Medicare pays doctors and other providers virtually everywhere in the United States, amounting to more than $70 billion in 2013 alone. The money goes for medical exams, X-rays, injections and a host of other treatments and procedures.
The Centers for Medicare and Medicaid Services just released detailed payment data covering 2013. Until 2014, that information was kept secret for 35 years. That year, CMS released detailed payment data covering 2012. Now, health reporters can examine how those public funds have been spent over two years. Continue reading
Photo by Truthout.org via flickr.
When health policy experts talk about ways to improve how Medicare and commercial health plans pay for care, they often recommend eliminating what’s called the site-of-service payment differential.
This differential allows hospitals to charge more than physicians can charge for doing the same service, in part because hospitals have more overhead.
For patients, the difference can affect whether a copayment is low if care is delivered in a doctor’s office or high if the service is done in a hospital. Continue reading
President Obama signed the Medicare Access and CHIP Reauthorization Act of 2015 into law on Thursday afternoon, in what experts say could be the most significant change in Medicare’s 50-year history.
The law, part of a bipartisan deal to eliminate the Sustainable Growth Rate (SGR) formula that Congress had used to set physician payment rates under Medicare, shifts the 50-year-old program away from a fee-for-service model and moves physicians into value-based payment.
Earlier this week the U.S. Senate passed the Medicare Access and CHIP Reauthorization Act of 2015 by a vote of 92 to 8. Last month, the House passed its version of the bill by 392-37. Continue reading
After voting to eliminate the Sustainable Growth Rate (SGR) formula last week, the U.S. House of Representatives sent the measure to the U.S. Senate where the bill’s fate is uncertain. When the Senate recessed on Friday without considering the bill, H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015, it pushed off a vote until mid-April.
The bill’s supporters were hoping for a Senate vote last week because, as Jennifer Haberkorn, of Politico Pro, and Mary Agnes Carey explained for Kaiser Health News, the Senate’s return date of April 13 leaves two weeks for those who like the bill and those who don’t to gather support and consider their options.
“Traditionally in Washington, the more time you have, the more opportunity there is for opposition to fester. That should be a concern in this case because it is two weeks before the Senate returns,” Haberkorn said. Continue reading
The U.S. House of Representatives passed H.R. 2 on Thursday, a bill that would prevent an automatic cut of 21 percent in Medicare payments to physicians and would require seniors to pay more in the form of higher copayments and premiums. The Medicare Access and CHIP Reauthorization Act of 2015 also would extend the Children’s Health Insurance Program (CHIP) for two years through 2017.
The vote was hailed as a step forward for physicians because it eliminates the formula Congress has used for many years to increase payments to physicians. That formula, called the sustainable growth rate (SGR), was renegotiated annually and usually at the last minute. It’s been replaced with an annual payment increase of 0.5 percent. The vote was 392 to 37, including 212 Republicans and 180 Democrats voting in favor, according to Govtrack.us.
The strong support from both Republicans and Democrats puts pressure on the U.S. Senate to approve the bill, before Congress adjourns on Friday, Paul Demko wrote in Modern Healthcare. Continue reading
Finally, we may be seeing the beginning of the end of fee-for-service payment.
In an announcement Monday, the federal Department of Health and Human Services set two goals for changing how Medicare will pay for care, making the most significant change in payment in its 50-year history. First, HHS Secretary Sylvia Mathews Burwell said that next year, 30 percent of all payment to Medicare providers would be in alternative payment programs that reward hospitals and physicians for how well they care for patients rather than how much care they provide.
By 2018, 50 percent of payments would go into alternative payment programs, such as accountable care organizations, patient-centered medical homes and bundled payments, she wrote.
“In alternative payment models, providers are accountable for the quality and cost of care for the people and populations they serve, moving away from the old way of doing things, which amounted to, ‘the more you do, the more you get paid,’” Burwell added. Continue reading
A secretive committee of the American Medical Association exaggerates how much physician time and effort is involved in performing many medical procedures, according to an analysis of the committee’s work by journalists at The Washington Post.
That exaggeration skews payment in favor or physician specialists and at the expense of primary care physicians, according to the article by the Post’s Dan Keating (@dtkeating) and Peter Whoriskey (@PeterWhoriskey).
The claim that the committee overstates the time involved to do many procedures has been reported previously. What is unusual about Keating and Whoriskey’s analysis of the AMA’s 31-member Relative Value Update Committee is that they calculated the committee’s estimates of the time involved for physicians to do many procedures and found the numbers to be off by as much as 100 percent in favor of specialist physicians. Continue reading
One of the high-profile programs within the Affordable Care Act is the drive to reduce preventable hospital readmissions among the Medicare population. The program focuses on fee-for-service patients who came back to the hospital within 30 days. Hospitals in the third year of the program face a fine of up to 3 percent of their Medicare payments. Kaiser Health News analyzed the most recent CMS hospital data, and found more than 2,600 hospitals faced penalties in the last round and could lose $400 million.
Reducing unnecessary hospitalizations is a good idea, pretty much a slam-dunk quality move.
But is the readmissions program using the right metrics? Are hospitals that are doing all the right things cutting both readmissions and admissions – and therefore facing penalties because the proportion isn’t dropping, the readmission rate is the same share of the total admissions? Some new research suggests that may be the case. As Joanne Lynn, M.D., a geriatrician and prominent health policy researcher put it (and I’m paraphrasing), it’s the denominator, stupid. Continue reading
Compared with other industrialized nations, patients age 65 or older in the U.S. are generally in poorer overall health and have more challenges paying out-of-pocket expenses than their counterparts in other industrialized nations, according to a new study in the November 2014 issue of Health Affairs. (Remember, AHCJ members get free access to Health Affairs.)
Older adults in 11 nations – Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States – were asked by telephone about their health and health care delivery. Among the 15,617 adults, age 65 or older, who participated in the 2014 Commonwealth Fund International Health Policy Survey of Older Adults, 20 percent of respondents in every country except France reported problems with care coordination. Access to primary care was most challenging in Canada, the U.S., and Sweden. Continue reading
Medicare season is here, and consumers – your readers, viewers and listeners – need lots of help in making their choices.
Open enrollment begins Oct. 15 for the 49 million Americans on Medicare, and ends Dec. 7. This is the time when they can change the way they receive their health benefits, for coverage starting Jan. 1, 2015.
The choices are:
- Traditional Medicare, in which patients can get care from any doctor or hospital participating in the Medicare program. Beneficiaries pay for Part B, which covers doctors’ care, and Part D, which covers prescription drugs. Most people with this coverage also choose Medi-gap, a supplemental coverage which fills in some of the extra costs you may have. HHS just announced the Part B premiums for 2015.
- Medicare Advantage Plan, also known as a Part C plan. This is one-stop shopping, in which consumers pay a fee and get care, staying within a network of doctors and hospitals operated by the plan. In return for using the network, they may get some extra benefits, such as drugs, eyeglasses, and perhaps even a gym membership.