Tag Archives: medicare

New legislation may improve advance care planning

Sen. Mark R. Warner (D-VA)

Journalists may want to keep an eye on new companion bills recently introduced in the House and Senate. The legislation would expand access to critical advance planning services in Medicare and allow people with serious illness to access more advance care planning services.

The Improving Access to Advance Care Planning Act would allow social workers to provide advance care planning (ACP) services, remove beneficiary cost-sharing, promote increased education for providers on current ACP codes, and improve reporting on barriers to providing ACP services and billing the corresponding codes. The bill was introduced in the Senate by Mark R. Warner (D-VA) and Susan Collins (R-ME) and in the House by Rep. Earl Blumenauer (D-OR).

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Inflation Reduction Act will benefit millions of older adults

Photo by RODNAE Productions from via pexels.

Millions of older adults will soon benefit from lower prescription drug prices and a cap on out-of-pocket costs thanks to landmark legislation signed into law by President Biden today. Continue reading

Advocates, hospitals at odds about CMS plan to suppress a patient-safety score

Photo by Pixabay via pexels.

Federal officials intend to give hospitals a break in quality scoring due to pandemic strains, by halting reporting of a measure known as the PSI 90 score. Patient-safety and business groups are fighting this plan, arguing it would erode quality of care.

Journalists may find good stories in looking at this battle over a quality measurement that pits Medicare and hospitals against patient-safety and employer groups.

The American Hospital Association (AHA) and the Federation of American Hospitals supported this proposal, which was one of myriad policy changes included in Medicare’s draft fiscal year 2023 rule on payments for inpatient services. They agree with Medicare officials who said they feared the effects of the pandemic might result in distorted results that might prove unfair to hospitals that served many people at highest risk from COVID-19.

Opposition to PSI 90 proposal

Among the leaders of the opposition to the PSI 90 proposal is nonprofit Leapfrog Group. Founded in 2000 by business organizations, Leapfrog has become a major force in lobbying for greater transparency about the quality and cost of health care.

“Suppressing PSI 90 would be a giant leap backward in patient safety and transparency, literally life-threatening, and an outrageous violation of the trust Americans place in the Medicare program,” wrote Leah Binder, M.A., M.G.A., chief executive officer of Leapfrog Group, in a June 17 comment letter to the Centers for Medicare and Medicaid Services (CMS).

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Hospitals, HHS each scored a win and a loss in recent Supreme Court cases

Photo by Geoff Livingston via Flickr.

Amid issuing some of the most significant rulings this century, the U.S. Supreme Court (SCOTUS) also decided on two cases where certain hospitals challenged federal decisions that cost them money. 

Hospitals scored one win and one loss in these cases. Both cases involved Department of Health and Humans Services (HHS) policies created under Republican presidents that the Biden administration sought to defend. 

In Health and Human Services Secretary (HHS) Becerra v. Empire Health Foundation, the Supreme Court split 5-4 in a June 24 decision about a calculation used to decide which hospitals qualify for extra pay for serving many people with low incomes. The Supreme Court found in favor of HHS in this case, disappointing hospital groups.

On June 15 in the American Hospital Association (AHA) v. Becerra case, the Court said in a unanimous decision that HHS erred in the administrative procedures in cutting reimbursement on certain drugs. In this case, the Biden administration had defended a Trump administration bid to compel hospitals to share certain savings they get on medicines with Medicare and people enrolled in the program.

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New tip sheet urges journalists to advise Medicare members about the best plans to meet their needs

Trudy Lieberman

Every day, some 10,000 Americans become eligible for Medicare, a rate that’s projected to continue for the next 18 years, as the Federal Reserve Bank of St. Louis estimated in 2019.

For health care journalists, these startling numbers mean we have an important role to advise seniors on the best plans to meet their needs during Medicare’s annual open enrollment (Oct. 15 through Dec. 7). Our advisory role seems to become more important every year as costs rise and because we need to counteract the messages seniors get in the annoyingly frequent advertisements for Medicare Advantage (MA) plans.

Medicare open enrollment

During Medicare’s open enrollment period, seniors face a dizzying array of choices about whether to choose traditional Medicare or a MA plan or if they should add a Medicare Part D prescription drug plan.

So much advertising and reporting are devoted to MA and Part D plans that the more comprehensive coverage available to seniors through Medicare Supplement plans (also called Medigap) gets all but drowned out.

In a new tip sheet, health care journalist and former AHCJ president Trudy Lieberman (@Trudy_Lieberman) explains why reporters covering health care for seniors should write about the benefits of Medigap plans.

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