One of the leading topics in healthcare today is reducing hospital readmission rates. The National Institute of Health Care Reform’s 2011 report “Physician Visits After Hospital Discharge: Implications for Reducing Readmissions” found that the cost of hospital readmissions is $97 billion annually, $27 billion of which are Medicare expenditures according to Academy Health. Compounding the problem, discharged Medicare and Medicaid patients have higher bounce-back admission rates than those with other types of health insurance according to a study published in the Annals of Emergency Medicine.
5 Things to Do Today! Although you may make all the right financial moves, the economy might not be so cooperative. There could be more bear markets and recessions before and during retirement. Taxes may increase to pay for the growing national debt, which is growing ever larger with the recent billion-dollar stimulus and bailout programs and the rising entitlements of Medicare and Social Security. Energy prices could spike; inflation could eat away at more of your purchasing power. Part of setting realistic expectations about the future is understanding that you will probably experience, and need to overcome,…
Medicare patients who enroll in hospice care receive better care at a lower cost, with the greatest savings if they enroll 15 to 30 days before death, according to a study published in the March issue of Health Affairs. Amy S. Kelley, M.D., M.S.H.S., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues analyzed data from 3,069 subjects who were part of the Health and Retirement Study (where 1,064 were enrolled in a hospice before death) and their Medicare claims. Savings were examined for four periods of hospice enrollment: 1 to 7, 8 to…
The insurance industry has launched a second television ad against proposed cuts to private Medicare Advantage plans. The latest ad features seniors talking into the camera about the "drastic" consequences of losing access to their Medicare Advantage plans. "If Medicare Advantage has some cuts to it, I'm going to be in bad shape financially," one man says in the new ad, which began airing in Washington, D.C. on Monday and will air in Louisiana on Tuesday. It's the second television ad America's Health Insurance Plans (AHIP) has launched in a far-reaching lobbying campaign to block the proposed cuts. More than…
Skilled nursing facilities (SNF) are required to develop a care plan for each beneficiary and provide services in accordance with the care plan, as well as to plan for each beneficiary's discharge. These requirements are essential to ensuring that beneficiaries receive appropriate care and safely transition from one care setting to another. Several OIG studies and investigations found that SNFs had deficiencies in quality of care, did not develop appropriate care plans, and failed to provide adequate care to beneficiaries. In fiscal year 2012, Medicare paid $32.2 billion for SNF services. This study is part of a larger body of…
With all the deductibles, copayments and coverage exclusions, Medicare pays for only about half of the medical costs of America's senior citizens. Much of the balance not covered by Medicare can be covered by purchasing a "Medigap" insurance policy. Insurance companies may sell only Medigap policies that fall into one of 10 standard benefit packages, ranging from basic coverage to the most comprehensive coverage. The 10 available Medigap policy packages are identified by the letters A, B, C, D, F, G, K, L, M, and N (see chart below). Plans E, H, I, and J are no longer sold, but,…
House Budget Chairman Paul Ryan (R-WI) released his budget for FY 2014 this week. The Ryan FY 2014 budget is very similar to his budget proposals from years past and recommends significant reforms to Medicare and Medicaid. The proposal would balance the budget by 2023, cut $4.6 trillion in a decade, and leaves the sequester in place. The Ryan Budget recommends spending $41 trillion over the next decade, which is approximately $5 trillion less than would be spent under the current Obama Administration policies. Congressman Ryan proposes to “simplify the tax code to make it fairer to American families…
Medicare Part A covers institutional care in hospitals and skilled nursing facilities, as well as certain care given by home health agencies and care provided in hospices. Any person who has reached age 65 and who is entitled to Social Security benefits is eligible for Medicare Part A without charge. That is, there are no premiums for this part of the Medicare program. Medicare Part A covers up to 100 days of "skilled nursing" care per spell of illness. However, the conditions for obtaining Medicare coverage of a nursing home stay are quite stringent. Here are the main requirements: The…
The House Budget Committee has not agreed on whether to change Medicare benefits for people 55 years and older in the fiscal blueprint it will release next week. According to Reps. Bill Flores (R-Texas) and Rob Woodall (R-Ga.), both Budget panel members, the age could be 55 or 56 come Tuesday's budget unveiling. "Things will continue to be changed and tweaked and moved right up until the rollout," Woodall said. Analysts are waiting to see how House budget chief Paul Ryan (R-Wis.) will kill the deficit in 10 years without breaking the GOP's promise not to change Medicare benefits for…
Medicaid is an important source of coverage for people with disabilities, and the Affordable Care Act (ACA) makes several changes to Medicaid eligibility and enrollment rules, effective January 1, 2014, that impact this population. This issue paper provides a short summary of Medicaid eligibility and benefits for people with disabilities today and explains how these issues will be affected by health reform in light of CMS’s new regulations. Provisions of the new Exchange regulations are discussed briefly to the extent that they relate to Medicaid eligibility determinations for people with disabilities.
Frederick, MD 
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