While much of America was watching the New York Mets and Kansas City Royals battle it out for 14 long innings Tuesday night, House Republican leadership and the White House were battling out a budget compromise.
The agreement still must be approved by the full House and the Senate. Update: The House passed the bill with a 266 to 167 vote late Wednesday and the Senate approved it on Friday.
The bill funds federal government for the next two years and avoids a potential government shutdown. The deal plugs an impending hole in the Social Security disability trust fund. Without it, millions getting disability would have seen their benefits significantly cut. It also staves off a potentially historic increase in Medicare for Part B premiums for about 15 million beneficiaries.
The Medicare provision stalls a scheduled cut to the rates doctors get paid under Medicare by law for three months. Legislators hope to come up with a permanent fix to slow Medicare costs. Continue reading
This week marks the start of Medicare’s open enrollment period, when beneficiaries can shop for a Medicare Advantage (MA) or Prescription Drug Plan (PDP) for 2016. Open enrollment happens every year from Oct. 15 through Dec. 7.
The Centers for Medicare & Medicaid Services is encouraging people with Medicare to check whether they’re getting the best price and quality plan available based on their current and anticipated health needs. Continue reading
Some low-income seniors who qualify for both Medicare and Medicaid — the dual eligibles — have the chance to age in place in their communities thanks to Medicaid’s coverage of long term services and supports (LTSS). This is especially important for older adults who are juggling multiple chronic conditions and may require help with activities of daily living, like bathing, dressing, or eating.
This is a population at high risk for needing expensive institutional care, and is not the preferred site of care for most people. Community-based LTSS avoids institutionalizing many older adults and is a more cost-effective solution to the growing aging population. Continue reading
The job of a journalist is to seek the truth and report it. To provide comprehensive and fair accounts of issues. This mantra is written into the codes of ethics of journalism organizations worldwide.
However, when government officials throw up roadblocks, refuse to answer basic questions, and rely on excuses to thwart legitimate investigations into policy, presenting the whole truth to the public is nearly impossible. When requests for documents under the Freedom of Information Act are ignored, or responses delayed indefinitely, then it may be time to start filing legal challenges.
Such was the case with the Center for Public Integrity’s investigation into Medicare Advantage plans. Reporters tried for months to speak on the record with officials at CMS about the program’s financial probes and other oversight issues. CPI eventually filed Freedom of Information Act requests to get supporting documentation.
When CMS failed to respond after a year, CPI sued. Is this the only way to get government and other public organizations to open up their records? According to this tip sheet from Fred Schulte, it depends.
Quality measures are good, right? We all want our doctors and hospitals to follow best practices and be held to them.
It’s not so simple.
Put aside for the moment whether the measure is accurate – we don’t always know or agree on what the best thing is in health care (Exhibit A: mammograms).
There’s another quality problem.
There too many quality measures. Oodles and oodles of quality measures. Continue reading
Earlier this month, the federal Centers for Medicare & Medicaid Services proposed a five-year bundled-payment test program for hip and knee replacement surgeries.
At the time, CMS said its Comprehensive Care for Joint Replacement (CCJR) program would require 800 hospitals in 75 areas to test bundled payments for most of the 100,000 hip and knee surgeries that Medicare covers annually.
The proposal, which we covered here, would allow CMS to eliminate some of the widespread variation in costs and offer one more way for the Obama administration to squeeze out fee-for-service reimbursement by transforming payment from volume to value, CMS said. Continue reading
The 50th anniversary of Medicare and Medicaid is July 30.
Over the years, these programs have evolved from basic safety nets to comprehensive care models designed to improve quality and offer affordable health care for millions. According to the Centers for Medicare and Medicaid Services, about 55 million Americans have Medicare this year and more than 70 million have Medicaid in any given month
Bob Rosenblatt, a veteran at reporting on issues around aging, has put together a tip sheet with background on the Medicare program and some things to consider as you plan coverage of the anniversary. It includes story ideas and useful links as well as contact information for sources.
In the wake of last month’s Supreme Court ruling on marriage, same-sex married couples in all 50 states should now qualify for financial protection against impoverishment under Medicaid if one of them goes into a nursing home.
Before the high court’s decision, spousal financial protection rules were unavailable to same-sex couples if their state of residence did not recognize their marriage. With a semi-private room in a nursing home costing $80,000 a year, many couples can easily wipe out all their assets without such protection. Continue reading
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