Tag: prices
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.
Nearly a third of all Medicare beneficiaries may face a significant increase in their premium costs in 2017, if Congress doesn’t act soon. According to the federal government’s board of healthcare trustees June 2016 report, participants of Medicare Part B—nearly 51 million Americans in 2016—could face a 22 percent premium increase next year.
The report warned Washington lawmakers that Medicare’s trust fund for inpatient care will be exhausted in 2028, two years earlier than was previously projected. While this finding is of grave concern, the more immediate worry, according to the report is the steep premium increase for Part B beneficiaries scheduled to take place in 2017.
Medicare Part B covers doctor visits and other types of outpatient care, and people with higher annual incomes who would see the largest increases. By law (the Social Security Act’s “hold harmless” provision), premiums for most Medicare recipients cannot exceed their increase in Social Security payments. However, according to the Wall Street Journal, the adjustment is expected to be just 0.2% in 2017 due to low inflation. As a result, Medicare couldn’t pass along a premium increase greater than the dollar increase in Social Security payments to an estimated 70 percent of beneficiaries who will be “held harmless” in 2017.
In order to account for this discrepancy, Medicare would have to spread its cost increases across the remaining 30 percent of beneficiaries not “held harmless,” which is its higher earners. The trustees’ report predicts that individuals earning between $85,001 and $107,000 and couples earning between $170,001 and $214,000 would have their monthly premiums raise from $170.50 a person this year to about $204.40 in 2017. And it gets worse. For those earning more than $214,000 ($428,000 for couples), the increase is about $467.20 a month, nearly $100 more than 2016 costs. Increases this extreme will have a significant impact on the millions of Americans living on fixed incomes.
Potential premium hikes will likely affect higher earners, if the predictions from the trustees’ report come to pass, all Medicare beneficiaries will see their annual Part B deductibles rise in 2017. The report cautions that the deductible costs will increase by nearly $40, from $166 in 2016 to $204 in 2017. “Everyone on Part B will be liable for the full increase,” says Tricia Neuman, senior vice president and an expert on Medicare at the Kaiser Family Foundation. Medicare is expected to have 53.5 million participants in Part B in 2017, meaning nearly 3 million more beneficiaries than this year will be liable to pay this deductible increase.
There is still time for Congress to intervene this fall and prevent this potentially devastating increase. Last year, lawmakers reduced an impending 52 percent premium increase for Medicare beneficiaries not “held harmless” with a deal in the budget agreement that raised premiums by only 16 percent instead. However, the trustees’ report cautioned Washington to address Medicare’s financial challenges now, “Taking action sooner rather than later will permit consideration of a broader range of solutions and provide more time to phase in changes so that the public has adequate time to prepare.”
To learn more about what this potential premium increase means and how you can prepare, 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.” My Medicare Planner will offer guidance and help you find the plan that’s best for you—all at no additional cost.
Submitted by Kevin Hollister