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In the midst of a heated and contentious election season, seniors should be encouraged to know that some lawmakers in Washington are making progress toward increasing the efficiency of Medicare. According to The Hill, last Thursday, a bipartisan group of senators proposed legitimate legislation reforms to Medicare aimed at improving coordination and cost for treatment of various chronic conditions.
The Senate Finance Committee leaders who drafted the proposal included Committee Chairman Orrin Hatch (R-Utah), Senator Ron Wyden (D-Ore.), Senator Mark Warner (D-Va.), and Senator Johnny Isakson (R-Ga.). The bill, which is referred to as the Chronic Care Act, would form or expand on Medicare programs aimed at reducing costs and improving care for those with chronic conditions such as heart disease, diabetes, and Alzheimer’s. Beneficiaries with such conditions currently account for nearly 93 percent of all Medicare spending, according to the Centers for Medicare & Medicaid Services (CMS).
“Addressing chronic care in the Medicare program with reforms that improve outcomes for patients and save taxpayer dollars is a bipartisan goal, and I am proud that after a year and a half’s worth of work, the Finance Committee Chronic Care Working Group was able to unite around a set of reforms and recommendations to advance the conversation,” Sen. Hatch said in a statement.
Among the Act’s provisions is language to expand a Medicare pilot program that sends doctors and nurses to care for people at their homes. Also included in the draft bill is new permission for certain kidney disease patients to enroll in Medicare Advantage plans starting in 2021; increased flexibility for Accountable Care Organizations (ACOs); and a proposal to expand Medicare payment and use of telehealth services. The reform also would expand programs aimed at combating high drug prices, such as the new test model to improve how Medicare Part B pays for prescription drugs.
Lawmakers have included a section-by-section summary of all the bill’s provisions, which can be reviewed here.
Sen. Wyden was encouraged by the bipartisan proposal and by the prospect of providing seniors with chronic illnesses affordable and high-quality healthcare in the near future “At a time when chronic illnesses such as heart disease, diabetes, cancer and stroke dominate Medicare, too many seniors receive fragmented care that too easily allows them to fall through the cracks,” he said. “Releasing draft legislation marks the next significant step in the effort to ensure Medicare meets the needs of seniors with complex, costly chronic illnesses.”
As of now, the bill’s total cost and savings are unknown as it has not been reviewed by the Congressional Budget Office. However, the Senate Finance Committee members promise that the bill would give seniors enrolled in Medicare the “opportunity to receive better care at lower cost.”
The Hill speculates that the legislation could see a Senate vote during the lame-duck session following the election, but the Committee would have to turn last week’s draft into a final bill.
It’s doctors who usually know what’s best for your health. When President-elect Donald Trump nominated Rep. Tom Price (R., Ga.), an orthopedic surgeon, to head the Department of Health and Human Services (HHS), he must have thought the same thing. Trump is hoping that Price takes a doctor-oriented approach to reforming the nation’s healthcare system.
And that reform begins with repealing and replacing the Affordable Care Act (ACA), or Obamacare. To Trump, Price is the man to get the ball rolling. Not only is he a licensed and trained physician, but he’s also been a fierce critic of Obamacare and an advocate for overhauling the nation’s entitlement programs.
During his time in Congress, Price has been a leader on both projecting the disastrous impacts of Obamacare and developing positive solutions for improved access to healthcare for all Americans. He was one of the first representatives to draft his own plan to replace Obamacare, the Empower Patients First Act. After refining his plan, Price introduced it as a bill, which has been co-sponsored by several other representatives.
Price’s plan focuses on reforms that doctors care about. During his 12 years in Congress, he consistently argued for limited government and less spending. His legislation will likely mirror his actions as HHS Secretary: removing governmental red tape from doctors and giving Americans more control over their health care.
“As a physician,” he said in the House in 2007, “I know oh so well how the intervention of the state and federal government into the practice of medicine destroys the ability to take care of people. It makes it so you can’t provide quality health care for children and moms and dads.”
According to some, Price’s proposed replacement for Obamacare will offer tax credits to everyone, regardless of income, and help develop health savings accounts for beneficiaries who are not covered by their employers, Medicare, Medicaid, or other sources.
“We wanted to get away from the connection to income,” Price said in 2015. “I’ve become convinced over the past three to four years that it’s much more wise to relate the tax credits to age.” The legislation proposes tax credits of $1,200 per year for people aged 18-35, $2,100 for those aged 35-50, and $3,000 for those over 50.
Besides designing an innovative replacement for Obamacare, Price also wants to rework Medicaid and Medicare. Instead of entitlements, Price wants to convert Medicaid into block grants to states and require “able-bodied” applicants to meet work requirements to receive healthcare benefits. Regarding Medicare, Price supports the idea of moving from a “defined benefit” to a “defined contribution,” where the government would give older or disabled Americans financial help for them to buy private insurance policies.
While it’s still unclear whether Price’s ideas and legislation will receive the bipartisan support to become viable replacements for Obamacare, it’s clear that the nominated HHS Secretary has some thoughtful and innovative ideas on how to improve the nation’s healthcare system.
“There is much work to be done,” Price said in November, “to ensure we have a health care system that works for patients, families, and doctors; that leads the world in the cure and prevention of illness; and that is based on sensible rules to protect the well-being of the country while embracing its innovative spirit.”
To learn more about nominated HHS Secretary Rep. Tom Price and his doctor-oriented approach to reforming the nation’s healthcare system, visit mymedicareplanner.com and contact Tommy Chamouris. Tommy and his staff are committed to protecting senior citizens and helping them navigate through the “Medicare maze”—at no additional cost. See our ad on page 1 of Boomer magazine.
In a weekend interview with The Washington Post, President-elect Donald Trump offered some surprising news, declaring he is nearly finished with his plan to replace President Obama’s Affordable Care Act. Trump, who is less than a week away from beginning his four-year presidential term, did not reveal the specifics of his health care replacement but vowed his plan would “have insurance for everybody.”
Trump continued, “There was a philosophy in some circle s that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”
While Trump did not elaborate on the details of his plan, he did reveal that it’s formulated down the to the “final strokes.” He said he is waiting for his secretary of health and human services, Rep. Tom Price (R-Ga.), to be confirmed before he releases the specifics.
While he was tight-lipped about most aspects of his plan, which will replace most aspects of Obamacare, he did make his intentions to target pharmaceutical companies well known. He revealed that drug companies will be forced to negotiate on Medicare and Medicaid prices. Trump also declared his plan will have lower deductibles because he plans to fight pharmaceutical companies over drug prices. “They’re politically protected, but not anymore,” he said
In developing his replacement plan, Trump acknowledged that he paid attention to critics who say that repealing the Affordable Care Act would put coverage at risk for more than 20 million Americans covered under the law’s insurance exchanges and Medicaid expansion.
“We’re going to have insurance for everybody,” Trump said. “It’ll be another plan. But they’ll be beautifully covered. I don’t want single-payer. What I do want is to be able to take care of people” He also insisted that Americans “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better.”
Last week, Congress took a big step toward dismantling the ACA by approving a budget resolution that would begin repealing the healthcare law. According to House Speaker Paul Ryan (R-Wis.), the budget vote gives Congress “the tools we need for a step-by-step approach to fix these problems and put Americans back in control of their health care.”
While Trump seems all but ready to reveal and implement his replacement plan, there will likely be months of debate and Congressional infighting before the law is passed. However, Trump has warned Congress that he will use the power of his presidency (and social media) to let the American people know that Washington politicians are delaying the implementation of his replacement plan. He noted, “The Congress can’t get cold feet because the people will not let that happen.”
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To learn more about President-elect Trump’s comments about his forthcoming Obamacare replacement plan and his declaration to fight pharmaceutical companies over drug prices, visit mymedicareplanner.com and contact Tommy Chamouris. Tommy and his staff are committed to protecting senior citizens and helping them navigate through the “Medicare maze”—at no additional cost. See our ad on page 1 of Boomer magazine.
Since Trump’s election last November, there has been a lot of speculation over how the President-elect will overhaul and revamp America’s healthcare industry.
With his recent appointments of Seema Verma to serve as the Administrator of the Centers for Medicare and Medicaid Services, and Georgia Representative Tom Price as head of the U.S. Department of Health and Human Services, there is more clarity on Trump’s vision; and, despite the hysteria, many within the health industry are encouraged by what could be in store.
Throughout the election, Donald Trump declared he would “repeal and replace” the Affordable Care Act. Now that he’s elected, it seems highly likely that Trump will deliver on his promise. Although many predicted this would be a nightmare scenario, it seems that hospitals and health insurers are pleasantly surprised with the President-elect’s first steps.
Trump’s appointments of Rep. Price and Verma, along with his recent softening on some aspects of the Affordable Care Act, is a signal to some insiders that instead of chaos, he is preparing an orderly transition to replace Obama’s health program with a plan that healthcare companies may want.
Rep. Price is an orthopedic surgeon who has drafted legislation to replace the ACA. Meanwhile, Verma has close ties to Vice President-elect Mike Pence and helped design his ACA Medicaid expansion model, Healthy Indiana Plan 2.0. She has also advised several states on how to add elements such as health savings accounts and employment requirements to their programs. If both are confirmed, experts predict more power will be granted to states in crafting individual insurance plans and Medicaid programs.
“Pence and Trump have made a big deal about giving the states more flexibility and autonomy in managing their Medicaid programs and [Verma] would appear to be the perfect person, given her expertise, to manage that rollout of more state flexibility,” said Robert Laszewski, president of Health Policy and Strategy Associates.
Of course, some have been critical of Trump’s choices and his declaration to repeal and replace the ACA. There is a fear that millions of Americans will instantly lose health insurance and there will be even more uncertainty surrounding Medicare and Medicaid. However, lawmakers, including House Majority Leader Kevin McCarthy, have indicated that although they will work to repeal the ACA immediately, there will be a two-year transition period to phase out the law and citizens currently insured by the program won’t be left without a safety net.
One plan, proposed by House Speaker Paul Ryan, will offer individual insurance with a form of Federal subsidies, provide block grant funding for Medicaid, create vouchers for Medicare coverage, and the eliminate the advance paid premium subsidies for individual insurance. Many believe Ryan’s plan will serve as the foundation of the eventual replacement plan. In the meantime, members in Congress have been already asking healthcare companies for input and advice on functional alternatives for the ACA.
While the future of healthcare under the Trump administration is still uncertain, the President-elect’s recent appointments and proposals have excited many healthcare professionals, including Kathleen Harrington, chair of Policy of Government Relations for the Mayo Clinic. Harrington is pleased with what she has heard so far from the administration over the past few weeks. She notes, “We are very encouraged with the approach we’re hearing so far from President-elect Trump in terms of having a focused review and removing certain parts of it.”
To learn more about Donald Trump’s recent appointments and his plans to reform America’s healthcare system, visit mymedicareplanner.com and contact Tom Chamouris. Tom and his staff are committed to protecting senior citizens and helping them navigate through the “Medicare maze”—at no additional cost. See our ad on page 1 of Boomer magazine.
More than half of the nation’s hospitals –a total of 2,597—will be facing record fines once the federal government’s new readmission penalties go into effect in the next two months.
Beginning October 1, hospitals having more patients than expected return within a 30-day period will be subject to record-high penalties. The penalties are based on the readmission rate for patients with six conditions: heart attacks, heart failure, pneumonia, chronic lung disease, hip and knee replacements and — for the first time this year — coronary artery bypass surgery.
While the same number of hospitals as last year will face penalty, the fines will increase by a 20 percent, as Medicare withholds more than half a billion dollars in payments over the next year. According to Medicare, the penalties are expected to total $528 million, about $108 million more than last year.
Proponents of the Hospital Readmissions Reduction Program (HRRP), which began in 2012, believe that these higher penalties will help hospitals identify best practices and develop a quality-improvement infrastructure that will address readmissions in the context of other priorities. Research conducted by the Centers for Medicare and Medicaid Services (CMS) supports this notion. Data shows that national readmission rates have dropped as many hospitals pay more attention to how patients fare after their release.
However, there are others who oppose these penalties because of the challenges faced by hospitals that treat large numbers of low-income patients. They argue that these patients may have recuperating because they can’t afford their medications or lack the social support to follow physician instructions.
The American Hospital Association published a report asking several physicians for their reactions to the HRRP. Doctors Karen E. Joynt, M.D., M.P.H., and Ashish K. Jha, M.D., M.P.H. candidly disclosed that “the growing body of evidence suggests that the primary drivers of variability in 30-day readmission rates are the composition of a hospital’s patient population and the resources of the community in which it is located—factors that are difficult for hospitals to change.”
Despite the continued debate, hospitals with more unplanned readmissions than expected will receive a reduction in each Medicare case reimbursement for the upcoming fiscal year, which runs from October 1 through September 2017. These payment cuts apply to all Medicare patients, not just those with one of the six conditions Medicare measured for readmission.
According to Kaiser Health News (KHN), starting in October, more than 2,500 hospitals will receive lower payments for every Medicare patient that stays in the hospital. “The average Medicare payment reduction is 0.61 percent per patient stay, but 38 hospitals will receive the maximum cut of 3 percent. A total of 506 hospitals, including those facing the maximum penalty, will lose 1 percent of their Medicare payments or more,” KHN reported.
It’s important to note that under the Affordable Care Act, a variety of hospitals are excluded from readmission penalties, including those serving veterans, children, and psychiatric patients. Despite the more than 1,400 hospitals exempt from these fines, KHN determined that 1,621 hospitals have been penalized in each of the five years of the program.
To learn more about the Hospital Re-admissions Reduction Program (HRRP) and its impact on you or your loved one, visit My Medicare Planner and contact Tom Chamouris. Tom and his staff are committed to protecting senior citizens and helping them navigate through the “Medicare maze”—at no additional cost. See our ad on page 1 of Boomer magazine.
Beginning Saturday, August 6, a federal law goes into effect requiring hospitals to tell their Medicare beneficiaries if they have not been formally admitted and why.
The NOTICE Act is a nationwide law which addresses complaints from Medicare patients who were surprised to learn that although they had spent a few days in the hospital, they were receiving observation care and were not admitted. Observation care is when patients are considered too sick to go home yet not sick enough to be admitted into the hospital.
Often, seniors are unaware they have not been admitted because they are getting treatment and, in some cases, staying in the hospital overnight, yet they are subject to higher charges than admitted patients and do not qualify for Medicare’s nursing home coverage.
The law states that starting August 6, “Medicare patients receive a form written in ‘plain language’ after 24 hours of observation care but no later than 36 hours.” The form must explain the reason a patient was not admitted and how that decision will affect Medicare’s payment for services and the patient’s costs. This information must be provided verbally to patients and a doctor or hospital staff must be available to answer any additional questions.
According to a Kaiser Health News analysis, claims for observation care have skyrocketed in recent years. Since 2006, the total number of claims has increased 91 percent, and long observation (stays of 48 hours or more) have increased by 450 percent.
“We are in complete agreement with the notion that the patient should certainly know their status and know it as early as possible,” said Sean Cavanaugh, Deputy Administrator at the Centers for Medicare and Medicaid Services, about the legislation.
However, some are worried that the law does not require hospitals to explain exactly why a patient is getting observation care instead of being admitted. Rep. Lloyd Doggett (D-Texas), who co-sponsored the bill, said that the plain language form does not comprehensively explain “the difference between Medicare’s Part A hospitalization and nursing home benefit and Part B, which covers outpatient services, including doctor’s visits, lab tests and hospital observation care.”
Also, a study by Brown University, which was published in Health Affairs, documents the increased use of observation status for Medicare beneficiaries, and notes that, “Although observation services are often appropriate, the extended use of such services could have unintended consequences for some Medicare beneficiaries by limiting access to skilled nursing care and subjecting them to higher out-of-pocket spending.”
While the goal of the new law is to educate beneficiaries, patients who are concerned about the potential costs associated with observation status, may elect to return home and leave the hospital against medical advice, which could be dangerous to their health.
Others, particularly medical professionals, believe another flaw is that the form does not sufficiently explain a doctor’s decision to either admit or provide a patient with observation care. This is a concern because if Medicare auditors find that hospitals erred by admitting patients who should have been in observation care, Medicare pays nothing, leaving patients to pay hospital and nursing home bills worth thousands of dollars.
Ultimately, once the NOTICE Act goes into effect, patients and their families should address hospital admission status vigilantly. The patient or the patient’s family must determine the hospitalization status as quickly as possible and challenge an observational placement if they think that the status is incorrect; waiting too long may mean an expensive bill.
To learn more about the NOTICE Act and how you can prepare for its implementation, visit My Medicare Planner and contact Tom Chamouris. Tom and his staff are committed to protecting senior citizens and helping them navigate through the “Medicare maze”—at no additional cost. See our ad on page 1 of Boomer magazine.
This past Monday, July 25, the Department of Health and Human Services (HHS) proposed a new model to pay hospitals that treat Medicare beneficiaries for heart attacks, cardiac bypass surgery, hip replacements, and other hip surgeries with an emphasis on controlling costs and improving outcomes for patients.
If implemented, this “bundled” payment model would shift Medicare payments from quantity to quality by creating incentives for hospitals to deliver better care at a lower cost.
According to the Centers for Medicare and Medicaid Services (CMS), who published a fact sheet about the proposed rule, “These models would reward hospitals that work together with physicians and other providers to avoid complications, prevent hospital re-admissions, and speed recovery.”
Under this proposed bundle payment model, hospitals that admit patients for a heart attack, bypass surgery, or hip/femur fracture treatment will be offered a target price from Medicare for all of the services during inpatient stay and for 90 days after discharge.
The hospitals that work with physicians and others to deliver the needed care for less than the target price, while also meeting or exceeding quality standards, would receive the savings achieved. Meanwhile, hospitals with costs exceeding the target price would be required to repay Medicare.
Hospitals would be incentivized to provide high-quality care. Each hospital would be assessed on quality metrics appropriate to each episode. These assessments would use performance and improvement on required measures and the submission of voluntary data for other quality measures, according to the CMS fact sheet.
“Today’s proposal is an important step to improving the quality of care Americans receive and driving down costs. By focusing on episodes of care and rewarding successful recoveries, bundled payments encourage hospitals to coordinate care to achieve the best outcomes possible for patients.” HHS Secretary Sylvia Burwell said on Monday.
HHS noted that in 2014 alone, more than 200,000 Medicare beneficiaries were admitted into hospitals for either heart attack treatment or bypass surgery, which cost Medicare over $6 billion. In addition, the costs of surgery, hospitalization, and recovery were wide-ranging for these patients. Cost varied by 50 percent across hospitals, according to the HHS.
The proposed mandated bundle payment model would standardize and curb these costs by holding hospitals responsible for the cost and quality of care provided to Medicare beneficiaries. Under the current model, Medicare typically pays hospitals and doctors separately for each service; hospitals and doctors that do more get paid more. Ideally, the new model would emphasize overall health outcomes, rather than the volume of services provided.
“We think this is a significant positive step forward on behalf of patients. I think we are moving at the right pace. That’s absolutely where I would want the delivery system to be focused,” said CMS Chief Medical Officer Patrick Conway.
If approved, this bundled payment model would be phased in over a five-year period, beginning July 1, 2017. Once the plan is implemented, this model would be mandatory for nearly every hospital accepting Medicare beneficiaries in 98 metropolitan areas.
My Medicare Planner is committed to educating and protecting senior citizens and helping them navigate through the “Medicare maze.” Tom Chamouris and his staff offer guidance and help seniors find the Medicare plan that’s best for them—all at no additional cost. See our ad on page 1 of Boomer magazine.