective in preventing secondary complications and reducing the risk for influenza-related hospitalization and death among adults > 65 years with and without high-risk medical conditions (e.g., heart disease and diabetes).
- Among elderly persons not living in nursing homes or similar chronic-care facilities, influenza vaccine is 30-70 percent effective in preventing hospitalization for pneumonia and influenza
- Immunization rates (Healthy People 2010 goal is 90 percent nationwide):
- 74% - 73.5% for FFS
- 76.9% for Medicare Advantage
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| Pneumococcal Pneumonia Immunization: |
- The Centers for Disease Control and Prevention (CDC) reports the annual incidence of invasive pneumococcal disease is greater thatn 50 per 100,000 in the 65 and older population (21,000 cases annually).
- Based on 2004 CAHPS survey data, the pneumococcal vaccination rate was about 67.7 percent for combined FFS and Medicare Advantage beneficiaries.
- Coverage:
- Medicare pays for one pneumococcal vaccination for all beneficiaries. One vaccine at age 65 generally provides coverage for a lifetime, but for some high-risk individuals, a booster vaccine is needed.
- Medicare will pay for the booster vaccine for high-risk individuals if five years have passed since their last vaccination.
- Medicare pays separate rates for the administration and cost of the vaccine.
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| Reducing Disparities - Diabetes Self-Management: |
- The number of diabetics has more than tripled (5.8 million to 20.8 million) between 1980 and 2005.
- The diagnoses of diabetes for African American and Hispanic patients continue to grow and far exceed the diagnoses of diabetes for Caucasians across all age groups.
- Compared to Caucasians, African Americans are 1.6 times more likely to be diagnosed with diabetes and suffer from complications related to the disease, i.e., kidney failure, eye disease, and amputations.
- Published research reveals that racial and ethnic minorities are less likely to receive routine medical procedures than Caucasians.
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| Chronic Kidney Disease: |
- CKD affects 11 percent of the US population over the age of 65, and those affected are at increased risk of cardiovascular disease (CVD) and kidney failure.
- The cardiovascular mortality risk rate is 32 deaths/1000 person-years among those with CKD vs. 16/1000 person-years among those without it.
- In more than 90 percent of Medicare patients with CKD (1,336,320), the disease is accompanied by diabetes (4.1%), hypertension (42.9%), or both diagnoses (43.9%), with 9.1% diagnosed with CKD only.
- The leading cause of renal failure is diabetes with a primary diagnosis of diabetes representing 41.5 percent of the dialysis patients in 2005.
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Ethnic minority populations are more likely to develop kidney failure, particularly African-Americans (four times more likely than Whites), Hispanics (two times more likely than Whites), and American Indians (three times more likely than Whites).
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