Update: Medicare Advantage Payments

This post on GOOZNEWS.com discusses how several reports have recently taken aim at Medicare Advantage. The NY Times states that payments to health insurance organizations on average are 12 percent higher than what the government would spend on beneficiaries in traditional Medicare, and payments to Medicare Advantage plans are 17 percent higher.

How will the new administration deal with Medicare Advantage, since payments are ridiculously higher than traditional Medicare?

Medicare Advantage Paid Too Much

Fierce Healthcare reports that studies form the Medicare Payment Advisory Commission suggest that private health care plans for Medicare beneficiaries may be a good place to start cutting. The studies also show that private insurance plans are driving up costs because they are paid on average 13 percent more than allocated for traditional Medicare. Do you think private health care plans should be cut?

Medicare Part D Drug plans

At US News, they have the new prices for most popular Medicare Part D stand alone drug plans. Most have increased a significant amount. See the prices here.

Medicare drug benefits cause confusion

In a survey released by MedCo Health Solutions today, we find out that of the 1,000 Medicare beneficiaries selected, that 62% do not understand the doughnut hole when it comes to prescription drugs. More alarming is that 28% of those surveyed stated they weren't aware it existed.

For more information, read here.

The Disabled Have a Long Waiting Time Before Qualifying for Medicare

Stuart recently posted on MS Related News that Congress and the Obama administration should put an end to the 2 year waiting period people deemed as “too sick” have to face before qualifying for Medicare. Medicare covers both disabled and elderly people, but approximately 1.5 million disable people find themselves waiting for a very long time before receiving any benefits from Medicare.

Of the 1.5 million, 40% are uninsured for part of the wait and 25% are uninsured for the full 24 months. There is new legislation proposed by Rep. Gene Green, D-Texas, and Sen. Jeff Bingaman, D-N.M that would eliminate waiting time gradually over 10 years. Will the Obama campaign help get this legislation passed?

New Rules are Imposed on Medicare Advantage Plan Sales

Yesterday’s article on ModernHealthcare.com discusses that the Centers for Medicare and Medicaid Services have issued compensation requirements for sales agents that sell Medicare Advantage plans and prescription drug plans to Medicare beneficiaries.

Some of the rules include paying compensation to all agents according to fair-market value and adjusted for inflation for similar products in the same geographic area. To make sure that everyone is compliant with the new rules, agents will have to CMS their compensation structures for the previous three years as well as the compensation structure they are implementing for 2009.

Private Plans for Medicare that Cover Dental Care

This post on AMPSYS discusses how Medicare does not cover dental care, but there are ways around this. There are many private plans for Medicare that do offer such coverage for dental expenses. Some of these private plans include the basic Medicare coverage, and also offer savings in eyeglasses, hearing devices, and dental care as well. The post gives an example of how Humana pays for about 25 percent of fillings, 75 percent of the cost of examinations, cleanings and X-rays, and 50 percent of extractions.

Physicians Receive Medicare Incentive for e-Prescribing

Pizaazz reports in this article that the Centers for Medicare and Medicaid Services have announced an incentive plan for physicians so that providers will receive a 2% bonus on total Medicare charges during 2009 for using qualified e-prescribing system.

According to CMS, providers must use the e-prescribing systems that:
-Communicate electronically with the patient’s pharmacy,
-Remind physicians about cheaper alternatives (if available),
-Provide Medicare formulary information, and
-Alert prescribers about allergies, improper dosing and drug interactions.

Home Health Care Agencies will Receive a Slight Medicare Payment Increase in 2009

EmaxHealth recently reported that CMS will slightly increase Medicare payments on average to home health agencies in 2009. It will also take steps to remedy cases in which providers bill Medicare unusually large amounts.

Home health agencies on average are expected to receive an increase of 2.9% or an additional $490 million for changes in costs of goods and services. Agencies will have to report quality data on a regular basis to avoid a 2% reduction in payments.

Medicare Co-Pays and Premiums Expected to Rise

FierceHealthcare reports today that a recent study conducted by Avalere Health LLC found that for the largest 10 drug companies, premiums are expected to rise up an average of 31 percent next year. It is also speculated that this in term might cause insurers to increase drug co-payments 75 percent (about $7) for generic drugs and a 60% increase (about $40) for brand drugs.

A spokesperson from Humana, an insurer, mentions:

“Prices reflect the experience we've seen over the past three years, and our expectations around what will most interest our members and potential members going forward."

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.

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.

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.

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

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:

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?

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.

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?

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.

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.