The Hunt is Afoot For Medicare Part D

Posted by:  :  Category: Medicare

You can complete an easy-to-use online application for Extra Help at www.socialsecurity.gov. Click on Medicare on the top right side of the page. Then click on “Get Extra Help with Medicare Prescription Drug Plan Costs.” To apply by phone or have an application mailed to you, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) and ask for the Application for Extra Help with Medicare Prescription Drug Plan Costs (SSA-1020). Or go to your nearest Social Security office.
Source: patch.com

Video: Annie Kuster’s TV ad: Medicare

Senior Care in Rochester, NH: Open Enrollment for Medicare –Now through Dec 7, 2012

Would a small increase in premiums result in a large reduction in health care costs you pay? Check, for example, what coverage is available for prescription drugs you take? Medicare representatives can create a report containing the costs and benefits of various insurance products if you supply them with a list of your drug prescriptions. Ask questions about participating doctors and clinics. Some Medicare Advantage plans limit which physicians a patient can visit.
Source: atlantichomelifeseniorcare.com

Campaigning in New Hampshire, Obama ramps up attacks over Medicare, taxes

Complicating the argument for Republicans has been the vague nature of their plans for both Medicare and taxes. Romney has endorsed Ryan’s most recent budget, for instance, but more recently has backed away from it, saying he’ll offer his own plan sometime in the future. Also, while Ryan’s budget repeals most of the Democrats’ healthcare reforms, it keeps the more than $700 billion in Medicare cuts – the same cuts the Republicans are warning will devastate the program.
Source: thehill.com

NH Medicare recipients' privacy violated

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Source: americablog.com

DownWithTyranny!: What Do NH

Lee Rogers is an innovative surgeon who’s internationally acclaimed practice centers on preventing amputation. McKeon’s disdain for their neighbors and his vote to kill Medicare helped persuade Lee to jump into the race. He and McKeon have something in common though. Neither liked Obamacare. McKeon just wants to– and has voted to– kill it. Lee wants to capitalize on what’s good in the bill and fix what isn’t. And Carol is a grassroots organizer who’s as close to the street as any politician is likely to be. She’s as likely to do anything that would adversely impact her neighbors as she would harm her own family. In the last weeks of the campaign, both these challengers are in tight races and both can use some last minute help. If you can, they’re both on the same page– this page.
Source: blogspot.com

A Call for Mandatory Disclosure of Corporate Political Spending

Second, over the years, this issue has been caught, legislatively speaking, in a weird deadlock between Democrats and Republicans that involves, oddly enough, corporate philanthropic grantmaking. As readers know, corporate grantmaking through 501(c)(3) corporate foundations that file 990s gets disclosed, but direct grants from companies’ executive offices, marketing and PR arms, community relations divisions, etc. can be, and frequently are, done without disclosure. For some years, a Republican member of Congress would introduce a bill calling on disclosure of corporate charitable giving. Democrats (and leading nonprofit associations) have consistently opposed corporate charitable disclosure, saying that disclosure would make corporations apprehensive about supporting some causes and charities. Democrats would instead counter that if Republicans wanted disclosure of corporate philanthropic spending, they should be willing to require the disclosure of corporate political spending. And that’s where the debate would always grind to a halt.
Source: nonprofitquarterly.org

What Medicare changes could mean to local hospitals

Posted by:  :  Category: Medicare

Joe the Plumber - To Flush The System ... More scams aim to ensnare Brevard seniors - Their ingenuity is boundless, Archer said. (Jul 2, 2012) ... by marsmet524Topics: Centers for Medicare and Medicaid Services, Healdsburg District Hospital, Health Care Update 2-18-2013, Kaiser Permanente, Marin General Hospital, Medicaid, Medicare, North Bay Business Journal 2-18-2013, Novato Community Hospital, Palm Drive Hospital, Patient Protection and Affordable Care Act of 2010, Petaluma Valley Hospital, Queen of the Valley Medical Center, Santa Rosa Memorial Hospital, Sonoma Valley Hospital, St. Helena Hospital, Sutter Medical Center of Santa Rosa
Source: northbaybusinessjournal.com

Video: NCML Head Office Opening

Local case triggers Medicare change

“It gives seniors some peace of mind on a couple levels,” Murphy said. “They want (to be sure) Medicare will be there for their future. It was one of those unfortunate bureaucratic glitches that hurts seniors who may have been injured and prevents them from getting their bills paid,” Murphy said. “Without this bill, a senior may wait years for settlement. Without this bill, Medicare may spend large amounts money with delays.”
Source: triblive.com

North Adelaide Medicare Local crisis?

I too am concerned about power (see Dr Whom’s comment), but not in the same way and for very different reasons. The misuse of power by ANDGP in the takeover of Northern Adelaide Medical Local is concerning indeed. ANDGP were concerned that the original NAML Board and staff were ‘misinterpreting the meaning of health reform’ and failing to meet the Commonwealth’s requirements. These concerns were not communicated to the NAML Board prior to the takeover. NAML was conceptualising their local health planning and assessment tasks through the lens of the Social Determinants of Health (SDoH) (see James Lamerton, Croakey Nov 30th). The northern area of Adelaide is home to some of the most disadvantaged people in Australia, and for a significant proportion of people, this disadvantage is intergenerational in nature. These people also experience the poorest health outcomes. They are over represented in the tertiary health system, the child protection system and the justice system. NAML recognised the interconnected nature of the issues faced by these individuals and families and was making good progress in developing respectful and collaborative relationships between diverse stakeholders to underpin planning and delivery of interconnected, well coordinated high quality services and programs. In stark contrast, the covert and subversive actions of ANDGP are counter to the principles of good governance for collaboration and transparency/accountability. Action on the SDoH means tackling the inequitable distribution of power, money and resources and addressing the inequities in the way that society is structured and organised. The dynamics of unequal power relations (mirrored in the actions of ANDGP) are fundamental drivers of continuing inequities in health and social outcomes. Genuine cross agency collaboration around complex and often contested social health issues is not easy. It requires a commitment to a sophisticated level of communication with diverse stakeholders, particularly among those in leadership positions. The undemocratic and hostile takeover by ANDGP raises serious questions about their interpretation of health reform and their leadership capacity to achieve the promise of Medicare Locals.
Source: com.au

Illinois Medical Care Set For Economy Plan

More than 135,000 high-cost Illinois patients who are eligible for both Medicare and Medicaid will be assigned to a managed care health plan by early next year. The initiative is a partnership between Illinois and the federal Centers for Medicare and Medicaid Services and is designed to cut costs.
Source: cbslocal.com

Oregon May Provide Model For Restructuring Medicaid In Alabama

Last October, a commission established by Bentley began researching ways to restructure the state’s Medicaid program to make it more efficient. The group concluded that Alabama should follow Oregon’s path. “It will be a heavy, heavy lift,” says state health officer Don Williamson, who headed the group. But he said the overhaul is necessary if the state is ever going to expand Medicaid. Otherwise, he said, “we will find ourselves with a program that simply collapses under the weight of the expansion.”
Source: kaiserhealthnews.org

Man pleads guilty in Medicare fraud conspiracy

If you enjoy the content on the Crain’s Detroit Business Web site and want to see more, try 8 issues of our print edition risk-free. If you wish to continue, you will receive 44 more issues (for a total of 52 in all), including the annual Book of Lists for just $59. That’s over 55% off the cover price. If you decide Crain’s is not for you, just write “Cancel” on the invoice, return it and owe nothing. The 8 issues are yours to keep with no further obligation to us. Sign up below.
Source: crainsdetroit.com

Medicare quality will drop

“We’ll bring down costs by changing the way our government pays for Medicare, because our medical bills shouldn’t be based on the number of tests ordered or days spent in the hospital – they should be based on the quality of care that our seniors receive … our government shouldn’t make promises we cannot keep – but we must keep the promises we’ve already made.”
Source: spokesman.com

Darling Downs South West Queensland Medicare Local: Stanthorpe cancer support group

Recently CEO Andrew Harvey and newly appointed Regional Program Officer Sarah Densley met with members of the Stanthorpe Cancer Support Group. The group works closely with the McGrath Foundation Breast Cancer Nurse Program and also the Cancer Council to ensure locals are provided with advice and care. 
Source: blogspot.com

Law For All: Medicare according to American Laws

Posted by:  :  Category: Medicare

The Anatomy of Obamacare (What's not to like?) by Third Way       Medicare Part A provides assistance with hospital care coverage. This includes short term hospital visits, long term care in nursing homes, some at-home services, and hospice care. If you have worked and contributed to Medicare through taxes, then you are eligible for premium-free Medicare Part A. If you have not contributed enough, you will have to pay a monthly premium for Part A.
Source: blogspot.com

Video: Boston: Medicare Fraud Summit Law Enforcement Panel

Massachusetts Medicare and Medicaid

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Source: massestatelawyer.com

Medicare Had Violated Federal Laws

ccording to the two reports issued by the federal health officials, the tax-payer funded Medicare program paid more than $120 million from 2009 to 2011 in violation of the federal law for medical services for inmates and illegal immigrants. According to the federal law, generally Medicare does not give payments for either group of patients. According to the reports from the Department of Health and Human Services Inspector general, the bill however was billed for more than $33 million for inmate care and more than $91 million for illegal immigrant care over that period.
Source: thepointdaily.com

winantscott: What Are the Medicare Lein Laws for Personal Injury Settlements …

Your Personal Injury Attorney will report to the Coordination of Benefits Contractor (COBC) with information such as the Medicare number, injury, date of injury/loss, and other pertinent information. ?Later, they must submit consent forms and proof of representation to the Medicare Secondary Payer Recovery Contractor (MSPRC). ?Then you and your attorney can address any unrelated payments and dispute those payments. Finally, a settlement should be immediately reported to Medicare?s MSPRC.
Source: blogspot.com

ObamaCare and Medicaid: More Pre

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Source: libertylawsite.org

Medicare Fraud News: Services Not Eligible For Reimbursement Result in Whistleblower Lawsuit

From our offices in San Francisco, California, New York, New York, and Nashville, Tennessee, Lieff Cabraser’s whistleblower attorneys represent whistle blowers in False Claims Act, SEC/CFTC, and IRS/tax cases nationwide. Our whistleblower lawyers practice in federal court throughout the United States. Members of the firm are also licensed to practice in local courts in California, New York, Massachusetts, Tennessee, New Jersey, and Pennsylvania, as well as Washington, DC. We have affiliations in particular cases with attorneys licensed to practice in almost every state court in the United States. For a free, confidential prompt evaluation of your whistleblower case, please contact us.
Source: uswhistleblowerlaw.com

Proposed ACO Waiver Regulations: Not Far Enough? An OIG Challenge During My Presentation at Friday's AHLA Medicare and Medicaid Institute

WAIVER PROPOSAL #3: The CMP laws would be waived in two circumstances. First, there would be a waiver with regard to payments from hospitals to docs that do not relate to limiting medically necessary services and the hospital and the docs were in an ACO. This seems like a great use of the waiver authority, as this will carve out many payments under the ACO from CMP risk, while maintaining a balance with regard to ensuring that medically necessary services continue to be rendered. However, note that this waiver ONLY applies to distributions of shared savings. So any underlying relationship that does not relate to the shared saving distribution would NOT be covered by this waiver proposal. To my way of thinking, this again seems unduly restrictive. Hospitals and physicians should have the flexibility in ACO design to design payment methodologies and relationships that effectuate the delivery of value, providing that medical care is not compromised.
Source: triagehealthlawblog.com

ObamaCare Opponent Rick Scott to Proceed With Health Law’s Medicaid Expansion in Florida

During the transition period, Cannon says he “pushed hard” for the health care task force to recommend that Scott not implement any part of ObamaCare. When the time came to make that recommendation directly to Scott, Cannon says it didn’t require a hard sell. Scott quickly declared that he had no plans to implement any part of the health law in Florida. “I didn’t even have to make the pitch. He was already on board,” Cannon tells me. “That makes this an even more dramatic flip-flop.”
Source: reason.com

Report Shows Value of Medigap for Rural and Low

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSA joint letter to the NAIC from a variety of consumer groups said that these proposals “are based on the false assumptions that beneficiaries with supplemental coverage use more Medicare services than necessary and that additional cost sharing will result in federal health care savings.” Moreover, the groups said, “We remain deeply concerned that any attempt to add cost sharing in Medigap plans will cause disproportionate harm to beneficiaries with low and modest incomes, those who are chronically ill and those living in rural communities.”
Source: ahipcoverage.com

Video: Best Medicare Supplement Plan

Medicare and Medicare Supplemental Insurance

Medicare supplemental insurance is the easiest way to bridge the coverage gaps in traditional Medicare coverage.  The Medicare supplement plans will cover varying numbers and combinations of the nine gaps.  The most popular and expensive of the plans is plan F because it covers the all of the gaps, while plan A tends to be the least expensive because it only covers the minimum of four gaps.  Each plan has its merits but knowing which one to get can only be based off of your individual needs and budget. You can get a free quote of medicare supplement rates here.
Source: tablib.org

Do I Need Medicare Supplement Insurance Coverage?

If you have health issues, you will probably pay less in health costs overall if you sign up for this insurance during your open enrollment period. If you have any joint replacements or other costly medical procedures that have been recommended by your doctor, you should figure medicare supplement insurance costs into your budget. These products are insurance policies, not Medicare, and insurance companies only survive if they make a profit from their overall pool of policies. They probably will not accept you at a later date if the above applies to you.
Source: seniorcorps.org

Insurance: What Is Medicare Supplement Plan F?

The coverage required of Medigap coverage plans is mandated and regulated by the Centers for Medicaid and Medicare. Plan F also has a “high deductible” plan because it will not pay for any type of services covered by Medicare until the plan beneficiary has paid an out-of-pocket minimum of $2,000. Once that deductible has been met, Plan F will cover 100% of the co-insurances, co-pays, and deductibles of Parts A and B including hospice care co-insurance as well as preventative services. If you get the regular Plan F you will have no deductibles or coinsurance. When speaking to an insurance professional it’s important to make sure which Plan F you are being quoted.
Source: blogspot.com

Los Angeles Medicare Supplement

I recommend seniors turning 65 to enroll in a Plan F because the rates are relatively good at that age, and they can always switch to a lower coverage plan, every year on their birthday. Another popular plan to consider is Plan N. Plan N has great rates, but you will have some cost sharing on this plan. You will have to pay co-pays, deductibles and co-insurance with Plan N.
Source: healthbrokerdave.com

Transitioning to Medicare

Once you have your Medicare in place you will quickly realize that there are gaps in the coverage that Medicare provides.  This means that people on a fixed income could be in a position where they have to deal with a large bill after an extended hospital stay or a series of out-patient services.  To help with this private insurance companies partnered with the government to provide Medicare supplemental insurance.  These Medigap plans are designed to fill the coverage gaps in Medicare Part A and Part B.  There are ten plans in all and each one covers a different number of the gaps. The same plans have been adopted by 47 of the 50 states, with the exceptions being Massachusetts, Wisconsin, and Minnesota, whom have adopted their own standardized plans. What that means is that the best Texas Medicare supplement is no better in coverage than the same California Medicare supplement.
Source: lauragibson.net

The ABCD’s of Medicare

Part D Tip: Each year since 2010, the donut hole amount has been reduced by 10%. It will continue to go down 10% each year until it disappears in 2020. Then, you will only pay your normal 25% coinsurance after you reach your deductible. Coinsurance means Medicare pays 75%, you pay 25%. Since it’s 2012, and you still have a donut hole, the government has negotiated with brand name drug manufacturers to offer 50% off some prescriptions. Check with your local pharmacy to see if the discount applies to your medications.
Source: hoopayz.com

What Is A Medicare Supplement

There are ten different Medicare supplement plans.  Each one is given a different letter.  The letters skip a few here and there because plans that were once available have been retired and the labeled the new plans with the next letter in the alphabet so as not to create confusion for people who were grandfathered in on the old plans.  The plans themselves cover a varying number of combinations of the nine different coverage gaps that were left by the coverage you get with Medicare Part A and Medicare part B.  The Gaps include: the deductible, coinsurance, first three pints of blood and hospice care from Medicare Part A, The deductible and coinsurance for Medicare Part B, skilled nursing facility care, and expenses for foreign travel emergencies. Which plan you select dictates how many or what combination of these coverage gaps are covered.  Plan A covers only four of the gaps while Plan F covers all nine.
Source: seanbrock.com

Lamar & Bob Talk Medicare Cuts and Other TN Fiscal Cliff Notes

Posted by:  :  Category: Medicare

DesJarlais, of Jasper, Tenn., was one of 234 members of his caucus who listened in on a conference call Thursday with House Speaker John Boehner of Ohio. Boehner said the House will return to work Sunday at 6:30 p.m. and remain in session in case lawmakers and President Barack Obama reach agreement on a deal to avoid more than $600 billion in tax increases and spending cuts that will otherwise take effect on Tuesday. Economists fear the combination could jar the nation’s economy back into recession.
Source: knoxnews.com

Video: Tennessee Medicare Supplement

Medicare Pay Cut Averted but Uncertainty Remains for Physicians

That increasing unreliability is already affecting physicians and patients. In Texas, for instance, the number of physicians accepting Medicare patients dropped from 78 percent in 2000, to 58 percent in 2012, according to a recent survey by Texas Medical Association. That decline in Medicare-accepting physicians would certainly have accelerated throughout the country if Congress had not delayed the SGR pay cut Tuesday.
Source: msochealth.com

Medicare agrees to cover TMS treatment for depression in TN, GA, AL

“TMS will now be available to more patients, giving them the hope of living a life free of depression,” said Burton Hills-based Dr. Scott West, who was the first local psychiatrist to acquire the TMS machine, a space-age contraption that looks similar to a dentist’s chair. West has been using TMS to treat patients since 2010. (See our September magazine story here.)
Source: nashvillepost.com

New Medicare Regulations Require Face

The Center for Medicare & Medicaid Services (“CMS”) recently published a final rule implementing several changes to policies relating to payment of physicians.  Among the changes is a new requirement that certain items of durable medical equipment (“DME”) can only be ordered after the physician, physician assistant, nurse practitioner or clinical nurse specialist has had a face-to-face encounter with the patient to evaluate the patient for the medical condition for which the DME product is needed.
Source: barrettlawofficetn.com

Tennesseans Divided Over Necessary Changes to Social Security, Medicare

"People were talking about how the government took funds out of Social Security, and they want the government to pay back into that fund so Social Security wouldn’t be on the brink of bankruptcy," said Bob Paredes, 68, of Murfreesboro. "They seemed to appreciate the fact that somebody was listening to them." Paredes is the AARP chapter president for Murfreesboro and helped collect responses.
Source: aarp.org

DownWithTyranny!: Bob Corker (R

Corker won’t have to face Tennessee voters again until 2018. He just won reelection against an anti-Choice, homophobic, bigoted fake Democrat, Mark Clayton, who even Tennessee’s Blue Dog-riven Democratic Party disavowed and urged Democrats to not vote for. Clayton only managed to pull 30% of the vote and lost every single county in the state save Democratic strongholds, Shelby (Memphis) and Haywood, even losing Davidson County (Nashville) where Democrats always win and where Obama swamped Romney. Aside from Corker winning Nashville, he racked up 80% of the vote in half a dozen counties and 82% in Bradley County: Corker- 28.179, Clayton- 5,299! That’s what happens when democracy devolves, as it has in Tennessee, to a one-party state. Corker feels like he’s in the cat bird’s seat and it makes it possible for him to cater to an extremist base and offer crazy legislation that flies right in the face of what the American people say they want– and don’t want. I’ll add one note worth pondering: in distorted DC politics, Corker is considered a “moderate” or “mainstream.”
Source: blogspot.com

Debt Ceiling Increase 1: Senator Bob Corker (R

Senators Bob Corker today voted against the debt limit bill and urged Congress to focus on reforming Medicare, Medicaid and Social Security. “I hope over the next few months the House and Senate will be able to come together and pass structural, transformative reforms to Social Security, Medicare and Medicaid that will save these programs and put our country on a path to fiscal solvency,” said Corker. “We have an obligation to older and younger Americans. Young Americans expect us to solve our fiscal issues so they aren’t saddled with debt and robbed of their opportunity for the American dream, and seniors expect us to honor the commitments we have made to them.” Read more:http://1.usa.gov/WVITfL
Source: wordpress.com

Privately Run Medicare Plans are Really Expensive

Austin Frakt draws my attention today to a new article about the administrative costs of Medicare. Exciting stuff! Long story short, Kip Sullivan of the Minnesota chapter of Physicians for a National Health Program wants everyone to understand just what’s involved in figuring out the true administrative costs of Medicare. The cost of collecting payroll taxes is one frequently overlooked element, for example. More interestingly, though, there’s a large and growing gap between the overhead calculations of the Medicare Trustees and those of the National Health Expenditure Accounts. Why is that?
Source: motherjones.com

Obama’s Medicare Drug Rebate Plan Could Save The Government Money But Also Hit Drug Industry’s Bottom Line

Posted by:  :  Category: Medicare

Deputy Administrator and Director for the Center of Medicare at CMS Jonathan Blum visits Christiana Care to speak about accountable care organizations by Christiana CareThe Associated Press/Washington Post: A Look At How Administration Says Automatic Budget Cuts Would Diminish Government Services The sequester law exempts Social Security, Medicaid, food stamps and Medicare recipients’ benefits from cuts, but most programs are vulnerable. … The National Institutes of Health would lose $1.6 billion, trimming research on cancer, drying up money for hundreds of other research projects and eliminating up 20,000 private research positions nationwide. Health departments would give 424,000 fewer tests for the AIDS virus this year. More than 373,000 seriously ill people may not receive needed mental health services (2/15).
Source: kaiserhealthnews.org

Video: Medicare Part D and Prescription Drugs

OIG Report: Medicare Part B Overpaying for Infusion Medications

OIG recommended that CMS “seek legislative change” over reimbursement policies or include the devices used with such drugs in the next round of competitive bidding. According to “RegWatch,” CMS “partially” has agreed to ask Congress to change the rules and said it will go forward with the competitive bidding suggestion (Wilson, “RegWatch,”
Source: californiahealthline.org

CMS Releases Proposed 2014 Payment Plan for Medicare Part D, Advantage

For the first time in Medicare Part D’s history, CMS would lower beneficiary’s deductibles and copays for covered prescription drugs as part of the agency’s proposed payment plan for 2014. Among other features of the proposed rule (pdf) are details regarding the health law’s 85 percent medical loss ratio requirement for Medicare Advantage and prescription drug plans. The proposed rule would also forbid plans from raising costs to members more than $30 per member per month, which is even more stringent than the previous cap of $36 per member per month. Another key element of the rule would be a new requirement on Part D pharmacies to require a beneficiary’s consent for each prescription drug delivery unless he or she personally requested the refill. That’s a move to help eliminate unwanted shipments to covered Medicare beneficiaries who could be billed for drug shipments they no longer required.
Source: beckershospitalreview.com

Medicare Drug Costs Going Down for Seniors

For the first time since the inception of the program the 2014 defined standard Part D prescription drug benefit will have lower co-payments and a lower deductible than in 2013. These costs are decreasing at the same time that coverage for Medicare beneficiaries in the Part D prescription drug coverage gap, or “donut hole” will continue to increase in 2014. As a result of the Affordable Care Act, in 2014, enrollees with liability in the donut hole will receive coverage and discounts of 52.5 percent on covered brand name drugs and 28 percent on covered generic drugs.
Source: moneytalksnews.com

Article > US health insurers’ profit cap to include prescription drugs from 2014

The MLR rules note that many insurance companies spend “a substantial portion of consumers’ premium dollars on administrative costs and profits, including executive salaries, overhead and marketing.” The ACA requires health insurers to submit data on the proportion of premium revenues spent on clinical services and quality improvement (which constitute MLR), and to issue rebates to enrolees if their spending on these benefits does not meet the minimum percentages. The proposed new rule will require Medicare Advantage and Medicare Prescription Drug plans to meet a minimum MLR from the start of next year. “Plans must spend at least 85% of revenue on clinical services, prescription drugs, quality improvements, and or/direct benefits to beneficiaries in the form of reduced Medicare premiums. Enrolled seniors and individuals with disabilities will get more value and better benefits as plans spend more on health care,” says CMS.
Source: pharmatimes.com

Medicare Open Enrollment: last chance to review and compare plans

With the holiday season upon us, it’s easy to get busy this time of year. Some pretty important tasks can get left to the last minute. One of those important tasks is ensuring you are in the right health insurance plan in Medicare.  Selecting the right plan is a personal choice, and a lot of thoughtful consideration goes into finding the right match.  But just like the holidays, those key dates come whether or not you are ready.
Source: medicare.gov

CMS Proposes Medicare Advantage, Part D Drug Plan Medical Loss Ratio Rule and Advance 2014 Rate Information : Health Industry Washington Watch

On February 15, 2013, CMS released a proposed rule implementing the ACA’s medical loss ratio (MLR) requirements for Medicare Advantage (MA) and prescription drug (Part C and Part D) plans. Under these provisions, which are intended to limit plan spending on marketing, overhead, and profit, MA organizations and Part D plan sponsors will be required to report their MLR, reflecting the percentage of contract revenue spent on clinical services, prescription drugs, quality improving activities, and direct benefits to beneficiaries in the form of reduced Part B premiums. CMS has generally aligned the Medicare MLR rules with commercial MLR regulations that went into effect January 1, 2011.  Plan sponsors that do not have an MLR of at least 85% will be subject to payment remittance; if a plan sponsor fails to meet MLR requirements for more than 3 consecutive years, it also will be subject to enrollment sanctions and, after 5 consecutive years, to contract termination. CMS expects the first year of MLR reporting to occur in 2015 for the 2014 contract year. Comments on the proposed rule will be accepted for 60 days. The official version of the proposed rule will be published in the Federal Register on February 22, 2013.
Source: healthindustrywashingtonwatch.com

Assessing Risk: Medicare Advantage vs. Medigap vs. Drug Coverage Only

As Medicare’s open enrollment season draws to a close, it’s a good bet that seniors are still sifting through all those brochures and flyers that have come in the mail the last several weeks.’  My husband received 22.’  Some used tried-and-true scare tactics that Medicare insurance sellers have relied on forever to get him to open the envelope and bite.’  Others simply designed ways to gauge his interest in hopes that a salesperson could get in the door. Under current government rules, health insurance agents must make an appointment before coming to a senior’s home.’  That’s the government’s way of protecting them from pushy salespeople making cold calls.’  The theory is that an agent who is invited in will help seniors compare plans and choose the best one; though, the ‘best’ may very likely be what helps the agent or insurance company the most.’  Flyers are mere appetizers for the main course served by an agent.’ ‘  The first solicitation from First United American blared on the envelope:’  ATTENTION: NEW 2011 MEDICARE PRESCRIPTION DRUG COVERAGE INFORMATION HAS ARRIVED.’  The next one said:’  SECOND NOTICE:’  PLEASE REVIEW MEDICARE PRESCRIPTION DRUG COVERAGE FOR 2011.’  The second notice bit, of course, was to make the envelope look like something official from the government. Both were pushing a prescription drug plan, called a PDP in Medicare-speak.’  It’s meant to be used along with an old-fashioned Medigap policy that does not cover prescription drugs.’  I spotted some scary fine print.’  It said that if you sign up for the drug benefit, your membership in a Medicare Advantage (MA) plan may end.’  No more doctor, hospital, or drug coverage from that plan.’  I wonder how many seniors missed that warning. Emblem Health sent three messages.’  Two pushed plans using scary language highlighting changes in the law to get people interested in their brand of MA plan.’  One said:’  ‘ACTION REQUIRED’ and noted that’  ‘due to the recent changes in health care legislation, you will no longer be able to switch Medicare Advantage Plans after December 31.”  Another warned my husband ‘may not have a second chance to get the right Medicare Advantage coverage,’ and urged him to get the facts to make the right choice by calling for a free Medicare decision guide.’  Another of Emblem’s solicitations contained a short survey to fill out and return.’  The company would then send along a copy of the decision guide. What was missing from most of these solicitations was real information.’  The AARP-UnitedHealthcare solicitation for Medigap policies gave the table of standard benefits and premiums for New York.’  That’s kind of helpful.’  Their solicitation for Medicare Advantage plans was more explicit.’  The envelope enticed with ‘Looking for a plan with a monthly premium starting at $0?’ ‘ The flyer for United’s MedicareComplete plan gave a brief summary of benefits: zero monthly premium, zero annual medical deductible, zero copayments for routine physicals, immunizations and preventive screenings.’  What a deal!’  But a good consumer needs to know more. First of all, the new heath law allows all of those services without copayments whether you have a Medicare Advantage plan or not, so United wasn’t offering anything special here.’  There were other caveats.’  What about staying in a network and the lack of freedom to go to any doctor?’  What about coinsurance (a percentage of a medical bill that you are required to pay) that you might have to pay: for chemotherapy drugs, for example?’  To find out more, a shopper would need to call the company, visit with a sales agent or use Medicare’s website, not a simple task. So I suggest a simple rule no matter whether you use an agent or the government website: the Medicare option you choose boils down to your risk vs. premium calculation.’  A combination Medigap policy with a stand-alone drug benefit may cost more upfront than a Medicare Advantage plan with no monthly premiums and deductibles.’  But if you are seriously ill, the combo plan may be cheaper in the end when you consider the hidden costs of an MA plan that may not be disclosed when you sign up. ‘ In our ZIP code alone there are 84 options.’  Mindboggling!’  There’s no way anyone can choose “the best” from that kind of crowd, which raises a point I have made before ‘ do we really need all that choice in health care?
Source: cfah.org

Last Chance to Disenroll from Your Medicare Private Health Plan

Beneficiaries who disenroll from their private plan may need to join a stand-alone Medicare prescription drug plan in order to maintain drug coverage. Medicare Rights advises beneficiaries who are choosing a plan to consider not only premium and copayment costs, but also whether the drugs they take are on the plan’s formulary (list of covered drugs) and whether they can use the pharmacies they prefer. Beneficiaries should also check to see whether the plan places any restrictions on the drugs they take. Restrictions can take the form of quantity limits, prior authorization and step therapy. To learn more about choosing a Medicare prescription drug plan that best meets your needs, visit Medicare Interactive.
Source: utahboomersmagazine.com

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

Posted by:  :  Category: Medicare

meds: it's obscene by fallsroadThe page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Video: Medicare Part D – the Prescription Drug Plan – is Working for Seniors

Obama’s Medicare Drug Rebate Plan Could Save The Government Money But Also Hit Drug Industry’s Bottom Line

The Associated Press/Washington Post: A Look At How Administration Says Automatic Budget Cuts Would Diminish Government Services The sequester law exempts Social Security, Medicaid, food stamps and Medicare recipients’ benefits from cuts, but most programs are vulnerable. … The National Institutes of Health would lose $1.6 billion, trimming research on cancer, drying up money for hundreds of other research projects and eliminating up 20,000 private research positions nationwide. Health departments would give 424,000 fewer tests for the AIDS virus this year. More than 373,000 seriously ill people may not receive needed mental health services (2/15).
Source: kaiserhealthnews.org

Privately Run Medicare Plans are Really Expensive

Austin Frakt draws my attention today to a new article about the administrative costs of Medicare. Exciting stuff! Long story short, Kip Sullivan of the Minnesota chapter of Physicians for a National Health Program wants everyone to understand just what’s involved in figuring out the true administrative costs of Medicare. The cost of collecting payroll taxes is one frequently overlooked element, for example. More interestingly, though, there’s a large and growing gap between the overhead calculations of the Medicare Trustees and those of the National Health Expenditure Accounts. Why is that?
Source: motherjones.com

Part D Politics: Medicare Drug Rebates or Price Controls?

While health care was barely mentioned in the recent State of the Union address, President Obama generated some interest in his proposal to cut Medicare spending by reducing “taxpayer subsidies to prescription drug companies.” That’s code for requiring pharma marketers to pay rebates on medicines provided by Medicare Part D plans to low income “dual eligibles” who previously received prescription drugs through state Medicaid plans. Savings to Medicare are calculated at about $150 billion over ten years, and many Democrats and consumer advocates think it’s a great idea.  
Source: pharmexec.com

OIG Report: Medicare Part B Overpaying for Infusion Medications

OIG recommended that CMS “seek legislative change” over reimbursement policies or include the devices used with such drugs in the next round of competitive bidding. According to “RegWatch,” CMS “partially” has agreed to ask Congress to change the rules and said it will go forward with the competitive bidding suggestion (Wilson, “RegWatch,”
Source: californiahealthline.org

Medicare Drug Costs Going Down for Seniors

For the first time since the inception of the program the 2014 defined standard Part D prescription drug benefit will have lower co-payments and a lower deductible than in 2013. These costs are decreasing at the same time that coverage for Medicare beneficiaries in the Part D prescription drug coverage gap, or “donut hole” will continue to increase in 2014. As a result of the Affordable Care Act, in 2014, enrollees with liability in the donut hole will receive coverage and discounts of 52.5 percent on covered brand name drugs and 28 percent on covered generic drugs.
Source: moneytalksnews.com

Critiquing The Medicare Part D Low

At the outset, however, it is important to note that we agree on the basic goal: a Part D program that displays effective cost containment in a very tight federal budgetary environment.  The good news is that the existing program is quite successful in this regard. Since 2007 per capita costs in Part D have grown at a compound annual rate of 1.8 percent, while costs in Part A and B have grown at 3.6 percent and 3.7 percent, respectively. The program’s negotiated rebates between large purchasers and drug manufacturers, and the ability for consumers to compare plan prices and benefits, have resulted in lower than expected Part D spending overall.  (In contrast, note that from 1990 to 2005, average annual drug cost growth in the Medicaid program was about 13.1 percent per year.)
Source: healthaffairs.org

CMS Proposes Medicare Advantage, Part D Drug Plan Medical Loss Ratio Rule and Advance 2014 Rate Information : Health Industry Washington Watch

On February 15, 2013, CMS released a proposed rule implementing the ACA’s medical loss ratio (MLR) requirements for Medicare Advantage (MA) and prescription drug (Part C and Part D) plans. Under these provisions, which are intended to limit plan spending on marketing, overhead, and profit, MA organizations and Part D plan sponsors will be required to report their MLR, reflecting the percentage of contract revenue spent on clinical services, prescription drugs, quality improving activities, and direct benefits to beneficiaries in the form of reduced Part B premiums. CMS has generally aligned the Medicare MLR rules with commercial MLR regulations that went into effect January 1, 2011.  Plan sponsors that do not have an MLR of at least 85% will be subject to payment remittance; if a plan sponsor fails to meet MLR requirements for more than 3 consecutive years, it also will be subject to enrollment sanctions and, after 5 consecutive years, to contract termination. CMS expects the first year of MLR reporting to occur in 2015 for the 2014 contract year. Comments on the proposed rule will be accepted for 60 days. The official version of the proposed rule will be published in the Federal Register on February 22, 2013.
Source: healthindustrywashingtonwatch.com

Seniors’ Medicare Costs Will Be Reduced For Medicine

“Historically low growth” in health-care spending for the nation’s 50 million Medicare beneficiaries also led to a proposed 2.2 percent reduction in payments from the federal government to private Medicare Advantage plans offered by insurers including UnitedHealth Group Inc., the agency said in a statement. About one-quarter of Medicare’s participants choose Advantage plans, which provide extra benefits such as fitness programs and eye glasses compared with the traditional program.
Source: ctwatchdog.com

Last Chance to Disenroll from Your Medicare Private Health Plan

Beneficiaries who disenroll from their private plan may need to join a stand-alone Medicare prescription drug plan in order to maintain drug coverage. Medicare Rights advises beneficiaries who are choosing a plan to consider not only premium and copayment costs, but also whether the drugs they take are on the plan’s formulary (list of covered drugs) and whether they can use the pharmacies they prefer. Beneficiaries should also check to see whether the plan places any restrictions on the drugs they take. Restrictions can take the form of quantity limits, prior authorization and step therapy. To learn more about choosing a Medicare prescription drug plan that best meets your needs, visit Medicare Interactive.
Source: utahboomersmagazine.com

Reductions in Medicare Advantage Payments: Impact on Seniors

Posted by:  :  Category: Medicare

[35]This is slightly different conceptually from the elasticities explained in elementary economics textbooks. Those elasticities are typically the “price elasticity of supply” and the “price elasticity of demand,” which measure the effect of a change in price on either supply or demand in isolation from the other. The price elasticity of demand is the ratio of the percent change in the quantity demanded to the percentage change in the price, assuming the supply function stays the same. Likewise, the elasticity of supply assumes the demand function remains unchanged. However, this study follows the example of the CMS actuary and calculates a “benchmark elasticity of enrollment,” a combined elasticity that is the ratio of the percent change in the MA benchmark to the percent change in MA enrollment. This elasticity captures both the supply effect and the demand effect. The supply effect results from lower revenue to MA plan providers, and the demand effect results from MA plans having to provide less generous benefits.
Source: heritage.org

Video: Medicare Part C Defined: Medicare Advantage Plans — UHC TV

Medicare Advantage Insurance

By definition Medicare Advantage provides all of your Part A and Part B coverage. A Medicare supplement on the other hand, fills in the gaps of original Medicare and generally pays the hospital deductible and the 20% of Part B charges that would be your responsibility.
Source: affordablemedicareplan.com

Medicare Advantage: Facts, Fallacies, And The Future

In 1997, this program was absorbed into the Medicare+Choice program as a result of the Balance Budget Act of 1997 (BBA). Medicare+Choice expanded the type of private plans available to Medicare beneficiaries and also made a series of changes in payment. While the intent was to gradually reduce payment variation across counties, the main operational effect in most counties was to limit payment increases to 2 percent annually. The BBA also added “floor”, or minimum payment levels, in rural counties. (Two years later authority for a second, and higher, “urban floor” was added.). These changes broke the link between fee-for-service (FFS) and MA payment levels in counties, and initiated changes which led to some counties being paid substantially more than FFS. The BBA also authorized the phase-in of a strengthened program of risk adjustments in rate setting that better reflected differences in the health status of enrollees in the programs. These adjustments are important since research on Medicare HMOs showed Medicare overpaying private plans by failing to adequately adjust for the health status of patients enrolled in them.
Source: healthaffairs.org

The Dilemma in Choosing A Private Fee

Whether you choose a network based plan or a private fee-for-service Medicare Advantage plan, you have enrolled in the plan for that calendar year. The plans can change from one year to the next and are not required to renew. If you have a Medicare Advantage plan it makes good sense to speak with an independent agent during your Annual Enrollment Period that runs from Nov. 15 to Dec. 31 each year to see if there is a better alternative out there. Its your right and every dollar counts so you can Retire as Planned.
Source: myplannedretirement.com

GOP Must Not Cave to the Bully on His Sequestration

But those who control the writing of history (and the other disciplines, such as economics, that have been thoroughly politicized in modern academia) have an advantage in controlling the present. Liberal academic revisionists have firmly planted in our history and economic texts the myth that FDR’s big-government policies brought us out of the Great Depression. Only recently have a number of modern historians and authors set the record straight: His policies exacerbated and prolonged the Depression. Yet Obama persists in touting his own big-government prescriptions, demanding we ignore history and his own record.
Source: townhall.com

Medicare Advantage Special Needs Plans: SNP Enrollment Grows to 1.4 Million in 2012

An expert on Medicaid, Medicare, and health reform, Kip Piper, MA, FACHE, is a consultant, speaker, and author. Kip Piper advises health plans, hospitals and health systems, states, and pharma, biotech, medical device, HIT, and investment firms. With 30 years’ experience, Kip is a senior consultant with Sellers Dorsey, top specialists in Medicaid and health reform. He is also a senior advisor with Fleishman-Hillard and TogoRun. For more, visit KipPiper.com. Follow on Twitter @KipPiper, Google +, Facebook and connect on LinkedIn.
Source: piperreport.com

The American Spectator : Obama's Latest Plan to Snooker Seniors

Except, genius, among the reasons you have a banana lodged where it must be strangling the oxygen to your brain, you are equating constitutional providing for the common defence, with unconstitutional domestic spending, unless you friggin try the liberal gambit that social security is constitutionally promoting the general welfare, in which case, how, exactly, is the general welfare promoted, exactly, by a general welfare promotion that is already actually unfunded in ponzi scheme actuality by more than $100 trillion, which means is actually unfunded in ponzi scheme actuality by more than $1 million for each and every single taxpayer already, actually, which actually unconstitutionally unsecures not only the blessings of liberty to ourselves, but unsecures the blessings of liberty to our posterity created equal that is actually endowed with actual birth, not to mention the unsecured blessings of liberty to our posterity created equal that is not actually endowed with actual birth, insanely, much less unconstitutionally forming a less perfect union, unconstitutionally unestablishing justice, and unconstitutionally uninsuring domestic tranquility, in exactly insane liberal progressive socialist tyrannical insane order, insanely.
Source: spectator.org

Study Finds Premium Support Plan Could Raise Medicare Premiums In Many Parts of Country

Posted by:  :  Category: Medicare

Newsweek Magazine (February 16, 2009) ... Lenders Add Bigger Fannie, Freddie Fee – Thanks to Payroll Tax Cut (January 15, 2012) ...item 2.. Dupuy: GOP trying to sell pyrmaid scheme to voters (September 3, 2012) ... by marsmet526The study modeled the impact of a generic version of premium support, under which beneficiaries would receive a defined subsidy, or voucher, to buy health insurance in a competitive market instead of getting a guaranteed set of benefits as Medicare has traditionally provided. That payment would be tied to the second lowest cost plan offered in an area or traditional Medicare, whichever is lower. This kind of a change is a central part of the House Republican budget written by Rep. Paul Ryan of Wisconsin, now the GOP’s vice-presidential candidate, and it has also been embraced by GOP presidential nominee Mitt Romney. Even a few Democrats have flirted with such a plan as a way to leverage market efficiency to rein in the spiraling cost of Medicare.
Source: kaiserhealthnews.org

Video: SHIIP Medicare Premiums.flv

More retirees face rise in Medicare premiums

Reader comments on sltrib.com are the opinions of the writer, not The Salt Lake Tribune. We will delete comments containing obscenities, personal attacks and inappropriate or offensive remarks. Flagrant or repeat violators will be banned. If you see an objectionable comment, click the red “Flag” link below it. See more about comments here.
Source: sltrib.com

Using FSA funds for Medicare premiums

Yes, you can pay your Medicare Part B or Part D premiums using funds from your Flexible Spending Account (FSA).   Yours is an unusual situation.  Most people who have an FSA would not need Medicare Part B and Part D, since the employer plan covers hospital services and prescription drugs. Nevertheless, it is an allowable expense.  See IRS Publication 502 for a complete list of expenses that an FSA can pay.
Source: bangordailynews.com

Obama’s Proposals For Medicare — Do They Go Far Enough? Will They Become Law?

Why has Medicare been overpaying Advantage insurers? Under the Medicare Modernization Act (MMA) of 2003 Congress agreed to pay Advantage Insurers 13% more than it would cost traditional Medicare to cover the same seniors.  Since then research has shown that seniors themselves didn’t believe that Advantage is worth the premium.  A 2009 study published in the International Journal of Health Care Finance and Economics reveals that, when Advantage beneficiaries were asked how much they would pay, out of their own pocket, for the benefits provided by their insurer, they estimated the value of those benefits at just 14 cents for every extra dollar that Medicare was paying. The Incidental Economist’s Austin Frakt, a coauthor of the report, concluded: “This relatively poor return of value on taxpayer dollars is why I support reductions in Advantage payments.”
Source: healthbeatblog.com

Medicare Premiums Could Rise for Many Retirees

Both sides agree on expanding a current, little-known law so more retirees considered well-off by the government are required to pay higher premiums for outpatient and prescription coverage. That would raise $20 billion or more over 10 years.
Source: kolotv.com

Medicare Premiums – Beware of Deceptive E

As is always the case in an election year, hot topics are regularly used as canon fodder. One such hot topic is Medicare. The deceptive letter below is making the rounds via e-mail on the letterhead of Blue Cross of Alabama, appearing official until you notice the political commentary. The information in the e-mail regarding premium increase to Medicare part B is 
Source: ostdiek.co

Understanding Paul Ryan’s Medicare reform plan in three minutes

The federal government will determine the minimum level of benefits that all plans must offer. The premium-support payment is capped at the growth of GDP, plus 0.5 percent. The subsidy will be adjusted based on the income level of the consumer.
Source: constitutioncenter.org

OIG Report: Medicare Part B Overpaying for Infusion Medications

OIG recommended that CMS “seek legislative change” over reimbursement policies or include the devices used with such drugs in the next round of competitive bidding. According to “RegWatch,” CMS “partially” has agreed to ask Congress to change the rules and said it will go forward with the competitive bidding suggestion (Wilson, “RegWatch,”
Source: californiahealthline.org

Poll: Americans Overwhelmingly Oppose Raising the Medicare Retirement Age

Posted by:  :  Category: Medicare

Hopefully the combination of the idea being both unpopular and unsound will prevent it from being part of any fiscal cliff deal, but the fact that the idea is still being discussed is a perfect symbol of what is wrong with the current dialog in Washington. Politicians promoting bad and unpopular ideas are treated as serious thinkers instead of psychopaths, because advocating for needlessly hurting poor people is somehow seen as a badge of courage.
Source: firedoglake.com

Video: Touchstone Health HMO 2013 Commercial – Rudy Rubano

AIDS Healthcare Foundation

As a result and on the heels of a recent pricing agreement on Gilead’s new four-in-one AIDS tablet that was reached with the ADAP Crisis Task Force (ACTF) of the National Alliance of State & Territorial AIDS Directors (NASTAD) on behalf of the nation’s hard-hit network of AIDS Drug Assistance Programs (ADAPs), officials from AHF pressed Gilead to similarly lower the price for Medicaid, Medicare, private insurers and other payors that otherwise face Gilead’s steep price tag for the new medication. AHF officials also sent letters to private insurers and state health department directors nationwide urging that those programs exclude Stribild from their drug formularies if the drug was not priced price-neutral to Atripla. On September 14, 2012, Janet Zachary-Elkind, Deputy Director, Division of Program Development & Management for the New York State Department of Health responded via letter noting that, “At this time, Stribild is not covered by the Medicaid program,” and that the state is also, “…evaluating coverage options and possible prior authorization requirements to ensure the product is utilized in a medically appropriate and cost effective manner…”
Source: aidshealth.org

Schneiderman catches top NYC hospital overbilling Medicare and Medicaid

According to the Complaints and Settlements filed in this case, the hospital double-dipped by billing New York and the federal government for psychiatric services provided by its physicians.  St. Luke’s-Roosevelt billed out-patient psychiatric services to Medicaid as a rate-based service, which included the care provided by the physician and all other related costs. At the same time, SLR billed the state and federal governments on a fee-for-service basis for the same care provided by the physician. Also, St. Luke’s-Roosevelt sought and received reimbursement from Medicare for non-reimbursable costs for outpatient psychiatric visits. As a result, the Hospital received Medicare and Medicaid payments that it was not entitled to receive.
Source: seniorlivingcare.com

Making the Election About Race

The result is a campaign run at two levels. On the trail, Paul Ryan argues that “we’re going to make this about ideas. We’re going to make this about a positive vision for the future.” On television and the Internet, however, the Romney campaign is clearly determined “to make this about” race, in the tradition of the notorious 1988 Republican Willie Horton ad, which described the rape of a white woman by a convicted African-American murderer released on furlough from a Massachusetts prison during the gubernatorial administration of Michael Dukakis and Jesse Helms’s equally infamous “White Hands” commercial, which depicted a white job applicant who “needed that job” but was rejected because “they had to give it to a minority.”
Source: nytimes.com

The Poor Get Poorer: The Fate of Distressed Hospitals Under the Affordable Care Act

 This Hospital Value Based Purchasing Program (“VBP Program”) requires that hospitals measure performance in clinical areas while monitoring patient satisfaction in others through Hospital Consumer Assessment of Healthcare Providers and Systems (“HCAHPs”) surveys, among others. These surveys obtain feedback on how a patient perceives the hospital’s services and whether the patient would recommend the hospital to a friend or family member. While these surveys make up only 30% of the Total Performance Score under the VBP Program, the other 70% comes from the ways in which a hospital scores on its Clinical Process of Care criteria, including those in such areas as acute myocardial infarction, heart failure, pneumonia and surgical care improvement. These patient satisfaction surveys will typically be conducted by private companies either by telephone or mail, and will ask patients to rank the hospital in eight separate areas of their experience (including communication with nurses and doctors, pain management and cleanliness). Medicare will withhold one percent (1%) of its reimbursements to hospitals in 2012 (rising to two percent (2%) in 2016), but hospitals that perform poorly will not be entitled to any of the bonus pools created by the holdback of the one percent. For hospitals that treat primarily poor and elderly patients and lack the resources to invest in infrastructure, obtaining high marks under the VBP Program may prove elusive, if not impossible. For example, financially distressed hospitals frequently are forced to curtail capital improvements, leading to a deteriorating physical plant. Patients treated in an older, less attractive facility may rank the quality of care as lower, even if it is not. Thus, financially distressed hospitals may have a hard time obtaining scores that would result in additional funding under the bonus pool, and may even face a permanent reduction without much hope of participating in the bonus pool.
Source: garnerhealthcare.com