Extending Medicare Coverage for Preventive and Other Services (2000) / Chapter Skim
Currently Skimming:
Appendix E: Cost Estimates for Expanded Medicare Benefits: Skin Cancer Screening, Medically Necessary Dental Services, and Immunosuppressive Therapy for Transplant Recipients
Appendix E: Cost Estimates for Expanded Medicare Benefits: Skin Cancer Screening, Medically Necessary Dental Services, and Immunosuppressive Therapy for Transplant Recipients
Pages 329-362
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 329... ...
The Lewin Group was commissioned by the Institute of Medicine (IOM) Committee on Medicare Coverage Extensions to prepare cost estimates for selected expansions of Medicare benefits.
|
From page 330... ...
Because most transplant recipients qualify for Medicare based on disability or diagnosis of end-stage renal disease rather than age, premium offsets were not deducted from gross cost estimates for dental care or immunosuppressive therapy for transplant recipients.
|
From page 331... ...
Later sections discuss the three screening alternatives and the cost estimates for each. Cost-per-Screen-and-Biopsy Methodology Some basic cost assumptions underlie our gross cost estimates.
|
From page 333... ...
The 5-year gross cost estimate is also $1.12 billion because there was no evidence of cost offsets substantiated by the current literature. Methodology We assume a majority of Medicare Part B beneficiaries visit a primary care physician each year.
|
From page 335... ...
335 .= Cam V To Ct 5°¢ o Cow o V Cam Ct o En o I to JO to o g to to to ¢ ¢= ¢~¢= Z Z ~t Z - ^ Z C~)
|
From page 336... ...
We estimate a total 5-year net cost of $199.5 million for this mass screening approach, detailed in Table E-5. The 5-year gross cost estimate is also $199.5 million because there was no evidence of cost offsets substantiated by the current literature.
|
From page 338... ...
The HCFA Office of the Actuary estimated costs for the five conditions, but it estimated that a fixed percentage of all dental visits of Medicare beneficiaries would be covered under this benefit, essentially a "top-down" approach. In contrast, the cost estimates in this report constitute a "bottom-up" approach, beginning with incidence data for each condition and building the estimate based on these data.
|
From page 339... ...
339 go U)
|
From page 340... ...
The 5-year gross cost estimate for this benefit is $18.6 million. We have projected potential cost offsets (savings)
|
From page 342... ...
There were no cost offsets identified from evidence in the literature review, therefore, our gross cost estimate is equivalent to our net cost estimate, as displayed in Tables E-ll and E-12. Methodology Assumptions for gross cost estimate of leukemia and lymphoma dental services are built from incidence rates of leukemia and lymphoma in the aged (65 and over)
|
From page 344... ...
344 o ._ o 3 Cal .s o Cal a, ._ V)
|
From page 345... ...
There were no cost offsets identified from evidence in the literature review, therefore, our gross cost estimate is equivalent to our net cost estimate, as displayed in Table E- 13. Methodology We assume an average of 1.6 dental visits per patient per year, two per patient with teeth (assumed to be 80% of the transplant patients)
|
From page 346... ...
346 .= Ct Cq Cal 50 Ed o sit ho sit v o o v Cal En Cal Cal Ct o to to o o 8 o to ¢¢ ¢ ¢¢¢ zz z zzz SO o o o _^ t ~ _ AD ~ ~ ~ ~ o _ ON _, ~ — ^, , it, _ ~ ~ ~ Go o o ~ Do ~ ~t o _ _, ~ ~ ~ As, ~ ~ _ USE — — _ _ o Go ~ O~ ^—~3 I,, ~ o 0 ~ ~ o _ O ~ ~ d" ^ ~ e3 U~ Ct A U
|
From page 347... ...
. Second, extended coverage of immunosuppressive drugs could apply to the entire Medicare transplant population including those kidney transplant recipients who are not classified as either aged or disabled and currently lose all Medicare coverage 3 years following a transplant.
|
From page 349... ...
We do not apply a 25% premium offset to the gross costs because Medicare Part B premiums are based on treatment costs for the elderly and only a small proportion of covered tranplants recipients are elderly. There are several key assumptions that underlie our cost estimates: · Key assumption 1: As noted above, the proposed coverage could take the form of either a coverage extension or an entitlement extension.
|
From page 351... ...
The CBO estimate considered the pool of transplant recipients that would still be Medicare eligible 3 years after transplant, whereas our estimate considers both this subgroup and all Medicare-covered transplants. For the Medicare-eligible extension, this would produce 5-year savings to the federal share of the Medicaid program of approximately $32.5 million.~° Current figures suggest that 66% of Medicarecovered transplants who survive beyond 3 years retain Medicare eligibility (i.e., are either disabled or over 65)
|
From page 352... ...
This estimate incorporates a 5-year gross cost estimate of $1.12 billion, and a 5year cost savings offset estimate of $554 million, as shown in Table E-17. We estimate a total 5-year net cost of $848 million for a coverage extension for the "entire" kidney transplant population.
|
From page 353... ...
353 o o Ct of Ct Cal so En ;^ .~ .
|
From page 354... ...
Gross costs are the annual costs of immunosuppressive therapy for all Medicare-eligible kidney transplant recipients with graft survival greater than 3 years, and net costs are the gross costs less the avoided costs due to this extended coverage. The 5-year gross cost estimate of this coverage is $1.
|
From page 355... ...
355 o cd a)
|
From page 356... ...
Gross costs are the annual costs of immunosuppressive therapy for all kidney transplant recipients with graft survival greater than 3 years; net costs are gross costs less the avoided costs due to extending coverage. The S-year gross cost estimate of this coverage is $1.68 billion.
|
From page 357... ...
357 Cal Ct · C)
|
From page 359... ...
We assume an annual graft failure rate due to cost pressure of 2.5%. This assumption is based on the weighted average failure rate of kidney grafts after 3 years of 7% (cadaveric donor 8%, living donor 5%~.~4 We then assume that onethird of these failures are due to noncompliance with immunosuppressive therapy due to cost pressure.
|
From page 360... ...
The results are displayed in Table E-22. Heart, Liver, and Lung Gross and Net Cost Estimates We estimate a total 5-year gross cost of $212 million for the extension of immunosuppressive therapy coverage for heart, liver, and lung transplant recipients.
|
From page 361... ...
^a' an .
|
From page 362... ...
362 ._ sit ;^ Cal En ._ cn Cal U' o o o UO no U
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.