In the campaigns leading up to the final election day, both Barack Obama and John McCain are giving due importance to “healthcare reforms”. With fast rising health care costs, this has become an issue not just for them but for those running the healthcare system as well. With the elections inching closer, ABL (Adaptive Business Leaders Organization) carried out a survey amongst its California-based Healthcare members, most of whom are health industry leaders. The survey questioned them about some of the glaring issues of the day being faced by the presidential nominees, federal and state legislators and the voters.
The survey covered a wide span of top-level executives who run insurance companies, hospitals, medical groups, healthcare information and medical technology, government agencies, biotech, home health and professional healthcare service firms. Mimi Grant, the ABL President said that with the projected spending on healthcare for 2009 deemed at $2.5 trillion which is 16% of the GDP, the task before the candidates is to effectively ‘fix’ this problem. Their decisions shall influence voters in their roles as patients, tax-payers as well as employees. Read more…
In an opinion piece published in the New York Times, Tyler Cowen a professor of economics at the George Mason University has debated on length about the ‘financial crisis’ US is currently facing. He said that much of it is due to the spending on entitlement programs and the situation is set to become worse as health care costs rise and the aged population increases.
Cowen suggests implementation of means testing where full benefits are given only to the really needy while payment cuts are made to everybody else as a possible solution. He says that it is a better way of allocating benefits and thereby reducing needless spending on entitlement programs. Cowen also recommends the expansion of Medicaid while making it an absolute federal program rather than one which is partly funded by the states. He also calls in for limiting the growth of Medicare as limited resources would be more efficient in allocating health care subsidies to the low income groups, young or old. Read more…
H.R. 6506, Improving Children’s Doctor Access Act of 2008 was introduced by U.S. Representative Charles W. Boustany, Jr., (MD, and R-Southwest Louisiana) in a bid to promote states to report and measure the problems low-income group children in S-CHIP face while trying to access medical care from doctors. This move is also meant to ensure that these underprivileged children are given top-priority in the states’ enrollment efforts.
Boustany said that he felt proud to support S-CHIP and Louisiana’s LaCHIP. He said that by ensuring easy access to doctors for children, we could reduce health care costs and also shorten the waiting lines in emergency rooms in hospitals all across Southwest Louisiana. He added that the success of the program is the surest way to ensure that the taxpayer dollars are being spent responsibly. At least 68000 children from the low-income group Louisiana remained eligible but were not listed in LaCHIP. Read more…
In a recent development, George Bush’s veto of the bill to put a stop to the cuts in doctor’s payments from Medicare (insurance scheme for the disabled and seniors funded by the government), was thwarted by the US Congress. The Senate voted 70 to 26 and the House of Representatives voted 383 to 41, clearly overriding the White House veto which requires a two-third majority in both houses.
The reduction in doctor’s payments was planned in order to balance the spending targets that were not attained. This move which would have come into effect at the beginning of this month was thought unwise by the Democrats as well as many Republicans. The Congress instead voted for a reduction in the refund made to insurance companies that give services via Medicare. Read more…
The Republican Presidential nominee, Senator John McCain promised on Monday that he vouches to balance the federal budget by 2013 if he becomes the next US President. He aims to bringing about this reform through changes in the entitlement programs.
The McCain campaign released a policy paper on Monday saying that the balancing of the budget can only be brought about through a successful reform of the expenditure on Social Security, Medicare and Medicaid. However, the policy paper did not give an in-depth analysis of how it plans to accomplish this feat. Also mentioned in the paper was a demand for a one-year freeze in domestic spending. This would be subject to annual appropriations and facilitate a comprehensive review of the situation. The paper proposed that this measure would freeze overall spending growth at 2.4% annually. This remains a matter of deep speculation as the federal spending growth rate has been recorded to be growing at an average of more than 6% per year since the last five years. Read more…
The National Association for the Support of Long Term Care (NASL) and the American Health Care Association (AHCA) were all praise for Senator Marc Baucus (D-MT). His urge to the Centers for Medicare and Medicaid Services (CMS) to keep the exception process to Medicare Part B therapy caps earned him much appreciation from the Long Term Care Leaders.
Bruce Yarwood, President and CEO of AHCA thanked the Senator for his role in the fight to protect access to important rehabilitative services for seniors. He added that on the behalf of all Medicare beneficiaries who are looked after by AHCA members, he would like to repeat the Senator’s call for CMS to holdup implementation of the burdensome therapy caps. Peter Clendenin, Executive Vice President of NASL stated that over 700,000 Medicare beneficiaries will exceed their Part B OP therapy limit this year and it is of utmost importance that the exception process be extended otherwise these people will be deprived of essential care that they deserve and need. Read more…
In a recent development, the Washington Post reports that CMS has issued an additional rule that requires hospice providers who are Medicare participants to put into effect a quality assessment and improvement system. This rule shall be implemented beginning December and involves patient participation in hospices to help settle upon treatment plans and the required improvement in areas of the hospice that seem deficient. Eventually the data shall be made public but for the beginning it shall be provided to Medicare and hospice organizers only. It will be akin to the way the federal government shares information on hospitals, home health agencies and nursing homes.
The number of Americans utilizing hospice services has increased by over two times since 1996 to an approximate count of 1.3 million in 2006.From $3 billion spent by Medicare on hospice care in 2000, the amount has increased to $10 billion in 2007.But experts say that hospice services are still not being utilized to the maximum. Malene Davis, the president and CEO of Capital Hospice attributed this underutilization to the popular misconception that hospices are for cancer patients only.
The Centre for Medicare & Medicaid Services (CMS) has proposed new rules under which Medical beneficiaries in rural areas will be able to access health care through Rural Health Clinics (RHCs) that have been designed to meet their specific needs.
Speaking on the issue, acting CMS administrator, Kerry Weems said that the changes that have been proposed to the rural health clinic program are meant to ensure good quality health services to Medicare beneficiaries in rural and previously underserved areas. Along with regular physicians, certain non physicians too shall aid in the program. The aim is to provide best value services from RHCs.
Are the US Presidential candidates building castles in the air? If reports are to be believed, the countless promises they have made regarding health care and other issues are going to be really difficult to implement. The reason being that in present day US, the budget deficit is rising, tax collection is slowing down and the national debt is soon going to cross the $10 trillion mark.
Not just this but even the federal deficit is estimated to reach a record high of $400 billion by the end of this fiscal year. If nothing is done as regards policy changes, then the promised Medicaid and Medicare programs are likely to gulp down over 50 percent of federal spending till 2050. Read more…
As per the Washington Post reports, the $257.5 billion War Appropriations Bill (HR 2642) has been passed by the House. The bill has been passed along with a clause that allows for the delay of six Medicaid regulations that have been proposed by the Bush government. The approval was given via two votes- for war spending (268-115) and another for domestic programs and spending (416-12).
The passage of this bill was no easy task. It took weeks of negotiations between the Democrats, the White House and the chambers. It is being heralded as a victory for many Republicans, Democrats and governors all over the country against the irresponsible Bush administration that has designed these rules to cut down on Medicare expenses.
Read more…
A recent study published in the June issue of Medical Care says that with the expansion of the EPSDT Program (Early Periodic Screening, Diagnosis, and Treatment) in California, accessibility to mental health care for children has greatly improved. The principle author of this study is Lonnie R. Snowden, a PhD of University of California, and Berkley.
The biggest improvement is said to have been in the rural areas and communities where there is a higher percentage of children suffering from health problems and who are not given adequate care. These areas are known to have a history of poor state funding when it comes to medical health services. The study reflected on the changes that have influenced children’s access to mental health care which was the major aim of the EPSDT expansion.
According to a recently published study, higher levels of regional spending on medical care don’t actually impact Medicare beneficiaries’ perception of quality of care. The survey, administered by researches from the University of Massachusetts, showed that although spending per capita varies depending on region, this difference in spending doesn’t seem to be reflected in care quality responses.
The study, acknowledging that there is a disparity between region spending, was designed to see whether or not regions with low expenditures see themselves as receiving lower quality of care than those in high-expenditure regions. Surveys were conducted by both mail and telephone in 2005. The survey asked three questions about perceived unmet need for care, four about the perceived quality of ambulatory care, and three about ratings of overall quality of care. 2515 people responded to the survey.
The survey showed that higher per capital spending was related to receiving more medical care, such as more ambulatory visits to physicians and more cardiac tests. But the questions that measured perceived quality of care – 7 of the ten measures - showed that there really was no strong correlation between greater spending and increased perceived quality. In fact, at times, perceived quality of care was actually higher in areas with lower-expenditures.
For some, the study asks the question as to whether or not more spending actually improves the Medicare experience of beneficiaries. For others, it also raises the question – if increased spending doesn’t work to increase the perception of care quality, what are some other solutions?
The study can be found published in the May 28 issue of the Journal of the American Medical Association.
In Michigan, an Isabella County Sheriff is warning people to be wary of a telephone scam under the guise of a Medicare validation.
Apparently, people have been receiving fraudulent calls from someone claiming to represent Medicare. The Sheriff is advising citizens, particularly seniors and individuals with disabilities, to be cautious if asked for certain personal information over the phone.
According to the Sheriff, the caller will allege that they are calling from Medicare, and that the recipient’s Medicare card needs to be updated in the next 30 days in order to remain valid. The caller will assure the recipient that updating the card is free, and all that is required is the individual’s bank account, Social Security, and Medicare numbers.
However, be aware that Medicare shouldn’t ask you this information via a telephone call, and they don’t ask for payments over the phone. The caller is counting on victims not knowing Medicare’s privacy procedures or their own rights, and on being easy targets for financial or identity theft. Identity theft is when people use someone else’s information (without their consent) to commit crimes, including fraud. It can happen when people have access to someone else’s personal information.
To protect yourself, whether you live in Michigan or any other State, don’t ever give out personal information to unknown callers. Your social security number, Medicare number, banking account numbers, and credit card numbers/expiry dates can all be used to steal from you or to commit crimes using your information.
If you live in the Isabella County area and have received a call from someone asking for your personal information, call the Sheriff Department at (989) 772-5911.
If you live anywhere in America and you suspect you may be a victim of identity theft, call the Fraud Hotline at 1-800-447-8477, or the Federal Trade Commission’s ID Theft Hotline at 1-877-438-4338.
Medtronic Inc.’s spinal unit has agreed to pay the government $75 million in order to settle false claim submission allegations. The allegations were originally against Kyphon Inc., which was purchased by Medtronic Spine in November. Medtronic Spine bought Kyphon Inc. for $4.2 billion, even after the allegations had been made. They were aware of the lawsuit allegations before acquisition.
The allegations were brought forward by two former Kyphon employees. According to one, when he realized they were involved in Medicare fraud, he spoke with the company’s vice president of reimbursement – to no avail. Eventually, he accepted another job at a different company, for less money.
The specific fraud allegations involved Kyphon’s submission of claims for a number of kyphoplasty procedures. The Kyphoplasty procedure is a treatment for spine compression fractures. This treatment is normally an outpatient procedure and only minimally invasive. Kyphon Inc., however, was accused of marketing this procedure as a more expensive inpatient treatment, causing Medicare to pay more for some of these surgeries.
The lawsuit, filed under the Federal False Claims Act, will also award two whisleblowers in the case $14.9 million. It also required Medtronic Spin to agree to follow Medicare regulations in all future claims. Although Medtronic Inc. agreed to pay a settlement, the company admitted no wrongdoing.
The U.S. Food and Drug Administration is working with the Centers for Medicare & Medicaid Services to improve the safety of Prescription drugs, as well as other medical products.
The new initiative will make Medicare prescription drug data available in order to assist researchers and government agencies in ensuring and improving safety, quality, and care. It will incorporate a new electronic system – the “Sentinel System” - that will allow the Food and Drug Administration to look at a wide variety of information in order to see potential concerns. The system will utilize substantial databases – including information provided by Medicare – to carefully monitor effects of medical products and to provide prompt information about the performance of a drug or other medical product.
The use of Medicare claims information, like diagnoses, treatments, and hospitalizations is particularly helpful, since it is such a large database. The Centers for Medicare & Medicaid Services has published a final rule which will allow them to use Medicare Part D claims data to aid research, care coordination, program oversight, and quality improvement and performance measurement initiatives.
The Sentinel System will be good, in particular, for Medicare Part D beneficiaries. A survey done by the Center for Medicare & Medicaid Services shows that Medicare beneficiaries use over twice the medications as other Americans. Because this means that Medicare beneficiaries would therefore be at greater risk of negative medication effects, a system designed to protect people from these risks is of particular use to people enrolled in Medicare Plan D.
With the new Sentinel Initiative underway, we can look forward to both an improvement in safety and an increase of relevant, timely information.
If you’re new to Medicare, you can look forward to a number of benefits. However, there are a variety of things to consider as you start your program.
The first thing you should do is, if you already have insurance, look into how it works with Medicare. For instance, if you have veterans’ benefits, military benefits, federal employee health benefits, or employer or union health coverage, you should make yourself aware of how these will work with your Medicare plan.
You will also need to choose the Medicare health plan you want, whether it is the Original Medicare Plan or a Medicare Advantage Plan, and if you want both parts A and B. You’ll need to decide if you want part D as well, which is your prescription drug coverage. If you do want prescription drug coverage, you’ll need to look at your various options and choose the prescription drug plan which will best meet your needs. In addition to your hospital, medical, and prescription coverage, you’ll need to decide if you want a Medigap Policy.
Another important thing to do within the first 6 months of joining Medicare is to go for your “Welcome to Medicare” physical exam. You should also talk to your doctor about what other preventive services you may need.
Finally, you’ll need to look at the basic information you need to make the most of your Medicare policy. Make sure you’re aware of enrollment dates, and use the password and instructions mailed to you by Medicare in order to access your personalized information online. If you need further assistance with your Medicare, contact your State Health Insurance Assistance Program.
A new advertising campaign, created to increase awareness and informed decision making about health care choices, is being released by the U.S. Department of Health and Human Services. Placed by the Centers for Medicare & Medicare Services in the May 21 edition of 58 newspapers, the ads will focus on health care information and quality by promoting the HHS’ Hospital Compare website. The Hospital Compare site, found at www.hospitalcompare.hhs.gov, allows users to compare hospitals in terms of patient experiences and quality of care. The site deals with ten specific components, using 26 quality measures, of patient experience, like communication, promptness of help, and an overall rating.
The advertising campaign will highlight the scores of two specific measures of quality and patient satisfaction from the Hospital Compare site, in newspaper area-specific hospitals. The ads should encourage people to use the technology available to them, in order to help them make more informed choices in their own health care decisions.
The campaign includes information about the percentage of patients at each hospital who report receiving help when first requested, the percentage of patients at each hospital given antibiotics an hour before surgery (according to the hospitals), and the state average for both measures. The ads, in combination with the website being promoted, should not only help people increase their access to clear health care information, but also, at the same time, urge hospitals to improve their patient care.
After being diagnosed with a renal disease or permanent kidney failure, you know that your whole life will change. You may become sad, frustrated and there are some people who becomes confused about the whole thing. However, you have to consider that you will still be able to take control your life and live a comfortable and meaningful life even with renal disease.
With Medicare, you will be able to see that it will be able to cover treatments for renal disease or for permanent kidney failure. Basically, you will become eligible for Medicare if you are over the age of 65, if you are under 65 with certain disabilities, and you will also be able to get Medicare if you have end stage renal disease, which requires kidney transplant, or dialysis.
You will also be eligible for Medicare Part A no matter how old you are if your kidneys no longer work and that you need regular dialysis treatment or in need of a kidney transplant. If you have renal disease, you may want to get covered for both Medicare Part A and Part B. So, even if you are already covered by Medicare Part A, you need to enroll in Medicare Part B in order to cover certain treatments for your renal disease.
Medicare will be able to cover initial dialysis. It will also cover outpatient dialysis treatments under the Part B coverage. Training for self-dialysis will also be covered by Medicare as well as home dialysis equipments and supplies. Other factors can also be covered by Medicare such as certain drugs for home dialysis and laboratory tests that are part of the dialysis treatment.
As you can see, Medicare will be able to cover dialysis treatments. So, if you have renal disease, you can be sure that Medicare will be able to cover most of the treatments you need in order to live a comfortable life.
The competitive bidding program, intended to lower costs of various of durable medical equipment, prosthetics, orthotics, and supplies, is well on its way to achieving its projected goals. The program should see a reduction of costs both to the Medicare system and to beneficiaries (since beneficiaries are responsible for a 20 % coinsurance on these items).
Ten communities will start the competitive bidding program on July 1 of this year. According to the bids submitted by the winning suppliers, Medicare will see an average savings of 26%. These 325 winning suppliers were announced on May 19, 2008, and all met Medicare’s specific standards. They all also must be enrolled in Medicare based on their products and services, be financially reliable, fill orders from their own inventory (or have contracts with other companies), ensure beneficiaries can get necessary items, and offer quality customer service by promptly delivering products and resolving complaints efficiently and effectively.
Out of all the suppliers who bid, CMS offered contracts to 23%, who were asking the desired price and met financial and disclosure expectations. 61% of bids asked too high a price, and over half of those were disqualified because they didn’t meet other requirements. 16% of bids were in the winning price range, but they were also disqualified.
Consumers and provides can obtain a list of Medicare contract suppliers at www.medicare.gov, by using the search tool and selecting “find suppliers of medical equipment in your area”.
Over 30 communities have applied for an Electronic Health Record Demonstration project, which will reward the use of certified electronic health records in order to improve quality of care.
The project, intended to minimize medical errors and improve overall quality of care, will provide financial incentives to as many as 1200 small or medium practices in twelve communities over a five year period. The improvement of quality of care through the use of Electronic Health Records will be measured by gauging the practices’ performance of specific clinical measures. A survey which measures the number of Electronic Health Record functionalities employed by the practice will be used to award bonus payments.
Representatives for CMS spent time in a number of communities throughout the country in order to highlight the upcoming project and encourage local health care providers, health plans, officials, business leaders, and other key stateholders, to apply for the demonstration project. The visits apparently paid off, resulting in the application of over 30 communities.
In June, the communities selected to partner with CMS in the Electronic Health Record Demonstration Project will be informed, and they will work with CMS to recruit small to medium sized primary care physician practices to become involved in the demonstration project. This fall, four of these communities will begin recruitment; the other eight will begin next year.
For more information on the project, see http://www.cms.hhs.gov/DemoProjectsEvalRpts/downloads/2008_Electronic_Health_Records_Demonstration.pdf .
On Wednesday, May 7, the Centers for Medicare and Medicaid Services announced a pilot project to allow Medicare beneficiaries access to personalized medical information. This should, if the project is successful, allow them to play a more active role in their health care choices.
The project involves a Personal Health Record tool, which is an on-line record of health information, controlled by the beneficiary. In this pilot, it contains data entered by the individual and by Medicare. When the beneficiary registers and request it, hospital and provider medical claims can be automatically entered into the Personal Health Record.
This offers the beneficiary a number of advantages. It allows them to look up information pertaining to their health conditions, supplies on-line links to relevant health topics, and gives them control over who sees the information in the Personal Health Record tool. It presents beneficiaries with the ability to see a more complete medical history, increases their access to research material (allowing them to better understand their own medical conditions and needs), and ultimately provides them with more support.
The project began on April 4 of this year, and should continue for 12 months. The Centers for Medicare and Medicaid Services will use the information gathered from this pilot project to help them make decisions regarding future Personal Health Records.
On May 8, 2008, The Centers for Medicare & Medicaid Services proposed measures to further protect those in MA health plans and Medicare prescription drug plans. The proposal is in addition to other protective steps taken by CMS recently, such as posting summaries of corrective action against MA plans online and creating a rating system for plan performance. The new changes are intended to continue to ensure Medicare beneficiaries, or potential beneficiaries, in MA plans and drug plans are treated fairly and transparently.
The proposal would require a number of specific measures. For instance, it would prohibit cold-calling and door-to-door solicitation. It would limit an appointment with a beneficiary to market health care products to what the beneficiary has already agreed to. It would prohibit sales at educational events or waiting rooms. It would limit the value of promotional items offered to potential clients, as well as the type. It would introduce measures to help enrollees get the information to select the best plan for their health care needs.
There are also measures in the new proposal to streamline extra-help eligibility determinations, to reduce beneficiary liability, and to create specific cost sharing protections. Additionally, the proposal would allow Medicare clearer authority in calculating financial penalties against MAs or prescription drug plans that break Medicare rules, negatively affecting beneficiaries.
The measures suggested by the new proposal should see increased protection of Medicare Advantage and Medicare Prescription Drug Plan beneficiaries and, hopefully, increased confidence in the integrity of the system.
Rheumatism is a very disabling disease. It affects mostly old people and it will be able to incur a lot of cost when you try and treat it. Some Rheumatologists have stated that drugs for this kind of illness can be quite expensive. Because of this fact, the Medicare Prescription Drug Plan will be able to offer you with a lot of benefits in case you need prescription medication especially for rheumatoid arthritis.
The great thing about this plan is that it will be able to add coverage to your Original Medicare Plan. It will also add some coverage to some of the Medicare cost plans and Medicare Private Fee for Service Plans. It will also add coverage to Medicare Medical Savings Account Plans.
With the new Prescription Drug Plan provided by Medicare, you will see that you will pay less for your prescription medication. It will also give you a plan member card after enrolling in the plan and use it to get your prescription filled in the nearest pharmacy.
So, if you are suffering from rheumatism and your rheumatologist have given you a prescription medication to treat it but is rather expensive, the Prescription Drug Plan will be able to provide you with big discounts when you are filling your prescription.
These are the things that you should know about Medicare Prescription Drug Plan. With it, you will be able to get cheaper medicine, especially for rheumatism as this kind of illness is very common among older people.
According to a recent study by Harvard Medical School in Boston, Medicare prescription drug plans have yielded mixed results for enrolled seniors. While there have been significant gains in coverage due to Medicare Part D, many people are still struggling to meet the high costs of their medication.
The survey, addressing 24234 Medicare beneficiaries, involved questions regarding medication expenses and the personal changes necessary to meet those costs. The survey showed that although Medicare prescription drug plans do offer some substantial coverage to recipients, there are a number of individuals who are negatively affected due to the high financial impact of meeting remaining medication costs.
Before the new Medicare Part D plan was available, in order to meet drug costs, approximately 15.2% of Medicare beneficiaries chose not to fill prescriptions and/or switched to less expensive types, and 10.5% skipped basic needs to pay for necessary medications. In 2004, about 14.1% and 11.1%, respectively, chose to take these measures.
The good news? When Medicare Part D was instated, only 11.5% of recipients reported having to skip or switch medications, and only 7.6% said they were unable to meet needs in order to pay for their medications.
Unfortunately, although there have been substantial improvement in Medicare coverage due to Medicare Part D, the study also showed that not all needs are being met. It seems that in this case, the plans fall short where the financial need is the greatest. The most significant difficulty is for seniors requiring the most expensive drugs, falling between $2250 to $5100.
According to the study, Medicare Part D is, for most seniors enrolled in a plan, helpful in elevating prescription drug costs. However, it also illustrates the fact that there are still gains to be made in creating a system where even the neediest of beneficiaries are able to afford their expensive but ultimately life-saving medications.
The Centers for Medicare & Medicaid Services has added important new information to their Nursing Home Compare Website. The site, which is designed to assist families in finding quality nursing homes in their area, includes information about nursing homes in terms of quality, staffing, and health, safety, and fire inspection reports. Now, due to the inclusion of further data, beneficiaries will have a more complete picture of the quality of care nursing homes have to offer.
CMS is now including information about CMS’ special focus facility (SFF) list. A nursing home appearing on the SFF list means it has, at one point, had a history of poor performance or recurring infringements of state and federal health and safety rules.
The SFF list was created due to the fact that nursing homes with poorer quality of care were often able to pass a survey by simply making slight improvements. However, because they were not adequately attending to the issues causing the problems, they would fail the next. The SFF list identifies the nursing homes that have serious quality of care problems and are not making any real improvements. It also includes the category they are in, like “new additions”, “not improved”, “improving”, “recently graduated”, or “no longer in the Medicare and Medicaid programs”. When a nursing home becomes an SFF, twice the number of standard surveys is given to it, and the state survey agency will increase enforcement until the home improves and graduates, is given more time due to some improvements, or is terminated from Medicare and Medicaid. Currently, there are 16,000 active nursing homes, 134 of which are on the SFF list. The hope is that as nursing homes improve, they can graduate from the program.
The SFF information can now be found on the Nursing Home Compare site, at www.medicare.gov.