Bloomberg has a very interesting, in-depth article describing how Medicare’s auditing process is leading to much higher costs for many beneficiaries. The article opens by using Larry Barrows as an example. Larry spent eight days in a hospital to treat injuries from falling and was billed $36,000 that normally would be reimbursed. The problem was that Larry was classified as under observation during his stay and never admitted.
As many of you already know, beneficiaries classified as under observation incur 20% co-payments that aren’t required under admitted status. In addition to his eight day stay, Larry also needed three months of rehabilitation. Medicare didn’t cover this aftercare because the hospital didn’t classify him as inpatient.
The reason the hospital didn’t admit Larry is because it extended the use of the observation status to avoid being challenged by Medicare auditors on whether Larry should be classified as an inpatient or outpatient. Since inpatients are more costly to Medicare, auditors watch these cases very closely. If these cases are deemed inappropriate by the auditor, Medicare doesn’t pay the hospital. According to a representative for the Centers for Medicare and Medicaid Services, this extended use of the observation status should not be occurring, as it is meant for only the first 24-48 hours.
The article cites Nora Super, director of government relations for AARP, as saying “Certainly, hospitals will have an incentive not to admit people if they’re going to be penalized.” She also goes on to say the extended use of the observation classification may lead to higher costs, lower quality, and reduced access to aftercare for Medicare beneficiaries.
On Wednesday, Dr. Donald Berwick was chosen by President Obama to head the Centers for Medicare and Medicaid Services (CMS). Dr. Donald Berwick is a Harvard Medical School professor and president of the Institute for Health Care Improvement (IHCI). The recess appointment by President Obama ends a four-year period without an official director for CMS. It also allows President Obama and Dr. Berwick to avoid the normal nomination process that would have entailed an onslaught of questions from Republicans.
According to the Boston Globe, “appointments made during official congressional breaks do not require a vote.” President Obama took further advantage of the break by appointing two other director positions for other government agencies. Of course, Republicans are expressing their outrage at what they believe is an exploitation of the political process. According to The Hill, Republicans are questioning Dr. Berwick’s industry ties, as his IHCI organization received millions in gifts from undisclosed donors in 2009.
Second Round of Doughnut Hole Checks Sent to Seniors
Over 300,000 seniors will get a $250 check from the government to help close the Medicare prescription drug coverage gap known as the “doughnut hole.” This second round of checks is going to seniors who entered the coverage gap between April and June and were not able to receive low-income subsidies. The first batch of 80,000 checks was sent in June and according to a Department of Health and Human Services press release, “About 70 percent of the checks were cashed within a week.” The checks are a result of the agreement between Congress and the pharmaceutical industry to close the “doughnut hole.”
Health Affairs Releases Brief on Medicare Doc Reimbursement Issue
Health Affairs released an excellent document analyzing the Medicare Doctor reimbursement issue. The document looks at the history of the issue, as well as the current situation. The most interesting parts however, are the forecasts it makes and the options it identifies. One statement made in the report is especially eye catching. The report states that if Medicare rates are frozen through 2014, it could add $89 billion to the federal deficit. We highly recommend reading the report if you are interested in learning more about the issue. You can view the document here.
Sources: KHN, Boston Globe, New York Times, The Hill
According to a study published in PLoS Medicine, the government’s plan to implement a pay-for-performance system for Medicare would lead to greater inequality among hospitals in rich and poor areas. The study analyzed 2,700 hospitals from 2004 to 2007. Each hospital was assigned a baseline score based on a number of factors in accordance to the system the government is planning to use. The report found that hospitals in richer areas received better baseline scores than those in more disadvantaged areas. The report concluded that in general, hospitals’ performance increased over time with a pay-for-performance system, but the benefits and level of performance increases were much smaller for hospitals in disadvantaged areas.
The reason for this according to the report is that the pay-for-performance system gives hospitals with lower baseline scores less credit for performance improvements. So hospitals in disadvantaged areas must essentially achieve greater improvements than “richer” hospitals to receive the same amount of payments from the government.
The problem of course is that poorer hospitals have fewer resources to start with, so it is very difficult for such hospitals to close the performance gap with their better funded competition. Those hospitals with greater resources will have better performance thereby receiving the majority of government funding.
The report states that the Centers for Medicare and Medicaid Services has acknowledged that pay-for-performance could worsen the disposition of resource-strapped hospitals, but has taken a wait-and-see approach to see if that will be the case. For more information on the report click here.
New National Health Insurance Website Goes Live
If you haven’t already heard, you may be interested in knowing that the Health and Human Services Department has launched HealthCare.gov that offers consumers a central place to learn about all their insurance coverage options. HHS Secretary Kathleen Sebelius announced yesterday that this site is the first central database of health coverage options, including Medicare, Medicaid, and the Children’s Health Insurance Program. It also includes information from plan information from private insurance carries for small businesses and individuals. According to HHS, the new website offers billions of health care choices through its finder function. Check it out here.
SEC Investigates Major Home-Health Companies for Medicare Fraud
Amedisys, Inc., the largest U.S. home-nursing provider, and Almost Family, Inc., the fourth-largest, both recently announced that they are under investigation by the SEC. In May, following a Wall Street Journal article that identified irregular reimbursement patterns, the U.S. Senate Finance Committee said it was analyzing whether the home-nursing industry manipulated the number of visits made to patients to inflate government reimbursement payments. According to Businessweek, the recent announcements signal that the analysis is expanding and may even include more companies. With the announcements, most publicly traded home-health companies are seeing the value of their stock significantly decline.
Sources: KHN, NPR, Businessweek, Wall Street Journal, PLoS Medicine
A The Henry J. Kaiser Family Foundation released a report that provides an analysis of Medicare Advantage enrollment trends among HMOs, PPOs, and PFFS plans. The report highlights that 11.1 million people were enrolled in private Medicare Advantage plans as of March 2010. This is an increase from 10.5 million in March 2009. The report showed that this increase took place despite a reduction of available plans throughout that same period.
The report also found that three or fewer insurance companies dominate the Medicare Advantage market in every state except New York. In 14 states, one company enrolls more than half of all Medicare Advantage customers. Nationwide, both UnitedHealth Group and Humana Inc. control 33% of the total Medicare Advantage enrollment nationwide.
Medicare Doc Pay Cuts Expected to be Delayed Today
Last night, the House of Representatives voted 417-1 to approve a Senate bill that delays a 21% cut in Medicare payments to doctors. The bill delays the cuts another six months. Lawmakers will work on a more permanent solution in that time, but if history is any indication, a permanent solution isn’t coming anytime soon. Obama has expressed his approval of the bill and is planning to sign it into law today.
The Medicare doc pay cut delay was a part of a larger bill that included unemployment benefit extensions and more aid to states. When that bill was filibustered by Republicans, Democrats separated the Medicare doc pay cut delay into its own bill. Now the hope is that the much more expensive, permanent solution can be passed after congressional elections in November. The bill being signed today will increase payments to providers by 2.2% and will be paid for with a series of health care and pension changes.
Medicare and Medicaid Implements New Fraud Mapping Tool
The Centers for Medicare & Medicaid Services (CMS) implemented a new fraud mapping tool that will eventually be used throughout all government agencies. The fraud mapping tool was developed by the Recovery Accountability and Transparency Board to collect massive amounts of information in real time, analyze the data for fraud trends, and then project possible fraud or errors using an array of indicators. This new tool comes on top of the “Do Not Pay” list created last week. Both methods aim to achieve President Obama’s goal of cutting improper Medicare payments in half by 2012.
Sentinel Life Medicare Supplement Plan N Approved in CA, IA, and LA
Sentinel Life Medicare Supplement Plan N has been approved for Louisiana, Iowa, and California. Each of these plans offer competitive rates and generous commissions. To learn more about these products click here.
As part of a series of government spending cuts, President Obama today will announce that all federal agencies must create a national “do not pay list.” The goal of this list is to reduce the likelihood and impact of fraud. The list will identify people and organizations whom are ineligible to receive government benefits, contracts, grants, and loans. The Treasury Department, General Services Administration, and Office of Management and Budget will work together to create a database of dead people, delinquent or jailed contractors, and other debarred or suspended firms.
In addition to contributing to the creation of the “do not pay” list, CMS will implement an online fraud-detection program that will keep a close watch on medical providers and conduct deeper background checks. According to the Washington Post, CMS made $65 billion in erroneous payments in 2009. Additionally, CMS must cut at least five percent from its budget to meet President Obama’s budget cutting goals.
The Obama administration is also seeking out additional discretionary funding for the HEAT program. According to the Justice department and the department of Health and Human Services, the Health Care Fraud Prevention and Enforcement Action Team (HEAT) has experienced much success in fighting Medicare and Medicaid waste, fraud, and abuse in its first year. One highlight mentioned by the Justice department is that Medicare claims and payouts for medical equipment used in the home decreased significantly after HEAT arrested and prosecuted a number of criminals in South Florida where health fraud is rampant. The Obama administration wants to capitalize on the early success of the HEAT program by expanding it to a total of 20 teams by the end of 2012.
Still No Medicare Doc Pay Fix
“Tonight, every single Republican voted to give doctors a 21% pay cut,” said Senator Harry Reid after the defeat of a recent bill on Thursday that contained provisions to delay Medicare reimbursement cuts and the extension of jobless benefits. Republicans and even several moderate Democrats are calling for the bill to be paid for with cuts to other government programs and won’t vote for it until it is.
Recent Modernized Medicare Supplement Approvals
Sentinel Life’s Plan N is now approved in California.
Gerber Life’s Modernized Medigap Plans (excluding M & N) are now approved in California.
Sentinel Life Medigap Plan N now approved in Iowa.
Mutual of Omaha Modernized Medigap Plans N and M now approved in Florida.
In another sign that Medicare Advantage is falling by the wayside, yesterday CIGNA announced it will not offer CIGNA Medicare Access (PFFS), its individual private fee-for-service medical plan, in 2011. Customers of these plans will experience no change for this year. CIGNA will continue to serve its clients, brokers, health care professionals, and contractors into 2011 for 2010 claims. Now that CIGNA PFFS customers will need to choose a new medical coverage option for 2011, this presents a great opportunity to promote Medicare supplements to them, especially Medicare Supplement Plan N.
Medicare Checks Sent Out to Seniors
As posted on our Twitter feed earlier this week, the Obama administration started sending out $250 checks to seniors who fall into the Medicare prescription drug doughnut hole. With elections looming on the horizon, Democrats are touting the checks as the first of many benefits to come from health care reform legislation signed into law earlier this year (PP&AC Act). In some states, Democrats are buying air time to broadcast a 60-second television ad stating how Republicans promised to repeal the healthcare reform bill. Democrats also sent boxes of “GOP Doughnut Holes” to various media outlets as a sign that the doughnut hole rebate benefit would not exist under GOP leadership. Of course, as you may already know, in most cases, the $250 is only about 1/14 of the total $3,610 hole.
Infection Control a Major Issue at Medicare ASCs
Earlier this week, the Journal of the American Medical Association published a new study from the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare and Medicaid Services (CMS), that found 2/3 of ambulatory surgical centers (ASCs) in three states experienced infection control lapses. CMS defines ACSs as facilities that operate exclusively to provide surgical services to patients who do not require hospitalization or stays in a surgical facility longer than 24 hours. Roughly 70 ASCs that experienced the infection control lapses serve Medicare patients. The lapses were typically found in process including hand washing, injection and medication safety, and equipment reprocessing. To view a video overview of the report click here.
AMA Unleashes its Wrath on Congress for Neglecting Medicare
Due to a glitch with our e-mail system last week, many of you missed last week’s article. To view that article, click here.
Reminder: Modernized Plan Approvals Info
We just wanted to provide you with a friendly reminder that we offer three methods for checking out the latest modernized plan approvals. First, we post updates immediately to our Twitter feed, second we post the update to our approval chart, and third if a carrier’s plan is new to the state, we’ll add it to our product availability map. When it comes to modernized plan info, at PSM we’ve got you covered.
You may have read on other blogs that the doctor fix is in, but it’s not. The House of Representatives voted last Friday on May 28 to freeze the scheduled Medicare payment cut until 2011, however the U.S. Senate failed to pass the bill before going on a week-long Memorial Day break.
The 21% Medicare payment cut took effect June 1, but the Centers for Medicare and Medicaid Services (CMS) ordered a temporary freeze on doctor payments, giving Congress time to retroactively approve the bill that freezes the cut.
In response the American Medical Association (AMA) launched a multi-million dollar series of advertisements that will appear in newspapers, radio, and television. The ads aim to pressure senators to pass the bill as soon as possible by criticizing them for taking a vacation while more than 40 million seniors and millions of health care providers are left worrying about the future of their healthcare and businesses respectively. The AMA also hopes to further its goal of getting the government to pass a permanent fix by changing the current Medicare payment formula. Such a fix would cost an estimated $250 billion over ten years, which is why the Senate continues to repeatedly delay the cuts rather than address the root cause of the problem.
Various news outlets, such as Reuters are reporting that some doctors are no longer taking new Medicare patients due to the volatility of the situation.
Ironically, the Medicare payment cut also impacts TRICARE (the health program for military families), as it utilizes the Medicare payment formula. Looks like our Senators celebrated Memorial Day a little too quickly.
The AMA has set up a web page titled "Medicare Payment Action Kit." You can view many different documents it has created on the whole issue. Check it out here.
Earlier this week, the Centers for Medicare and Medicaid Services (CMS) dispatched a four-page brochure to 40 million senior citizens that explains how the new health care law will affect the Medicare program. The content of the tax payer funded Medicare brochure has Republican politicians incensed and calling for an investigation by the Government Accountability Office (GAO).
Several Republican senators describe the Medicare brochure as misleading and a form of government propaganda constituting an illegal use of tax-payer funds. At the heart of the controversy are statements in the brochure that allegedly promise savings and increased quality health care. The brochure uses the words “improves” and “improvements” eight times, which imply the superiority of the reforms over the old system.
Republican politicians are still very skeptical about the impact of the health reform law, and view the claims made in the brochure as unsubstantiated, as no one can say for sure that the provisions of the reform law will result in an improvement. Republicans are saying the mailing was sent out as a tool ahead of mid-term elections to garner crucial votes from seniors. In addition to the GAO investigation, Republicans on the Ways and Means Committee are asking HHS Secretary Kathleen Sebelius to halt distribution of the brochure until the investigation is complete.
Ironically, this situation was reversed six years ago. According to NPR, during that time George W. Bush’s administration sent out correspondence with the aim of educating seniors about a new Medicare prescription drug law passed at the time with mostly Republican votes. Democrats were outraged and called for investigations by the GAO. The investigations led to findings that the mailings were “misleading” and that public money was essentially used to make fake news. Then and now, both administrations claim the need to inform seniors about crucial changes to the Medicare program as justification for the mailings.
Precision Senior Marketing wishes you a great holiday weekend filled with fun and relaxation. Our offices will be closed on Memorial day and resume normal operating hours on Tuesday, June 1. Should you have any urgent issues, e-mail email@example.com.
Kaiser Health News has an excellent article on how Medicare costs are increasing rapidly in traditionally low cost areas. The article focuses on the city of Provo, Utah where residents are among the healthiest in the country and its largest hospital is operated by Intermountain Healthcare, an organization praised by President Obama for providing high quality care at reasonable costs. Despite these factors, spending on Medicare patients has increased significantly in the last few years.
According to experts cited in the article, the major reason for this spike in spending is the use of expensive, new technologies, (such as the use of robotics for surgery) many of which are said to introduce little to no improvement over traditional methods. They go on to say that competition forces hospitals to adopt the latest technology, as patients always want the “best” care, which they equate to new technology. The new health care law is only going to exacerbate this problem. Now that reimbursement will be tied to quality health care, not only will hospitals be pressured to use the latest tools and techniques, but they most likely will extend patient stays, and use more aggressive (and expensive) treatments at earlier stages of illnesses.
The article goes on to say that what is happening in Provo, Utah is also happening in other traditionally low cost areas of the nation. The biggest concern among experts in the field is that these spikes are indicative of what will happen throughout the country as more hospitals begin to focus on higher quality care for Medicare patients, just at a more severe level.
CMS Will Spend $73 million to Upgrade its Websites
CGI Federal Inc. was awarded a five-year, $73.2 million contract to upgrade and continue maintenance of Medcare.gov, cms.hhs.gov, and MyMedicare.gov. Together these sites see 500 million page views each year and provide information to 44 million beneficiaries and millions of other health care providers.
With the growing popularity of the phone & Internet sales process among senior insurance agents across the country, many are seeking out solutions to enhance the experience for both agents and consumers. One solution that is being used to great success by many of our top producing agents is screen sharing software.
For those of you who are unfamiliar with screen sharing software, it is software that you either install on your computer or access through a website that allows you to display whatever is on your Internet-connected computer onto other Internet-connected computers. Additionally, most screen sharing software also allows you to grant permission for your audience to take control of your computer. These two functions can also be reversed, so that you can view and control another Internet-connected computer. Instant messaging, VOIP (talking), video conferencing, and file sharing are other features that may be included with screen sharing software to give you the ultimate communication tool.
If you haven’t yet looked into incorporating screen sharing software into your sales and other business processes, we highly recommend that you do. Here’s why:
Increased interactivity with clients: The biggest benefit is the interactivity that screen sharing allows. No longer does your audience have to just sit and stare at a monitor throughout your whole presentation. Your clients can actively take control of whatever program or file is on your computer (that you determine) and vice versa. Your audience’s attention to the presentation will be much greater, and they’ll appreciate the more “in-home feel” without you actually being there.
More dynamic, engaging presentations: No longer are you confined to just a PowerPoint presentation. Since you have computer control throughout the entire presentation, you can make your presentations more dynamic by bringing up and showing various files based on the custom needs of the client. Website, videos, music, and other files can all be presented whenever and however you want in real-time. Then combine this with the IM, VOIP, and video conferencing features of most screen sharing software, and you have all the tools you need to give a highly engaging presentation.
Better reinforcement of training / education: If you are experienced with giving more educational presentations, you know the challenge of getting your audience to remember what was actually taught. A good example of this is getting seniors to remember many of the important points about their policies, or about the Medicare program in general. Screen sharing isn’t going to solve the problem, but it can help improve the learning experience by allowing you to present periodic reinforcement activities. Web based questionnaires are a great tool to accomplish this. With the real-time feedback on their performance you can adapt your presentation accordingly to make it more effective.
Reduction of application errors: Rework is something I think everyone can agree is bad for both business and our mental health. With screen sharing you can ensure zero defects on applications as you can walk a client through an application, seeing exactly what they are typing. The amount of time and money saved by eliminating application errors can be very significant over time, and that is just for the app process. I’m sure you will find many areas in your business where such technology can eliminate further rework.
Better evaluation of the sales process: Yet another great benefit of many screen sharing software is that you can record your sessions. By recording your sessions you can evaluate what went right and what went wrong, and then use that data to improve your future presentations. And after you record that perfect presentation, you can use that video as a training tool for others in your business, post it to your website to keep visitors longer, or even post it to YouTube and have it show up in the search engines to generate traffic to your site. Of course, always remember to follow HIPPA regulations and other common courtesies when recording, broadcasting, and disseminating information.