Friday, October 31, 2008

Medicare spending falls

According to this article at USA Today, the cost of drugs for Medicare fell $6 billion this fiscal year. The reasons for the fall are believed to be: more use of generic drugs, two million fewer participants and seniors avoiding falling in the doughnut hole.

Thursday, October 30, 2008

Medicare helps Aetna's ailing income

As reported by the Associated Press, Aetna faced third quarter losses this year. Although they saw their third quarter profits decrease 44% to $277.3 million, they still saw their revenue increase in healthcare premiums which doubled 8% to $5.09 billion. Medicare premiums increased to $1.21 billion and Medicaid raced ahead to $154.3 million, which accounted for an increase of 72%. Membership of Medicaid also increased 1% to 17.7 million members, which balances out the loss of those with a Medicare membership.

Wednesday, October 29, 2008

What's the future for healthcare?

One week from today, the American people will know who their leader is for the next four years. The future president has a huge impact on the future of Medicare. So what are their views on what to do? Whoever wins is up for a challenge, as Medicare spending has increased 40% in the past four years, from $309 billion in 2003 up to $431 billion in 2007. Not to mention, Medicare Part A is set to be bankrupt by 2019.

So what do the two presidential candidates have in mind to turn Medicare around? CBS News covers their plans here. John McCain wants to group together payments to providers into one large sum for better quality care than paying companies on a case-by-case treatment and test basis. He also looks to make those who make over $80,000 a year pay a larger percentage of their own prescriptions. For more on his platform, read here.

On the other hand, Barack Obama wants to allow Medicare negotiate with pharma companies to allow bring down prices of care, as the Vetrans Association currently does. For an in-depth look at Obama's Medicare platform, read here.

Monday, October 27, 2008

Thirteen Recommendations for Eliminating Medicare Fraud

Medicare fraud schemes are very common in this day and age. The American Association for Homecare has announced 13 recommendations in this post that could potentially eliminate most of Medicare fraud that relates to the home medical equipment (HME) sector. This association works alongside with Congress to implement these recommendations to combat Medicare fraud.

Here are the recommendations set forth by the American Association for Homecare:

Mandate Site Inspections for All New Home Medical Equipment Providers
Require Site Inspections for All HME Provider Renewals
Improve Validation of New Homecare Providers
Require Two Additional Random, Unannounced Site Visits for All New Providers
Require a Six-Month Trial Period for New Providers
Establish an Anti-Fraud Office at Medicare
Ensure Proper Federal Funding for Fraud Prevention
Require Post-Payment Audit Reviews for All New Providers
Conduct Real-Time Claims Analysis and a Refocus on Audit Resources
Ensure All Providers Are Qualified to Offer the Services They Bill
Establish Due Process Procedures for Suppliers
Increase Penalties and Fines for Fraud
Establish More Rigorous Quality Standards

Friday, October 24, 2008

Medigap Solutions

On Monday we discussed in this post the doughnut hole effect that many participants in Medicare are reaching right now. This latest article, also touches on the subject. One of their suggestions for combating this effect would be to put a little money away each month while they are on the plan and paying very little. Many agree that this is a logical solution, however, as one senior, Jim Walder, stated:

“But I didn’t see four dollar gallon gasoline coming. I didn’t see getting laid off to part-time work coming.”

Other solutions further mentioned in the article include patient assistant programs, using generic medications, and contacting Social Security regarding the Medigap policy.

Wednesday, October 22, 2008

DragNet Technologies Helps Health Care Providers

For the past 10 years, Medicare and Medicaid physicians have seen their profit margins shrink from 25% to just under 6%. Much of this change has been attributed to increasing complexity in recording and coding systems. Mentioned here, DragNet Technologies has

"announced the availability of their downloadable medical billing code lists directed toward the needs of healthcare providers all across the United States, especially in the Home Health arena." The article further mentions that "DragNet's goal is to arm healthcare providers in our country with the necessary information to get paid - and get paid quickly - for the services they have provided to Medicare and Medicaid patients"

Hopefully this will help Medicare and Medicaid physicians, and create a trickle down effect to help patients. With increased ease, more physicians maybe inclined to participate in these programs.

Tuesday, October 21, 2008

Cost of Health Care

In a recent report from the Centers of Medicare & Medicaid Services, they announced that Medicaid spending will grow at a rate of 7.9% over a 10 year period, with the cost estimated at $674 billion in 2017. It was also noted that the growth rate of the economy at 4.8%, and of health expenditures at 6.7% is lower. By 2013 it is expected that this cost will compromise 8.4% of federal budget in comparison to last years cost of 7%. It was noted in this article that

"Health and Human Services Secretary Mike Leavitt said the analysis was a reminder that Medicaid spending is on an unsustainable path that might threaten the health of the nation’s most vulnerable citizens."

Monday, October 20, 2008

Doughnut Hole is Not So Sweet

As recently reported here, in a study conducted by the Kaiser Family Foundation, 26% of Medicare beneficiaries who filed using the prescription drug benefit "reached the coverage gap in 2007." Of these individuals, 15% were taking medication for chronic diseases, and quite taking meds during the gap. As Carloyn Clancy from Agency for Healthcare Research & Quality, warns:

"High drug costs are a barrier, but this is the first time we're seeing it documented so plainly. This raises concerns about the consequences for people with serious chronic conditions. There is a growing recognition that the doughnut hole is impairing people's access to medications."

As is further mentioned in the article, this will be an issue that the next administration will have to address. As seen in the post from this past Friday, it seems that the candidates are already aware of the problems, and have plans to address this troubling statistic.

Friday, October 17, 2008

New Obama Campaign Warns Seniors About Medicare Reductions

I came across this post on The Huffington Post in which it discusses Senator’s Obama’s recent ad campaign that show several shots of distressed seniors in order to drive the message that McCain wants to tax health care benefits and cut Medicare.

The campaign puts the figure at $882 million for Medicare alone. The post also mentions that the McCain campaign did not make a statement about which elements of the program would be cut. Watch the video below:


Thursday, October 16, 2008

Top Rated Hospitals have 70% fewer deaths

As this article reports, patients that are treated in top rated hospitals have a 70% higher chance of surviving, than if they were to stay at hospitals with the lowest rankings. According to the study "HealthGrades Hospital Quality in America", 237,420 deaths of Medicare patients could have been avoided. The four most common reasons for death, in over have the patients included: sepsis, pneumonia, heart failure, and respiratory failure. The study was conducted using 41 million Medicare hospitalization records between the years of 2005-2007.

Wednesday, October 15, 2008

Should Medicare Pay for Hospital-Acquired Infections?

The Healthcare Economist poses the question “Should Medicare pay for these hospital-induced health care costs?” in this latest post.

The problem if Medicare implements a policy in which they do not pay for nosocomial infections is that doctors would report nearly all infections as community-acquired rather than hospital-acqiured. This in term would adversely affect the reporting of infections.

What are your thoughts? Should Medicare ultimately pay for hospital-acquired infections?

Tuesday, October 14, 2008

Extra Payments Made to Medicare Advantage Plans Total $8.5 Billion

The Healthcare Intelligence Network reports that in 2008 extra payments made to Medicare Advantage Plans will total over $8.5 billion. There are payments reductions scheduled for 2010, but if the Medicare Improvements for Patients and Providers Act of 2008 went into effect in 2008, MA plans still would have paid 10.6 percent more than expected fee-for-service costs.

The majority of the extra payments were made because of the Medicare Modernization Act of 2003 which has expanded the role of private plans in Medicare in an effort to reduce the growth of spending in Medicare.

Thursday, October 9, 2008

Government encouraging electronic prescriptions

As reported by The Columbus Dispatch, Medicare will pay health providers who switch to electronic prescriptions. They believe by having doctors switch to this form of prescription, they will eliminate errors in prescriptions caused by illegible handwriting. For those who switch, Medicare will increase payments in 2009 an 2010 by 2%, 1% in 2011 and 2012, and by .5% in 2013.

Wednesday, October 8, 2008

Dade County of Miami suspends some Medicare payments

According to the Miami Herald, the government is suspending payments to the top 10 home health care agencies suspected of Medicare fraud. Medicare is taking an offensive position to find fraudulent businesses, targeting suspicious claims, most having to do with treating diabetic patients at home. The suspension may last up to six months, and 6,500 patients will immediately be affected due to the the impact on skilled nursing visits. These patients will be transferred to other agencies. Read more about the investigation here.

Tuesday, October 7, 2008

Could Medicare bailout be worse than financial bailout?

William McKenzie at the Dallas Morning News thinks the current financial crisis will be a walk in the park compared to the next looming disaster - the downfall of Medicare. He believes many people are overlooking the oncoming bankruptcy of Medicare. However Michael Leavitt, the Secretary of Human and Health Services, is someone who is currently recognizing the problem.

The system currently faces two problems:

•There will be too few workers to pay for the benefits Medicare has promised today's workers. Right now, there are about four workers for every Medicare beneficiary. In 20 years, that ratio falls to about 2.5.

•Second, benefit costs will explode in inverse proportion to that dwindling work force. Mr. Leavitt projects that Medicare will rise from about 13 percent of federal spending today to about 23 percent in 20 years.

Do you agree or disagree with Mr. McKenzie? Is Medicare going to fall apart? What can be done to prevent this from happening?

Monday, October 6, 2008

Argus Leader encourages Medicare prescription holders to shop around for perscription coverage

In an article at Argus Leader, officials encourage Medicare users to shop around for prescription drug coverage. They foresee significant increases and changes in what Medicare part D will cover. For most of the popular drug plans, the most popular drugs could increase in price anywhere from 8% to 64%.

Other price increases include:
The monthly premium for the most popular Medicare Part D plan - the AARP Medicare Rx Preferred Plan - will increase 15 percent, from $32 to $37.

The next most popular plans come from Humana. The premium for the standard Humana plan will go up 60 percent, from $25 to $40, while the premium for the enhanced plan will go from $23 to $38.

Friday, October 3, 2008

Additional News for Medicare’s New Hospital Policy

Yesterday, we posted about Medicare’s implementation of its new policy in which it will not pay hospitals for any costs that are related to patients being injured due to medical errors while they are in a hospital’s care.

According to this article on NEWSInferno.com, Medicare posts a list of mistakes that it will not pay for on its website. Medicare will not pay for mistakes that include when patients

• Receive incompatible blood transfusions
• develop infections after certain surgeries
• must undergo a second operation to retrieve a sponge left behind from a first surgery
• experience serious bedsores, injuries from falls, and urinary tract infections caused by catheters

It is estimated that this policy will affect several hundred thousand hospital stays out of the 125 million people covered annually by Medicare.

Thursday, October 2, 2008

Medicare to stop paying 'never' procedures

In a report today by UPI, they relate the news that Medicare will stop paying for procedures that happen because a patient is injured while undergoing procedures. Private label insurers have already done this, and it is expected to save Medicare $21 million a year.

Wednesday, October 1, 2008

Managed Care Provider Cigna adds More States to Medicare Advantage

CnnMoney.com reports that Cigna will add 15 more states to its individual Medicare Advantage plans next year in order to grow its senior business.

Some of the states Cigna will introduce plans to include California, Florida, Illinois, Massachusetts and Ohio. Of the 13 existing states, Cigna also plans to expand the number of counties to which it offers Medicare Advantage plans. Cigna only recently started offering Medicare Advantage coverage last year. It is looking to expand their services by also adding preventive dental care reimbursement to its Advantage plans for next year.