A federal advisory panel said that Congress should move immediately to cut payments to hospitals for many services that can be provided at much lower cost in doctors’ offices. The Medicare Payment Advisory Commission said the current payment disparities had created incentives for hospitals to buy physician practices, driving up costs for the Medicare program and for beneficiaries. Hospital buyouts of doctors, turning independent practitioners into hospital employees, have also led to higher spending by private insurers and higher co-payments for their policyholders, the commission said. Congress often adopts ideas suggested by the commission, and hospital executives fear that could…
The House Ways and Means Subcommittee on Health held a hearing on proposals to reform Medicare at which critical issues facing the Medicare program and current and future beneficiaries were discussed. CMA, together with California Health Advocates and the Medicare Rights Center, submitted joint testimony to the Committee outlining concerns for beneficiaries and their families regarding certain proposals aimed primarily at achieving federal savings. These proposals seek to save the government money by shifting costs to beneficiaries. Among these proposals are three found in the President's budget and in other proposals: adding a co-pay to Medicare's Home Health benefit; increasing…
Planning ahead seems daunting – but if you take it step by step, it is really not so bad! First you organize, then you decide what you want, and then you sign the appropriate documents. Get Organized! Below are some specific strategies for gathering and keeping the information you need to make a thorough plan. If you don't gather this information, it can take weeks if not months for someone else to make sense of your organizational system (or lack of a system). Some of this information you need to make a plan and some of this information you will…
As part of the annual update to inpatient hospital reimbursement under the Medicare program, CMS is again considering observation status. This time, CMS is proposing "a time-based presumption of medical necessity for hospital inpatient services based on the beneficiary's length of stay" (78 Fed. Reg. 27486, 47644 (May 10, 2013)). Under the proposed rules, Medicare would presume that an individual is an inpatient if the physician documents that the patient requires more than two midnights in the hospital following an inpatient admission. The "starting point for this time-based instruction would be when the beneficiary is moved from any outpatient area…
A study published online finds that the private insurance companies that participate in Medicare under the Medicare Advantage program and its predecessors have cost the publicly funded program for the elderly and disabled an extra $282.6 billion since 1985, most of it over the past eight years. In 2012 alone, private insurers were overpaid $34.1 billion. That's wasted money that should have been spent on improving patient care, shoring up Medicare's trust fund, or reducing the federal deficit, the researchers say. The findings appear in an article published in the International Journal of Health Services by Drs. Ida Hellander, Steffie…
For the first time, the federal government has publicly announced what hospitals bill Medicare for the 100 most common diagnoses and treatments. The information shows hospitals across the country — and across Alaska — bill dramatically different prices for the same things. Hospital veteran Rick Davis, the CEO of Central Peninsula General Hospital in Soldotna, was eager to review the on hospital charges as soon as it was out. "It's going to create ripples across the nation, really, on pricing," he says. "It does show some pretty big disparities between hospitals." For example, Alaska Regional in Anchorage charges Medicare $46,252…
NAELA and seven other national organizations wrote this fact sheet on the harms of observation status. There has been a 34 percent increase in the ratio of observation stays to inpatient admission between 2007 and 2009. There has also been an 88 percent increase in observation stays exceeding 72 hours.
Spring is often a time for gatherings with family and friends – weddings, graduations, Mothers’ Day. Nursing home residents often want to participate in these gatherings but may be under the impression that they will lose Medicare coverage if they leave the facility to do so. This is not true. The Medicare Benefit Policy Manual recognizes that although most beneficiaries are unable to leave their facility, an outside pass or short leave of absence for the purpose of attending a special religious service, holiday meal, family occasion, going on a car ride, or for a trial visit home, is not,…
Former CMS administrator Mark McClellan discussed how to spend Medicare dollars in a smarter way during an Alliance for Health Reform feature. McClellan called for a comprehensive strategy in order to achieve better health care for beneficiaries at a lower overall cost. Watch the video.
A new poll finds that only a quarter of Americans think that it is very likely that they will personally need assistance caring for themselves as they age. Thirty-seven percent of those surveyed mistakenly believed that Medicare will pay for a nursing home and approximately 60 percent underestimated the cost of a nursing home. Read more details on the survey.
Frederick, MD 
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