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After December 31, 2010 a new health law goes into effect prohibiting physician-owned hospitals opening after that day from taking part in Medicare and other federal health programs. Whereas 30 hospitals are expected to open before the deadline, 44 will be unable to open in time; and, in some cases doctors will have to sell their stakes in order to open. Not only are there restrictions on the hospitals being built, but also on expansions. Some conditions that will be considered for new or expanding physician-owned hospitals are that the hospital is located in a state with a shortage of hospital beds, in a county that is showing growth 50% faster than the rest of the state, or seeing more Medicaid patient than other hospitals in their county. It has been suggested that very few hospitals will be able to meet these requirements. This new law stems from non-profit community hospitals and for-profit institutions without physician investors believing physician-owned hospitals are taking all of the lucrative outpatient surgery. In 2003 there was a moratorium placed on the construction of physician hospitals that lasted until August 2006; and, denying access to Medicare and federal health program funding is the newest attempt to suppress physician-owned hospitals.

Democrats' Projected Bad Election Year

A poor performance by Democratic Party members is expected due to the party's signature health care law, even in states that have voted Democratic predominately. A Battleground Poll shows that 54% of people are opposed to the health care law with 40% of those are strongly opposed, some favoring a repeal of the law. Participants polled by the National Republican Congressional Committee said the issue affecting their vote against the current member of Congress in their district was health care, surprisingly over the economy and jobs. The focus on health care by the administration came at the worst possible time and midterm election projections show Democrats who voted for the law not doing well at all. Especially the Democrats who voted as the decisive margin - the Stupak bloc - who are currently most at risk. The health care law is affecting both House and Senate Democratic members and the White House needs to address the opposition to the law. Or, they need to at least prepare for it, as Republicans elected plan to repeal at least part of the legislation when and if they are elected into office this November.

Paul Ryan's Generation of Conservative Leaders

Republican Paul Ryan, Wisconsin, wrote the book Young Guns: A New Generation of Conservative Leaders with Eric Cantor of Virginia and Kevin McCarthy of California, also Republicans in the House of Representatives. Ryan explains that Medicare is not supported well and needs help in order to continue its existence. In the book, the authors propose that those 55 or older will get Medicare as it is today, but for everyone else Medicare will start at 69 1/2. In their plan, a Medicare payment for the purchase of private health coverage would be distributed. To start the vouchers would cover $11,000 and they would increase with inflation. If beneficiaries have any money left at the end of the year, it will go into a medical savings or go toward long-term care insurance. Additionally, the payment amount would also depend on income, health status, and initially region with those earning under $80,000 a year receiving the full benefits. The midterm reelection gives them position to propose their ideas, if Republicans get control of the House, and protesters set up rallies to warn seniors about these issues before they vote.

November is Around the Corner

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Sources: KHN, USA Today, The Hill, National Journal

Medicare's chief actuary, Rick Foster, projects the new Health Care law savings of $575 comes from slowing the increase in fees paid to hospitals, home health agencies, and reducing payments to private Medicare Advantage plans. The new Health Care law does slow the growth of Medicare; but, does not cut spending from year to year over the next decade. In fact, no benefits under traditional Medicare will be eliminated and some will be added. The biggest impact will be on the roughly 24% of seniors on Medicare Advantage who will see extra benefits on their plan eliminated and some plans shut down all together. Seniors are concerned about finding new doctors, if and when they have to, and some doctors are refusing new Medicare patients because Medicare doesn't pay enough. Plus, a 1997 law beginning December 1, reduces doctors' Medicare payments even more causing concern. The law also adds new benefits to Medicare including free preventive screenings and $250 rebates to those seniors who hit the "doughnut hole" of prescription drug coverage and the changes will keep the Medicare hospital trust fun afloat until 2029, which is twelve years longer than projected without the law. Most speculate that Congress will postpone these law from going into effect.

Choices in Medicare Advantage Plans Equal Less Confusion

In 2011, Medicare Advantage premiums and Medicare Part D prescription drug packages will rise approximately 5% from 2010. One reason for the rise in cost is that there will be fewer options in Medicare Advantage. Some senior advocates say seniors were confused in the past by too many options and therefore some ended up making ill-informed decisions out of frustration. Joe Baker, president of the Medicare Rights Center says "People still have good choices, but they also have less choice, which makes it easier to choose." With the lowest cost prescription drug plan being offered from Humana and Wal-Mart Preferred RX, Baker also warns not to be too swayed by price and to make sure all drugs are covered on the approved list with no restrictions. Seniors have from November 15th to December 31st to decide on a new plan.

Forethought® Medicare Supplement Product Release

This week, the Forethought® Medicare Supplement product was released in Iowa, Louisiana, Mississippi, Ohio, Oklahoma, South Carolina, and West Virginia. Forethought Benefits Include:

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• Commissions Paid Weekly
• 9 - month advancing
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Mutual of Omaha offers Seminar Packages

Just in time for Annual Enrollment, Mutual of Omaha is offering a point-of-sale seminar package including a PowerPoint presentation, speaker notes, and an invitation flyer or postcard to send to invite perspective attendees. States that have already approved the package include AR, AZ, CT, DC, GA, HI, IA, IL, IN, KS, KY, LA, MI, MN, MO, MS, NC, NE, NJ, NV, NY, OH, OK, OR, RI, SC, SD, TN, UT, VA, VT, WI, and WV, with new states being approved continuously. The seminar package was created to help attract and educate groups of new prospects about the advantages of owning a Medicare Supplement, reasons to own a Mutual of Omaha Medicare Supplement, and a brief history of Mutual of Omaha. Materials are currently available under your Sales and Professional Access (SPA) account at Mutual of Omaha in the Forms and Materials section. For more information about getting contracted to sell Mutual of Omaha Medicare Supplement, click here.

Sources: KHN, The Washington Post, The Tennessean, Mutual of Omaha

The largest single operation fraud in Medicare's history was lead by an Armenian crime boss, called a "vor," named Armen Kazarian where fake health care clinics and identity theft were used to cheat Medicare out of $163 million. Compared to a fraud franchise, Armen Kazarian and his co-conspirators are currently in custody and charged with racketeering conspiracy, bank fraud, money laundering, and identity theft. The investigation began when 2,900 Medicare patients in New York reported their information stolen; and, it was later discovered that the defendants had also stolen the identities of over 100 doctors in 25 states. The defendants created false clinics and phony paperwork that had doctors performing procedures outside of their specialties, raising flags. However unlike previous scams by others, when patients were bribed to sign up for procedures they did not need, these scams never directly involved patients or doctors. They were the result of stolen identities and false paper work; and, in New York alone, $100 million in fraudulent bills were submitted and Medicare paid out approximately $35 million to the scammers.

Medicare Cuts Costs of Medical Equipment

On January 1, 2011 the first of the baby boomer generation will begin qualifying for Medicare. In preparation of this sergeant of new people claiming benefits, Medicare will begin cutting the prices it will pay for some wheelchairs, oxygen concentrators, and other medical equipment by 30%. Beginning in the Inland Empire of California; as well as, Miami, Orlando, Charlotte, Pittsburgh, Cincinnati, Cleveland, Dallas-Fort Worth, and Kansas City, MO, this plan will not only lower the cost for American taxpayers but the Medicare recipient as well, with anticipated savings of $17 billion over the next 10 years. Counteracting the huge increase of health costs, the new plan will require companies to bid for the right to sell this medical equipment through Medicare in order to combat inflated prices and fraud. Bidding began last year, the list of winners will be released soon, and Medicare officials say the plan includes 48% small business. However, critics point out problems with this plan such as lack of binding commitments, the use of composite bids, flawed pricing, and a lack of transparency. Also, the critics fear that product supply and service will go down with the influx of new business. Some even wonder if the plan will really launch January 1st.

Medicare and Advanced Cancer

In a study conducted by Camelia S. Sima, M.D., M.S., of Memorial Sloan-Kettering Cancer Center, New York on 87,736 Medicare beneficiaries with advanced cancer, her findings revealed that screenings on advanced cancer patients with less than 2 years life expectancy serves no meaningful benefit. Thus, her study suggests Medicare deny coverage for those patient's screenings. Cancer screening's primary purpose is the early detection of cancer, and this process has resulted in the decline in deaths from cancer. However, in advanced cancer, screenings can lead to over diagnosis and causing unnecessary risk due to testing, biopsies, not to mention psychological distress. The study found that screenings were more common with patients who had a history of screening at regular intervals, since the use of electronic medical records that set reminders for procedures. Sima concluded that in limited life expectancy from advanced cancer, screenings were not found useful and therefore Medicare might not provide coverage for the procedure in those patients.

PSM on Facebook

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Sources: The Associated Press, Redland's Daily Facts, Senior Journal

With the number of people aging and the continual rise in health care costs, our Nation's health-care obligations are becoming increasingly harder to meet. Federal Reserve Chairmen Ben Bernanke projects that Medicare and Medicaid needs will double our national income within the next twenty-five years. Social Security, too, will be strained as less people enter the work force than those ready to receive their benefits. Bernanke calls US public finances an "unsustainable path" but understands cutting spending on Medicare and Social Security would be very unpopular with the American public. He offers no new ideas on reducing spending, leaving those decisions to elected officials. However, he warns that underestimating these challenges would be detrimental to our economic future.

Woodmen of the World Plan N Released in Select States

On Wednesday, Woodmen of the World/Assured Life Plan N was released in Iowa, Arkansas, Alabama, Washington, Utah, Montana, Idaho, West Virginia, Texas, and Oklahoma. Also released was the news of expansions to California, Colorado, Mississippi, and Tennessee. With benefits like excellent commissions, 12 month advancement, competitive premiums, and liberal underwriting - don't miss the opportunity to add this excellent product to your senior portfolio. Click Here for more information.

Cost-Effective Medicare Reimbursement Rates

With the constant need to control the growth of Medicare spending, two policy experts have proposed that new treatments should be studied and then given a monetary value based on whether they are superior, comparable, or inferior to treatments already available. Currently, the national health reform law has created the Patient-Centered Outcomes Research Institute (PCORI) to advise and set guidelines for federal agencies on effective research and on funding research. The PCORI panel consists of a majority of physicians who study new treatments and give ratings, but cannot make decisions based on cost. The policy experts suggest rewarding treatments with the highest outcomes with the most funding and then reevaluating the treatment after three years for continued funding. They believe that limiting spending to three years will not only force manufacturers and clinicians to continue research on the treatments but to prioritize products that will have the most effect and positive outcome.

Seniors face Medicare Advantage Plans Eliminated and Automatically Enrolled

Representative Republicans Dave Camp (MI) and Wally Herger (CA) are calling into question the Centers for Medicare and Medicaid's (CMS) decision to eliminate some Medicare Advantage drug plans, which will affect approximately 3 million seniors and automatically enroll 1.5 million of those seniors into a new plan, costing 15% more in premiums alone. In a letter to the Health and Human Services Secretary Kathleen Sebelius, the Republicans questioned the decision to terminate another plan which has nearly one-half million beneficiaries enrolled, raise 600,000 premiums by 45%, increase monthly premiums in the top 10 Part D plans by 10% next year, and eliminate prescription drug plans. They also requested that the Centers for Medicare and Medicaid provide all of the analysis used to determine the impact on their decisions, so Congress can protect seniors from these decisions in the future.

More News for Medicare Advantage Plan Cuts

President Barack Obama's famous quote, "If you like your health plan, you can keep it" is coming under scrutiny after news of drastic Medicare Advantage plan cuts, from 14.8 million to 7.4 million by 2017; with approximately 70% of the cuts in this plan hitting low-income seniors and the disabled. Those who remain in Medicare Advantage afterwards will receive less generous benefits. Medicare Advantage benchmarks under the new formula will be determined by a fixed percentage based on the average fee-for-service (FFS) spending in each county; and, lower percentages will be applied to the counties with a higher FFS spending. A study shows that nearly every single county will have lower benchmarks, forcing beneficiaries to face cuts and some plans will pull out of the market completely.

Sources: Human Events, Right Side News, KHN, MedPage, The Wall Street Journal Health Blog, The Fiscal Times, American Medical News, Dow Jones Newswire, The Associated Press

Richard Ybarra Signing Off: I just wanted to say farewell to all of you. It has been both an honor and a pleasure to have managed the Web presence for PSM over the past two years. I enjoyed writing this blog each week and watching its readership greatly expand. Your comments have always been interesting to read, and I encourage you to continue to participate. I wish all of you great success in your endeavors. Here is the first blog post from my successor Lauren Hidalgo:

Campaign Fear Themes: Medicare vs. Social Security

Democrats and Republicans have begun the battle for votes from older voters who consistently turn out for midterm elections. Republicans say Democrats will cut Medicare by $500 billion and Democrats say Republicans plan to cut Social Security. Thus, forcing voters to choose between either potentially losing their health care or losing their financial support. Each party denies the allegations yet continues to invest millions of dollars into advertisements, hoping to sway voters with fear tactics. In the 2006 election 30% of voters were 60 and over and that number continues to grow.  Therefore, their loyalties will continue to be pursued.

New Required Checks for Medicare

A new anti-fraud law, proposed Monday, will require Medicare to verify claims first, acting more like a credit card company and flagging suspicious bills. This proposed law could limit wasteful government health care spending and save taxpayers billions of dollars a year. Sen. George LeMieux, a Republican from Florida, sponsored the bill because he is tired of seeing unnecessary, or false, service charges and then having to chase the culprit to recoup a fraction of the money lost. He estimates the cost to implement the technology for this program, which would process claims for both hospitalization and outpatient services, would cost $930 million over the next decade but the anticipated savings would far exceed the expense.

New Center for Medicare and Medicaid Innovation Chief

On Monday, Dr. Richard Gilfillan's appointment as acting director of the Center for Medicare and Medicaid Innovation became public. He has experience as the former president and chief executive officer of Geisinger Health System; as well as, executive vice president of insurance operations for Geisinger Health System, which is a based in Pennsylvania integrated health system that is often a model of how be cost effective in Medicare. During the 2008 election, Gilfillan contributed the maximum allowed $2,300 to President Obama's campaign.

Examining Health Reform's Effect on Medicare Advantage

On Monday, four Senate Republicans asked the top Medicare accountant to release the results of his analysis of health reform's impending effect; as well as, a breakdown of the impact based on "rural versus urban areas" and "an estimate of how much less [MA] plans will be able to spend per member per month on reduced cost-sharing and extra benefits" on the Medicare Advantage program. They fear the new cuts to Medicare Advantage may cause some plans to fold while still others will be forced to drop benefits in order to stay profitable. This comes just a week after Obama released estimates that Medicare Advantage is projected to jump 5% next year and average premiums will fall by 1%. The Republicans have requested the information be released by October 8, 2010.

Sources: The Hill, NPR, CMS, KHN, The Miami Herald