Medicare Covers STDs Screening

Sexually Transmitted Diseases (STDs) are no longer conditions that are only discussed in back alley clinics.  Proof is based on the fact that statistics show that STDs are commonly affecting those as young as 15 and Medicare now covers STD preventive services.  A diverse range of clinicians from Pediatrics to Geriatric Medicine are being called upon to help reduce STD’s in our communities.  

Not all diseases are preventable, but in the case of STDs, awareness is the key to prevention as emphasized this month by Centers for Disease Control (CDC).  As always awareness goes hand in hand with education.  As the key sponsor of Sexually Transmitted Disease Awareness for the month of April, the CDC is offering a wide range of information for both the public and healthcare professionals alike.  

Many people would be shocked to read these STD statistics:

Approximately 20 million new STD’s are diagnosed each year

Half of all new STD’s are attributed to people age 15-24

Annual cost of treating STD’s is almost $16 billion

Even though there have been noted disparities in the occurrence of STDs in certain populations, there is no race, sex, economic status or age group that is exempt.  It is of the utmost importance that healthcare professionals take advantage of each opportunity to have an open and frank discussion with all of their patients regarding these highly preventable conditions.   

These discussions should include these basics:

Inquiries about high risk behavior 

Ways to prevent contracting a disease

The signs and symptoms associated with common STDs

As mentioned earlier in this article, as of November 8, 2011, CMS made Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) part of its panel of covered preventive services. 

 The tables below highlight coverage information that can be found at: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/PreventiveServices.html

 

 

Covered Screening Service for Increased Risk Patients	HCPCS/CPT Codes	ICD-9 Codes	Patient Financial Responsibility
Chlamydia	86631, 86632, 87110, 87270, 87320, 87490, 87491, 87810	Non-pregnant female:V74.5 & V69.8 Pregnant female: V74.5 & V69.8 & V22.0,V22.1, or V23.9	Deductible and coinsurance waived
Gonorrhea	87590, 97591, 87850	Non-pregnant female:V74.5 & V69.8 Pregnant female: V74.5 & V69.8 & V22.0,V22.1, or V23.9	Deductible and coinsurance waived
Combined Chlamydia and Gonorrhea	87800	Non-pregnant female:V74.5 & V69.8 Pregnant female: V74.5 & V69.8 & V22.0,V22.1, or V23.9	Deductible and coinsurance waived
Syphilis	86592, 86593, 86780	Non-pregnant female:V74.5 & V69.8 Pregnant female:V74.5 & V22.0, V22.1 or V23.9 Male: V74.5 & V69.8	Deductible and coinsurance waived
Hepatitis B	87340, 87341	Pregnant female: V73.89 & V69.8 & V22.0, V22.1, or V23.9	Deductible and coinsurance waived

Covered Counseling Service for Increased Risk Patients	HCPCS/CPT Codes	Frequency	Patient Financial Responsibility
High Intensity Behavioral Counseling	G0445	Up to two HIBC counseling sessions annually	Deductible and coinsurance waived

Equal Healthcare for Minorities

This April, National Minority Health Month is supported by the Office of Minority Health and other agencies to raise awareness about health disparities that continue to affect racial and ethnic minorities. The Patient Protection and Affordable Care Act's groundbreaking policies are aimed to reduce these disparities and achieve health equity.

The National Institutes of Health (NIH) defines health disparities as differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups.

The Patient Protection and Affordable Care Act also created the National Institute on Minority Health and Health Disparities (NIMHD) at NIH. The NIMHD will control all aspects of the NIH in regards to these minority health issues. The main goal is to bring attention to and find solutions for the unequal burden of illness affecting minority, rural and poor populations in this country.

The United States Department of Health and Human Services (HHS) drew on the same legislation when developing its Disparities Action Plan. The HHS Action Plan to Reduce Racial and Ethnic Health Disparities outlines goals and actions HHS will take to reduce health disparities among racial and ethnic minorities that include current common healthcare improvement strategies of evidence-based programs, integrated approaches and best practices.

The HHS Disparities Action Plan is designed around race and ethnicity, but those are not the only American populations effected by health disparity. Geographical location and poverty have long been associated with reduced healthcare equity. Religion, gender, age mental health, disability, sexual orientation or gender identity can all provide obstacles to appropriate healthcare.

Even though causes of health disparities can vary as widely as the diversity of the population, one issue consistently shows to be a key indicator in the quality of health care received by minority populations: insurance coverage. Statistics have shown that racial and ethnic minorities are significantly less likely than the rest of the population to have health insurance. (See table below)

This article highlights how the ACA will facilitate access to insurance:
 http://www.iridiumsuite.com/mbs-blog/new-healthcare-law-2014-will-benefit-consumers-and-providers

As we have seen numerous public agencies have all joined together to affect change in the area of health disparities. Each of them plays a significant role in achieving the goals of the Healthy People 2020 initiative. Additional information can be found on the main CDC Minority Health website.

2010 United States Census has published the following insurance coverage statistics:

Race/Ethnic Group	% of Population with No Insurance
African-Americans	20.8
American Indians/Alaska Natives	29.2
Asian-Americans	18
Hispanics	30.7
Native Hawaiians/Pacific Islanders	17.4
Non-Hispanic Whites	11.7

The Benefits of a Care Team Approach for Head and Neck Cancer Treatment

As part of Oral, Head and Neck Cancer Awareness Week, I have reached out to South Florida Radiation Oncologist, Dr. James T. Parsons for some professional insight.  Dr. Parsons is an internationally recognized expert in the field of Head and Neck Cancer treatment.  

We would like to emphasize the importance of a coordinated team approach for successful treatment of one of the most complex of all cancer diagnoses.

Unless they have a previous experience or personal knowledge, when most people think of cancer treatment, rarely do they truly understand that it will require a finely choreographed coordination amongst several healthcare professionals and other caregivers.

I posed the following questions to Dr. Parsons about the “Care Team” approach in the treatment of Head and Neck Cancers.

Q:  Who would you say are the necessary healthcare professionals that a patient should consult when he or she is diagnosed with Head and Neck Cancer?

A:

1. Head and Neck Surgeon
2. Medical Oncologist
3. Radiation Oncologist
4. Dentist
5. Oral Surgeon

 Q:  How do patients navigate through the many treatment options, such as chemotherapy, radiation therapy and surgery or combinations of multiple modalities, to make the right decision about their treatment course?

A:  This is one of the benefits of having a “Care Team” approach.  If all the healthcare providers work together in evaluating the patient’s treatment needs, usually this provides a consensus of opinion, simplifying the decision-making process for the patient.  Occasionally, providers may agree on multiple treatments options, this is when assistance from family and/or close friends can be extremely helpful in the decision making process.

Q:  You mention the patient’s family and friends; I assume these persons can also have a tremendous impact on the well-being of the patient during and after treatment.  Do you consider family and friends to be part of the patient “Care Team” as well?

A:  Definitely.  Treatment for Head and Neck type cancers, like most cancers, can produce multiple side effects.  A strong at home support system is just as crucial to the success of the treatment as any medical service.  Once treatment begins, additional healthcare resources may join the “Care Team” such as: social workers, registered dieticians, and home health nurses or aides.  

Q:  Any final thoughts on the “Care Team” approach?

A:  Early intervention by the surgeon, medical oncologist, radiation oncologist, dentist and oral surgeon ensure that a rational plan of care can be developed, reducing the occurrence of any surprises along the way.

You can follow this link to the National Institutes of Health’s website for more information on Oral Cancer:

http://search.nih.gov/search?utf8=%E2%9C%93&sc=1&query=oral+cancer&m=&embedded=&affiliate=nih&filter=moderate

Alcohol Misuse Screening Covered by Medicare

Effective October 14, 2011, Medicare expanded its Preventive Services program to include steps to reduce alcohol misuse.  See table below for reimbursement details.

The National Council on Alcoholism and Drug Dependence is sponsoring April as the month to raise the awareness of alcohol use.   Since alcohol use can range from never to occasional to the far extremes of alcohol abuse and Alcoholism (alcohol dependence), healthcare providers can benefit from various educational tools available to assist in the evaluation of their patients. 

Reviewing up to date statistics on the prevalence of alcohol use are a great place to start.  On the National Institutes of Health website for National Institute on Alcohol Abuse and Alcoholism (NIAAA) http://www.niaaa.nih.gov/alcohol-health you can get find some of the following facts:

1. Of those adult Americans (ages 18 and over)that drank in the past year, 21.9% of       women and 42.3% of men consumed 3 or more drinks.
2. Daily consumption of adult Americans in the last year is 2.45% for women, and 5.78% for men. 
3. In the United States, one "standard" drink contains roughly 14 grams of pure alcohol, which is found in:

• 12 ounces of regular beer, which is usually about 5% alcohol
• 5 ounces of wine, which is typically about 12% alcohol1
• .5 ounces of distilled spirits, which is about 40% alcohol

Numerous health conditions can be brought on or exacerbated by alcohol use. 

1. Alcohol interferes with the brain’s communication pathways, disrupting brain function that can lead to mood or behavioral changes, thought processing and physical movement. 
2. High consumption of alcohol either over time or on one instance can cause heart problems like cardiomyopathy, arrhythmias, stroke and high blood pressure. 
3. The liver and pancreas can be affected in a variety of ways by heavy drinking including: steatosis (Fatty liver), alcoholic hepatitis, fibrosis and cirrhosis of the liver, and pancreatitis. 
4. High levels of alcohol consumption can increase risks of developing cancers in areas such as:  mouth, esophagus, throat, liver and breast. 
5. A weakened immune system can make heavy and/or chronic drinkers more susceptible to infections such as pneumonia and tuberculosis.

 Primary Care Physicians should review the following basic Medicare coverage information:

Service	HCPCS Codes	ICD-9 Codes	Coverage	Frequency	Beneficiary Financial Responsibility
Alcohol misuse screening in Primary Care setting	G0442	Contact local Medicare Contractor for guidance.	All Medicare beneficiaries are eligible.	Once per year	Deductible and coinsurance are waived.
Behavioral counseling intervention	G0443	Contact local Medicare Contractor for guidance.	All Medicare beneficiaries are eligible.	Up to four times per year	Deductible and coinsurance are waived.