GAO Questions Legality Of Medicare Advantage Bonuses
CQ HealthBeat: Congressional Watchdog Continues To Criticize Medicare Advantage Demonstration The General Accountability Office is continuing to hammer away at the Obama administration’s $8.35 billion Medicare Advantage demonstration program, this time in a 10-page letter Wednesday to Health and Human Services Secretary Kathleen Sebelius that questions her authority to create the pilot effort. Under the health care overhaul, the best-performing private Medicare health plans, called Medicare Advantage plans, were to receive bonuses. The idea was that these plans would have an incentive to get the highest performance rating: five stars. But administration officials decided that instead of relying on the health care law language, they would use their authority under Social Security to create a demonstration program that would give bonuses starting with average-performing plans that were rated at three stars (Bunis, 7/11).
Source: kaiserhealthnews.org
Video: Medicare Benefits Made Clear: News, Reform & Obamacare Exposed!
GAO Says Time to Call it Quits on Medicare Advantage Program
AAHomecare AARP Alliance for Home Health Quality and Innovation Almost Family American Association for Homecare Apria Healthcare Group Bank of America Brookdale Senior Living CareLinx Centers for Medicare & Medicaid Services CMS Emeritus Senior Living Employee Benefit Research Institute Ensign Group featured Fidelis Care First Care Home Health Care Gentiva Gentiva Health Services Griffin Home Health HCR Home Care HHS Home Health Depot Home Health International Home Health International Inc. Houston Compassionate Care Jordan Health Services LHC Group Inc LSU Medical Staffing Network Healthcare Medicare Medistar Home Health MedPAC Microsoft National Association for Home Care & Hospice National Association for Home Care and Hospice PACE Paraprofessional Healthcare Institute Partnership for Quality Home Health Care Partnership for Quality Home Healthcare PeopleFirst Homecare PHI Res-Care Inc. Stephenson Entrepreneurship Institute VA
Source: homehealthcarenews.com
Medicare Advantage bonus program illegal?
The Government Accountability Office this week took issue with the legality of the $8.3 billion Medicare Advantage Quality Bonus Payment Demonstration, The Washington Post reported. The GAO on Wednesday sent a letter to the U.S. Department of Health & Human Services, questioning the demonstration project in which the Centers for Medicare & Medicaid Services provides incentives to promote quality. The GAO in April released a report, criticizing what it saw as an ineffective program and called for its cancellation. Article
Source: fiercehealthcare.com
Medicare Advantage: ObamaCare Casualty?
Finding seniors and a group near you just got eaiesr and much, much quicker. We have good news for Super Seniors who want to find other Seniors near to them. A brand new feature on this site “Find a Group” at the top of the home page will help us to connect directly with each other.Please go to the top of the page and click on “Find a Group”. Then register your first name, your last name (or just an INITIAL you do NOT have to give your last name), plus your city and state. You can choose your state from the “Select forum” list then look for your city in your state.If no one has yet entered your city you can do so. Just enter your city’s name as a new topic. If your city is already there you can post that you have found them! Also, you can send the Seniors there a PM or private message by clicking on their name to the left of the post.That will take you to the person’s profile where you can read what they have written about themselves. Just below their profile is a link to “Send PM” or Private Message where you can email them directly.
Source: medicarewire.com
How to choose a Medicare Advantage plan
• Total costs: Look at the plan’s entire pricing package, not just the premiums and deductibles. Compare the out-of-pocket maximums plus the copays and coinsurance charged for doctor office visits, hospital stays, diagnostic tests, visits to specialists, prescription drugs and other medical services. This is very important because if you choose an Advantage plan, you’re not allowed to purchase a Medigap supplement policy, which means you’ll be responsible for paying these expenses out of your own pocket.
Source: pomeradonews.com
Obamacare Robs Medicare of $716 Billion to Fund Itself
In addition, as MA deteriorates under Obamacare’s cuts, many of those who are enrolled in MA (27 percent of total Medicare beneficiaries) will lose their current health coverage and be forced back into traditional Medicare, where Medicare providers will be subject to further cuts. The Centers for Medicare and Medicaid Services chief actuary predicted in 2010 that enrollment in MA would decrease 50 percent by 2017, when Obamacare’s cuts were estimated at only $145 billion. Now that the cuts have been increased to $156 billion (or possibly $308 billion, as the Ways and Means Committee estimates), MA enrollment will surely decrease even further.
Source: heritage.org
Advantage Medicare Plans « Insurance News from Crowe & Associates
A Medicare Advantage plan is offered by a private insurance company. The plan takes over for Medicare A and B and is your primary insurance. When you have an advantage plan, you show the advantage plan card. The provider you see will then bill the advantage plan instead of billing traditional Medicare. This is not a good or bad thing. It is simply a different way to obtain you health and drug coverage. Your own unique health care needs will determine if you should go with a Medicare Advantage plan or a Medicare Supplement with a drug card. Here is a quick overview of the strengths and weaknesses of an Advantage plan. Read our Medicare Guide for more information CLICK HERE FOR MEDICARE GUIDE
Source: croweandassociates.com
3rd Annual Medical Management In Medicare Advantage: Payer/Provider Collaborative Care Summit, 13
With over 200 attendees at our launch event, our Collaborative Care Summit has established itself as one of the premier Medical Management conferences. This August in San Diego, CA our 2012 program will continue to provide the “next generation” medical management tactics that Health Plans, Hospitals and Physician Group’s require in the current economic climate. As the chronically ill make up more of the Medicare Advantage population, hospital readmissions have become a significant financial challenge…
Source: hhealthh.com
Hallstatt s TI can almost always find you a room (either in town or at B&Bs and small hotels outside of town which are more likely to have rooms available and come with easy parking). Drivers, remember to ask if your hotel has in-town parking when you book your room. The stones symbolize community, groups of people gathering, conviviality.each is different, with heads nodding and talking. It s granite on granite. The movingheads are not connected, and nod only with waterpower. Whilefrozen in winter, it s a popular and splashy play zone for kids on hot summer days.
If you ask doctors about Medicare spending growth, most will tell you that Medicare payments to doctors haven’t increased in a decade, and that doctors are turning away Medicare patients in droves. But they would be mistaken on both counts. An authoritative compilation of current data from the Medicare Payment Advisory Commission shows what is really happening with Medicare physician spending: Medicare spending per beneficiary on physicians’ fee schedule services steadily increased from 2001 to 2011. In 2001, Medicare spent $1,374 per enrolled senior, and $1,160 per disabled enrollee; ten years later, it was $2,181 and $1,883 respectively. Volume growth is the reason Medicare is spending more. From 2000 through 2010, Medicare payment updates increased by only 8 percent (due principally to the Medicare SGR formula), compared to a 22 percent increase in physicians’ costs of delivering care as measured by the Medicare Economic Index. But overall spending per beneficiary on Medicare physician fee schedule services increased by 63.7 percent during the same ten-year period. How could that be? Because the volume of services—the number of tests, visits and procedures ordered by physicians on their Medicare patient’s behalf—increased at a much faster rate, pushing overall spending per patient upward, even as payment rates didn’t keep up with inflation. More diagnostic testing and procedures are the main culprits. From 2000 through 2010, the volume of diagnostic tests increased by 89 percent, the volume of imaging by 81 percent, and the volume of procedures other than major surgery by 65 percent. The volume of major surgical procedures, and evaluation and management services (office, nursing home, home, hospital, and other visits), increased at a much lower rate of 35 percent. Because of higher volume, physicians’ Medicare revenue has increased. Even though the SGR has kept payment updates below inflation, MedPAC reports that “growth in the volume of services contributed more to the rapid increase in Medicare spending payment rate increases … both factors—updates and volume growth—combine to increase physician revenues.” Medicare patients have better access to physicians than the privately insured. In 2011, 74 percent of Medicare beneficiaries, and 71 percent of privately insured patients, reported “never” having to wait longer than they wanted to get an appointment for routine care. Medicare beneficiaries also reported more timely appointments for injury and illnesses. Only 6 percent of Medicare enrollees said they were looking for new primary care physician, compared to 7 percent of the privately insured, suggesting that “most people are either satisfied with current physician or did not have to look for one.” A larger, but still comparatively small, number of Medicare patients reported trouble finding a primary care physician. Of the 6 percent of Medicare beneficiaries who were looking for a new primary care physician in 2011, 35 percent reported having trouble finding one—23 percent of them reporting their problem as “big” plus 16 pecent reporting their problem as “small.” The Commission notes that “although this number amounts to about 2 percent of to the total Medicare population reporting problems, the Commission is concerned about the continuing trend of greater access problems for primary care.” I suspect that the first reaction of many physicians to these data will to insist that MedPAC must be wrong, that they know from their own experiences that Medicare payments haven’t kept pace with their costs and that they know of many doctors who are turning away Medicare patients. And they may be right, in the sense that their own personal experiences may not match the data on national trends and the cumulative impacts of spending growth per patient and physician. But just as good physicians don’t ignore or dismiss clinical data that challenges their own perceptions and experiences, the medical profession shouldn’t ignore the data on what is really going on with Medicare spending and access. The fact is that spending on physician services in the aggregate has grown rapidly, even with the SGR-imposed limits on payment updates, and the culprits are more testing, imaging, and procedures being ordered for each beneficiary. And despite some evidence of greater access problems for primary care, most Medicare patients—so far—are not having major problems getting appointments or finding a primary care physician or a specialist. Armed with these data, Congress isn’t likely to spend hundreds of billions to just eliminate the SGR, absent a plan to control the volume of services. As MedPAC notes: “Volume growth increases Medicare spending, squeezing other priorities in the federal budget, and requiring taxpayers and beneficiaries to contribute more to the Medicare program . . . They are largely responsible for the negative updates required by the SGR formula. Rapid volume growth may be a sign that some services in the physician fee schedule are mispriced.” Last week, ACP’s President David Bronson, MD, FACP, told the House Energy and Commerce Committee about innovative, physician-led initiatives that could help solve the Medicare SGR problem, and today, he testified before the House Ways and Means on how ACP proposes “to transition from a fundamentally broken physician payment system to one that is based on the value of services to patients, building on physician-led initiatives to improve outcomes and lower costs.” Ignoring the facts will not heal a broken payment system, but offering the medical profession’s own diagnosis and treatment plan informed by the evidence just might help. Today’s question: what is your reaction to the data on Medicare spending on physician services?
It depends on when you need your Medicare prescription plan coverage to begin. Initially, you have a seven (7) month window of time to join a Medicare Part D or Medicare Advantage plan. So if you enroll in a Medicare Part D plan within the three (3) months before the month that you become eligible for Medicare (for example, the 3 months before you turn 65), your Medicare plan coverage will start on the first day of your birthday month (or Medicare eligibility month). If you join a Medicare plan during your birthday (or eligibility) month, your prescription drug coverage will start on the first day of the next month. Finally, if you join a Medicare plan during the three (3) months after your birthday (or eligibility) month, your drug coverage will start the first day of the month following the month when you enroll.
Dr. Victoria Tseng and her colleagues at the Warren Alpert Medical School of Brown University looked at a random sample of 1.1 million Medicare beneficiaries aged 65 or older who were diagnosed with cataracts between 2002 and 2009. They compared the rates of hip fractures in 410,809 patients who underwent surgery to remove cataracts with rates in patients who did not. Overall, the researchers found, patients who received cataract surgery were 16% less likely to break a hip in the year after the procedure, but the benefit was most pronounced in older patients.
BCBS Medicare PPO Advantage Plan gives you more of the benefits that you need and expect, including built-in prescription drug coverage. All three plans under the BCBS Medicare PPO umbrella offer all of the benefits of original Medicare along with several services that are not generally covered, as well as the convenience of one of the largest provider networks in the state.