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 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?

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.

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.

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."

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.

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.

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?

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.

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.

No Congress in Medicare Please

As this post in a WSJ blog states, the CEO's of Mayo and John Hopkins have given their opinion in an op-ed piece for the Chicago Tribune requesting Congress to but out of Medicare. They would like Congress to have less oversight and control, and instead, want to have a board providing guidance instead. To quote the article:

Decisions about coverage and payments are inappropriately subject to political influences and inefficiencies. Why should Congress spend time debating how much Medicare should pay for the rental of oxygen supplies? A non-political board could better fulfill the role of overseeing Medicare. The board should function like the Federal Reserve—with independent authority, but reporting to Congress.