23975375121Since 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.

 

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.

 

my medicare planner

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.

 

app

It’s time to face the facts, mobile software applications or apps aren’t just for young people anymore. In recent years, as seniors have become more tech-savvy—using smart phones, tablets, and laptops on a daily basis—several apps have been developed to make daily life easier for these older adults and their caregivers.

With each year, seniors aged 65 or older are plugging into the present. According to a survey from Pew Research Center, nearly 60 percent of seniors go online and over 75 percent own a smart phone. “Most seniors who become internet users make visiting the digital world a regular occurrence,” the research says. “Among older adults who use the internet, 71 percent go online every day or almost every day, and an additional 11 percent go online three to five times per week.”

In addition to embracing technology, nearly 90 percent of seniors want to stay in their own homes as they age, the AARP reports.  With this being the case, it’s important that seniors and their caregivers know about the technology that’s available to make independent living safer.

Below are several free or inexpensive apps offered for Android and Apple that can help seniors in their day-to-day lives and offer their families and caregivers some peace of mind.

 

 

Fade (for Android users) or Fall Safety Pro (for Apple users)

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Falls are the leading cause of fatal and non-fatal injuries for older Americans, according to the National Council of Aging. These two apps monitor a user’s smart phone for sudden movements that may indicate a fall. In the event of a fall, emergency contacts are alerted via text and voice message and given a location.

 

 

Pillboxie

pillboxie

This app offers an easy way to remember to take medication. Users can schedule easy reminders and color-code different types of medications. Also, after taking medication, it is easy to log the time it was taken and its effects.

 

 

 

Drugs.com Medication Guide

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This app is an easy way to lookup drug information, identify pills, check drug interactions, and set up personal medication records.

 

 

Tell My Geo (for Android users) or Comfort Zone (for Apple users)

TellMyGeo

These two apps allow caregivers to stay connected with loved ones wherever they are by scheduling regular location updates. Individuals with dementia or Alzheimer’s can live independently, while their caregivers can constantly monitor their current location to help them stay safe.

 

 

BlueLoop

blueloop

This is an app for users with diabetes and their caregivers. The app connects the user and caregiver, allowing them to share updates on food intake, insulin, and blood sugar levels. Also, caregivers can elect to receive text messages throughout the day with important updates on the user’s vital medical information.

 

 

 

 

These are just five easy-to-use apps that can help improve seniors’ lives as they continue to embrace technology. For a list of other helpful apps, visit mymedicareplanner.com and click on the tab labeled “Apps You Can Use.”

Mymedicareplanner.com is committed to educating and protecting senior citizens and helping them navigate through the “Medicare maze.” Tommy 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.

broken piggybank with dollar notes on whiteNearly 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

With insurance mega-mergers pending, the  existing competition may become even less.

 

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This image is by The Commonwealth Fund.

A national study by The Commonwealth Fund found that in 97% of counties “there is little to no competition in Medicare Advantage insurance markets.” Competition in any market is good, because it pushes the companies to provide better services and prices than their competitors. However, when there are only a few companies, there are no forces pushing them to work for the consumer.

Here are some takeaways from the study:

  • Rural counties have the least amount of competition.
  • In urban counties, the competition is still lacking: 81 out of the 100 counties with the most Medicare beneficiaries were found to be noncompetitive markets.
  • Only one of those 100 counties, Riverside, CA, was classified as competitive.
  • The Medicare Advantage markets are cornered by six insurers. The three companies with the biggest reach are UnitedHealth (38 counties), BlueCross (13 counties) and Humana (12 counties). Together, they control nearly two-thirds of all counties.

The Medicare Advantage market is a small but significant portion of the program. About 30 percent of beneficiaries have Advantage plans, which is roughly 16 million seniors.

But UnitedHealth, BlueCross and Humana are big in more than one market. The Government Accountability Office recently found that those three insurance companies cover 80 percent of Medicare beneficiaries across all markets.

With the pending mergers between insurance giants Anthem and Cigna, and between Aetna and Humana, that we covered previously, the competition will certainly not improve.

The American Medical Association released results of a study focusing on the Anthem-Cigna and Aetna-Humana mergers, and what effect they would have on insurance markets. They studied markets without the impact of the mergers, and found:

  • Three-fourths of urban areas are already ‘highly concentrated” with low competition.
  • 41 percent of urban areas have one insurance company with over half the market share.

Ultimately, the American Medical Association found that the mergers would decrease already low levels of competition by enhancing companies’ market power, which means it will “encourage one or more firms to raise price, reduce output, diminish innovation or otherwise harm consumers as a result of diminished competitive constraints or incentives.”

Studying the effects of the merger, the AMA found:

  • The Anthem-Cigna merger would be anti-competitive in the combined markets of 14 states, including Virginia.
  • The merger between Anthem and Cigna would enhance market power in 85 metropolitan areas in 13 states, including Virginia. Overall, 14 states would see significant decreases in competition from the deal, according to the study.
  • The Aetna-Humana merger would increase market power in 15 metropolitan areas in 7 states, not including Virginia. In total, the study says the effects of the merger would be seen in 14 states, where competition would lessen sharply.
  • tom
  • Tom Says:
    “Prepare yourself-  this will be the outcome of the mergers for Medicare beneficiaries throughout the country and in Virginia particularly.
    This is also a preview of the Annual Enrollment Period, starting October 7, for those who want to change their Medicare Advantage or Medicare Part D plans.”

To read the study by The Commonwealth Fund, click here.

For more on the American Medical Association’s study, see this New York Times article.

 

Anthem bought Cigna for $54 billion last week. Aetna bought Humana for $37 billion this month. What does that mean for consumers?

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This image is from ModernHealthcare.com.

 

In the last month, four of the five biggest health insurance companies have entered major mergers. The “Big 5” are UnitedHealth, Anthem, Cigna, Aetna and Humana; all but UnitedHealth (the largest) are involved in the deals. If the mergers are approved, the “Big 5” would become the “Big 3”, who would hold over half (52%) of the Medicare Advantage market. The companies insure approximately half of the entire insurance market.
Some speculate that prices will go up.
If there are fewer companies to compete with, rates could rise. Historically, mergers of big insurers have caused the price of premiums to increase.Some suggest that prices will go down.
Insurance companies say the deals would substantially reduce their own costs, allowing them to charge consumers less for their plans.

Some say the future of the deals is uncertain.
The mergers will be reviewed by the federal government, with special attention paid to anti-trust laws. Some believe they won’t go through at all. If the deals are upheld, they won’t go into effect until 2016.

Insurers aren’t the only ones joining forces. 

  • CVS, the largest drugstore company in the US, bought Target Pharmacy for $2 billion in June. The 1,660 Target Pharmacies nationwide will eventually be CVS pharmacies.
  • Centene, a Medicare and Medicaid health plan provider, bought Health Net, a health plan provider in the same industry, for $7 billion in early July.
  • The biggest generic drug producer in the world, Teva, bought Allergan, a manufacturer of generic drugs best known for making Botox, over the weekend for $40.5 billion.
Why is everyone merging?
  • Insurers are merging because they want to cover more of the market. With the influx of customers from the Affordable Care Act, and the revenue from Medicare and Medicaid, they are buying companies with these strengths.
  • When one subset of the industry begins merging and combining market power, the companies on the other side want to do the same. To maintain power in negotiations and stay afloat in the changing industry, companies see merging as the answer.

tom

Tom says:
“Generally speaking, when an industry like the insurance industry begins to see mergers of the largest companies, it portends less competition and more price control between the remaining behemoths. Such mergers will be examined closely by the government for anti-trust violation. I will leave you with these quotes.”

“In an environment where the scales are already tipped, we are extremely concerned about the market imbalance this creates for medical practices and patients,” said Dr. Halee Fisher-Wright [of the MGMA]… “This will do nothing more than inflate healthcare premiums and decrease payments to physicians in favor of insurance companies and shareholders’ profits.” – Forbes

“One of the main goals of the Affordable Care Act was to restore competition in the health insurance sector,” said David Balto, a former policy director at the Federal Trade Commission who is now in private practice in Washington. “This consolidation will reverse these gains of the Affordable Care Act.” – Forbes

Will the Anthem-Cigna deal cost you money?

To find out what other changes could come with the health insurance mergers, click here.

Medicare will reimburse doctors
who talk with patients about
end-of-life care

Yesterday, Medicare announced that it plans to pay for the end-of-life conversations between doctors and patients. The plan answers questions surrounding “Death Panels,” which have been debated since the passage of the Affordable Care Act.
Coverage for end-of-life counseling was not included in the Affordable Care Act, but some insurance companies have begun to offer coverage. More companies are expected to when Medicare finalizes the plan.
The proposal will be decided on November 1st.If this has been helpful, please feel free to forward this email to family and friends. Please contact us at [email protected] to be added to our email list.
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Medicare Proposes paying for end-of-life counseling in sweeping physician payment rule

Modern Healthcare
In a draft of Medicare’s first physician payment rule since Congress scrapped the sustainable growth-rate formula, the CMS proposes paying for end-of-life counseling and revises several quality-incentive programs that will be rolled into a new comprehensive program in 2019.

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Medicare Plans to Pay Doctors for Counseling on End of life

The New York Times
Medicare, the federal program that insures 55 million older and disabled Americans, announced plans on Wednesday to reimburse doctors for conversations with patients about whether and how they would want to be kept alive if they became too sick to speak for themselves.

Allergy“Achoo !” , “Achoo ! “,God Bless You! It’s allergy season, and the grass, air pollution, dust, and pollen  have got you sneezing. Well, hold on to your tissues…helpful allergy tips are on the way. Allergies aren’t just for Springtime, over 67 million Americans suffer from allergies every day. The most common  allergen is Pollen. Pollen is an airborne allergen transferred by the wind. Various trees, grasses, and weeds create pollen; which is the culprit that irritates your sinus passages, eyes, and skin.There are also Seasonal Allergies, which include grass, pollen and mold. These allergies have triggers which are tied to particular seasons.
Seasonal Triggers
Winter  –  Smoke

Spring & Summer – Insect bites and stings

chlorine from indoor / outdoor swimming pools

Holidays – peanuts, other nuts, or chocolate

Thanksgiving & Christmas – Pine trees and wreaths

For allergy sufferers it is recommended that you work with your doctor or allergist to treat your symptoms, and find a way to avoid triggers.

Tips To Avoid Allergy Triggers
Monitor mold and pollen counts

Keep windows closed during allergy season

Go out early morning to do errands when pollen count is low

Wash hair, clothes and take a shower after being outdoors working, or playing

Use the air conditioner in your home and car

Use a humidifier

Get Allergy Healthy by seeing your doctor  or Allergist today!

 

Since today is National Walking Day, today’s newsletter focuses on small, but significant, changes that can improve your health- like walking! Time Magazine recently did an in-depth review of aging and longevity, citing many studies with some surprising results. In summary, a little bit goes a long way. Here are some of Time‘s findings on how you can improve aging, disease and general health.

  • Diet

It’s common knowledge that cutting calories is good for your waistline, but one study, published last year, shed light on another benefit. Participants’ calories were cut by one-fourth, which brought a huge health change: blood pressure and cholesterol were slightly better, and their risk of heart disease decreased by 47% (almost half!).

Another diet study that cut calories, from as little as one-third to over one-half of participants’ normal diets, found that their risks were lowered in areas of “aging, diabetes, heart disease and cancer, including lower blood sugar,” and lower levels of a growth hormone that speeds aging.

  • Exercise

Walking isn’t the only activity that can lead to a healthier future- simply doing chores around the house is a way to stay active. One study tracked over a thousand seniors in their 70s and 80s who had limitations on their physical activity. The results? Those who exercised the least had the greatest chance of a heart event within the next decade. But even small activities, like household chores, lowered the risk.

A different study involved 1,600 seniors between ages 70-89. One group took a health education course and one group did activities like walking. After three years, the walking group could walk over an hour and a half more per week than the other group. Their rates for major mobile disabilities were “significantly less.”

  • Mindfulness

Thinking positive makes a big difference. Results of a study showed that men and women who had negative attitudes toward aging in their 40s, had greater brain loss in the region associated with Alzheimer’s. They had the same level of brain loss in three years than those with positive outlooks had in nine years.

Other studies have found that those with negative views on aging have a greater risk of heart problems in the next 40 years than those with positive views. People with “mindful dispositions” have less body fat and better heart health, according to a study by Brown University.

 

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