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August 2014

Medicare Slow Flow – Diagnoses, Disbursements and Decisions Slog On

Washington Watch


Smoker Screenings: Politicians, Docs, Medicare and Patients Weigh In


Bipartisanship has surfaced, at least briefly, on Capitol Hill. More than 130 lawmakers, from both parties, are urging the Obama Administration to expand coverage for a lung-cancer test under Medicare – screening they see as vital for vulnerable seniors. But the decision could cost Medicare billions of dollars.


In a letter to the Centers for Medicare and Medicaid Services, the lawmakers called for a timely decision on coverage for low-dose CT scans for older patients at higher risk of developing lung cancer.


Last winter, the U.S. Preventive Services Task Force recommended the test for people ages 55 through 79 who smoke a pack of cigarettes a day for 30 years or the equivalent. That’s about 10 million Americans. The low-dose CT scan will be covered by private insurance as required by the Affordable Care Act, with no copays, beginning January 1, 2015.


But the new law doesn’t require Medicare to cover the screenings, which cost between $100 and $400. CMS is reviewing the proposal with a preliminary decision expected by November. “Americans pay into Medicare throughout their working lives and deserve to have access to potentially life-saving evidence-based screenings that can prevent further health costs down the road,” wrote Reps. Jim Renacci, R-Ohio, Charles Boustany, R-La., John Barrow, D-Ga. and Richard Neal, D-Mass., and 126 other lawmakers.


A CMS spokesman said the agency’s decision will be based on whether the test is “reasonable and necessary,” without regard to its cost to Medicare.


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Finely Aged Whine!


Mary Ellen and I have been going through some 1,600 photos we took on a recent vacation. We tried to identify as many of the people we met on the trip as we could. One gentleman we were sitting next to really stumped us. He looked familiar and was very distinctively dressed, but we couldn’t remember his name or where we took the picture. It turned out to be King Wenceslas, and we were at a wax museum in Czechoslovakia.


Looking at that photo, I couldn’t help but comment to Mary Ellen that I thought I looked pretty good for my age, maybe 10 years younger than my actual 65 years. My wife agreed completely, and then she skipped to the next photo…


“Who’s the old man gobbling down that giant German sausage?” I asked.


“That old man would be you.”


“That can’t be. That guy looks 85.”


“You just didn’t take a very good picture that day.”


“For the record, you took the picture. And you’re saying that between Prague and Budapest, I went from looking like we were recently wed, to looking like I was nearly dead? In the Prague photos I have hair. In the Budapest pics I have hairs. What accounts for the big change?


“First of all, always be aware of what else is in the photo. When you were next to that attractive young waiter in Vienna, that made you look old in comparison.”


“I see, Mary Ellen. So is that why you always stood in front of 600-year-old castles?”


“It’s also about lighting, camera angle, and the colors you are wearing. And, of course, the number of pixels — whatever that means. For example, in our house you look much younger and more attractive in the kitchen lighting than in the bedroom lighting — sorry, that was an unfortunate example. Oh, you do look terrific for your age in the garage — those 40-watt bulbs do wonders. And while you’re tidying up in there one day, we’ll take a better picture for your Facebook page. Even the people at my office know that in the snapshot you have posted now, you’ve Photoshopped your own hair from an old college yearbook.”


One thing I’ve noticed is that I appear a lot younger when I look in my bathroom mirror than when I look in Mary Ellen’s bathroom mirror. I asked her why. “Simple,” she said. “In your bathroom, two of the bulbs are usually burned out and the mirror is always foggy. Peering at yourself through those conditions covers a multitude of sins.”


“So which one is the actual me? What do I truly look like?” (I know Joan Rivers asks herself the same question.)


“I would say, Dick, that when you first get out of bed in the morning, walk under the skylight, and stagger to the bathroom, that’s what you really look like.”


“And the same for you, correct?”


“Heavens, no. The real me is: AFBL.”




“Yes: After Foundation, Blush and Lipstick.”


As we took our evening walk the other night, a neighbor remarked that I looked tired and asked if I was under the weather. “No, he’s fine,” said Mary Ellen. “He’s just under a street lamp.”