The purposes of this study were 1) to review the Medical Nutrition Therapy (MNT) Act of the United States, 2) to introduce the efforts of the American Dietetic Association (ADA) to expand the Medicare coverage for MNT and 3) to provide information about the reimbursement under Medicare Part B for the cost of MNT. The MNT Act defined MNT services as "the nutritional diagnostic, therapeutic, and counseling services provided by a Registered Dietitian or nutritional professional for the purpose of managing diabetes or renal diseases". Also, the MNT Act defined "conditions for coverage of MNT", "limitations on coverage of MNT", and "qualifications of MNT service provider". To expand the coverage of Medicare to include MNT, the ADA realized the need for development of a protocol for MNT, as well as studies to evaluate the effectiveness and cost-effectiveness of the MNT protocol developed. Therfore, the ADA supported the studies to develop a strong database of scientific investigations of nutritional services. Furthermore, the ADA needed credible data that could be used by policy makers, so the ADA contracted with the Lewin Group to carry out the study to gather the additional data needed to strengthen the ADA's position. In the report of the Lewin Group, which was entitled, "The Cost of Covering Medical Nutrition Therapy under Medicare: 1998 through 2004", it was concluded, that if coverage for MNT in the Part B portion of Medicare had begun in 1998, by 2004, approximately $ 2.3 billion would have been saved through reduced hospital spending under Part A of Medicare ($ 1.2 billion) and reduced physician visits under Part B ($ 1.1 billion). Effective January 1 2002, the US Congress extended Medicare coverage to include MNT to beneficiaries with diabetes or renal diseases. The Centers for Medicare and Medicaid Services (CMS) established the duration and frequency for the MNT based on published reports or generally accepted protocols (for example, protocols suggested by the ADA). The number of hours covered by Medicare is 3 hours for the initial MNT and 2 hours for a follow-up MNT. In 2002, a Medicare coverage policy was made to define the Physician's Current Procedural Terminology (CPT) codes 97802, 97803, and 97804 for MNT.
Administrative Personnel ; Centers for Medicare and Medicaid Services (U.S.) ; Counseling ; Current Procedural Terminology ; Follow-Up Studies ; Humans ; Medicare Part B ; Medicare* ; Nutrition Therapy* ; Nutritionists ; United States

The United States recently adopted an entirely new system of paying physicians for the services they provide to elderly and disabled patients. The new system is based on a fee schedule in which the relative values among different services are derived on the basis of the cost of providing such services. To control expenditure growth, a system of Volume Performance Standards (VPSs) was adopted, which explicitly links physician fee levels to the success the physician community has in controlling the total volume of services provided. This article presents and analyzes the new payment system and examines its applicability to other countries. It concludes that the methodology used to develop the fee schedule may be useful to other countries, particularly if they are unable to reach a consensus on appropriate physician fee levels, but that the VPS system needs to be refined in a number of ways before it can be successfully exported.
*Fee Schedules/legislation & jurisprudence ; Medicare Part B/*organization & administration ; Reimbursement Mechanisms ; *Relative Value Scales ; United States

PURPOSE: To assess real-world treatment patterns, health care utilization, costs, and survival among Medicare enrollees with locally advanced/unresectable or metastatic gastric cancer receiving standard first-line chemotherapy. MATERIALS AND METHODS: This was a retrospective analysis of the Surveillance, Epidemiology, and End Results-Medicare linked database (2000~2009). The inclusion criteria were as follows: (1) first diagnosed with locally advanced/unresectable or metastatic gastric cancer between July 1, 2000 and December 31, 2007 (first diagnosis defined the index date); (2) > or =65 years of age at index; (3) continuously enrolled in Medicare Part A and B from 6 months before index through the end of follow-up, defined by death or the database end date (December 31, 2009), whichever occurred first; and (4) received first-line treatment with fluoropyrimidine and/or a platinum chemo-therapy agent. RESULTS: In total, 2,583 patients met the inclusion criteria. The mean age at index was 74.8+/-6.0 years. Over 90% of patients died during follow-up, with a median survival of 361 days for the overall post-index period and 167 days for the period after the completion of first-line chemotherapy. The mean total gastric cancer-related cost per patient over the entire post-index follow-up period was United States dollar (USD) 70,808+/-56,620. Following the completion of first-line chemotherapy, patients receiving further cancer-directed treatment had USD 25,216 additional disease-related costs versus patients receiving supportive care only (P<0.001). CONCLUSIONS: The economic burden of advanced gastric cancer is substantial. Extrapolating based on published incidence estimates and staging distributions, the estimated total disease-related lifetime cost to Medicare for the roughly 22,200 patients expected to be diagnosed with this disease in 2014 approaches USD 300 millions.
Aged* ; Delivery of Health Care ; Diagnosis ; Drug Therapy ; Epidemiology ; Follow-Up Studies ; Humans ; Incidence ; Medicare ; Medicare Part A ; Platinum ; Retrospective Studies ; Stomach Neoplasms* ; United States

The 20th National Assembly of Korea was called to order on April 13, 2016. The National Assembly is invested with the authority to play a significant role in influencing healthcare policy. There are many pending issues in healthcare policy that the Assembly needs to address in this term. The low fertility rate and population aging that Korea faces can exert a major impact on the healthcare system, as aging will lead to an expansion of non-communicable diseases, which can place a high burden on society. This requires strengthening the social security system, including National Health Insurance. A paradigm shift is necessary, in which healthcare providers are organized in the National Health Insurance using approaches such as the Accountable Care Organization (ACO) and Patient_Centered Medical Home (PCMH), and people are offered choices similar to the US Medicare Advantage Program. Additionally, it is essential that healthcare accessibility is enhanced by covering catastrophic medical costs and guaranteeing patient safety through quality improvement so that healthcare costs are kept within an affordable range. Therefore, the 20th National Assembly must overcome differences in ideology to improve the healthcare system with the aim of promoting national health.
Accountable Care Organizations ; Aging ; Birth Rate ; Delivery of Health Care ; Health Care Costs ; Health Personnel ; Health Policy* ; Humans ; Korea ; Medicare Part C ; National Health Programs ; Patient Safety ; Patient-Centered Care ; Quality Improvement ; Social Security