Posts tagged 'CMS'
Just as congress is trying to pass legislation which will give Medicaid a boost, Alaska has been put on a moratorium by the federal government and CMS due to noncompliance when it comes to enforcing Medicaid rules. This is temporary, however there is no guess as to how temporary it will be.
Because of this moratorium, many people who need to sign up for Medicaid need to wait until this is over. The review raised concerns that the state Medicaid agency has not taken necessary safeguards "to protect the health and welfare of the recipients of the services."
Until the review is done, there can be no more individuals added to the Medicaid rolls. The review has been called for because of several areas of non-compliance. For instance, form 27 to 2009 the state reported 27 Alaskans died while waiting for initial assessments and 227 died while waiting to be reassessed.
The system should work much faster than that. The state says that it was behind in assessments because it did not have enough nurses. The review also found the state is not in compliance with requirements for all waivers.
"CMS has determined, in order for us to develop our business processes and refine those that we have in place, that a moratorium is necessary," Rebecca Hilgendorf, director of Senior and Disabilities Services said.
Theresa Bovey, CEO of Trinion Quality Care Services, which provides in-home personal care in Anchorage, says this moratorium could have a huge impact on those who need Medicaid and won't be able to get it now.
It is hopeful that these issues can be resolved quickly and enrollment can begin again after the moratorium is lifted, however, the review is not scheduled until March. In the meantime, the state must create a plan that shows what they will do to improve their Medicaid services. This plan must be presented to CMS before they will consider ending the moratorium.
The cost to Medicare for managing chronic kidney disease (CKD) is high; however, IPRO is urging health care providers in New York to work together to both improve patient care and reduce costly complications from the disease.
Medicare costs for CKD and end-stage renal disease (ESRD) exceed $70 billion annually according to United States Renal Data System (USRDS) data. IPRO is one of only eleven organizations from across the country that has been chosen by the Centers for Medicare & Medicaid Services (CMS) to work on a new pilot project that has the potential to both help patients and save taxpayers a substantial amount of money.
"We are partnering with primary care physicians, nephrologists and vascular surgeons to improve care for patients at risk of, and with CKD by preventing or slowing the progression of the disease," explained Clare Bradley, MD, MPH, Chief Medical Officer at IPRO. According to the USRDS, the savings to Medicare for each patient who does not progress to dialysis is estimated to be $288,000.
Bradley said improving the health and well-being of CKD patients could have a substantial economic impact considering Medicare beneficiaries with CKD account for 16.5 percent of Medicare costs in the year the disease is diagnosed, and 11.1 percent in the next year.
"We are confident that better care for these patients can lead to considerable cost savings, improved outcomes and better quality of life because it can mean less reliance on drugs, dialysis, and hospitalization," said Bradley. The IPRO project encourages prevention and early detection of CKD and proper medication recommendations to slow the progression of the disease.
IPRO also supports the nationwide Fistula First effort which addresses the need for patients who suffer from ESRD to have safer, higher-quality access to hemodialysis through a fistula. Bradley explained that a fistula is a "connection" surgically created by joining a vein and an artery in the forearm allowing blood from the artery to flow into the vein for safe and easy access for dialysis.
"Fistulas make a real, proven difference in the health of the patient. By providing a method of dialysis that is safer, longer lasting, and less likely to cause infection, fistulas are seen as the gold standard for vascular access," said Bradley.
Fistulas reduce serious infections and complications leading to hospitalizations and mortality often associated with other forms of vascular access for kidney patients. Vascular access complications account for 16 to 25 percent of all hemodialysis patient admissions, contributing to about $1.5 billion in Medicare costs annually. In addition, fistulas cost less to maintain than other forms of access and are associated with less re-work and complications requiring hospitalization.
IPRO is part of the nationwide Quality Improvement Organization (QIO) Program. QIOs work with health care providers, consumers and stakeholder groups to refine care delivery systems to make sure all people - particularly those from underserved populations - get the right care every time.
This material was prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy.
This material was prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy.
The final Medicare physician fee schedule for 2009 is complete. Doctors are breathing a sigh of release knowing that many of them can now move forward and secure their salary and maybe even a raise for next year's work.
In July legislation reversed a 10.6% cut that took effect at the beginning of that month. Starting in January 2009, a 1.1% across-the-board increase will replace an additional roughly 5% cut that would have gone into effect if lawmakers had not acted, the Centers for Medicare & Medicaid Services said in the final pay rule issued Oct. 30.
"Medicare's new rule confirms that physicians caring for seniors would have faced a harsh payment cut of 15.1% next year if Congress had not stepped in," said American Medical Association President-elect J. James Rohack, MD.
The upcoming 1.1% boost is less than the CMS-projected 1.6% increase in the cost to physicians of providing care next year. Payment freezes and increases in recent years also have come in under the rise in costs. There are two bonus opportunities exist to more than quadruple the raise that doctors will get for the year.
Physicians who successfully participate in the Physician Quality Reporting Initiative will receive a 2% bonus on all of their Medicare payments for the year. Also, the program for the first time will award a separate 2% bonus to physicians who successfully prescribe medications electronically for their Medicare patients. This has been an issue on the table for quite some time and it is now a real possibility.
Bonuses will not be paid out until 2010 when all the bills are added up and the books are balanced, but they should result in about a 5% or more raise for doctors rather than doctors having to lose money and not be able to continue to serve their patients. The E prescription process is important so that there are less mistakes and less potential health complications to patients.
If you are on Medicare, you can breathe a sigh of relief. This new way of doing business will help you remain with your doctor, and help them remain in business.
The Centers for Medicare and Medicaid Services (CMS) have been providing information regarding Medicare for a long time. Most of the information is geared toward individuals who are Medicare beneficiaries
Though this information is essential, CMS has realized the importance of providing information for caregivers. They have designed a web page for this purpose. The web page, www.medicare.gov/caregivers, discusses accurate information regarding many aspects of Medicare including what the Medicare program covers, access to services and resources to help care for a beneficiary.
Many times caregivers are family or close friends, and though they save the Medicare system over $350 billion per year (figures from 2006), they often don’t think of themselves as “official” caregivers and, until now, have not had access to information and tools specifically designed to make their caregiving easier.
The new web page will help in many ways. A caregiver’s job is exhausting. There is a lot for a caregiver to learn about benefits. A caregiver must be a staunch advocate. To help with these and other responsibilities, which can be quite overwhelming, there are direct links to other organizations who can help the 4.4 million unpaid caregivers who are simply trying to find enough information to help their loved ones.
Some sections of the page include “Navigating Medicare”, “Help with Billing” and “Care Options.” For caregivers who are overwhelmed and need help or support themselves there is a section that lists various options for help. A newsletter will come out on a bi-monthly basis starting in November of 2008.
An essential part of the goal of this web page is to lighten the load for caregivers, making it easier to care for the people they love. If you are a caregiver – paid or unpaid – take the time to check into this new web page. You may find the support you are looking for to help your loved one and yourself.
It stands to reason that the most vulnerable individuals in the United States who have some of the most extensive health problems and have paid into Social Security and Medicare while they worked for years, should not have to worry about how they will be able to get their medication. In their minds – and most of the rest of the nation’s – they have paid their money dutifully, month after month and year after year, and they were told that they wouldn’t have to worry when they got older and retired. They have been thinking that Medicare would take care of them and they would have the medical treatment – and medication – that they need to live as full a life as possible with their medical symptoms controlled as much as possible.
Unfortunately, for individuals who are in this situation and happen to have a very low income, it is not working out that way. What has happened is that with the “new and improved” Medicare prescription coverage, things have changed.
The new Medicare drug plans were introduced three years ago. At that time, numerous health insurance companies made bids to provide prescription coverage for low-income Medicare recipients because Medicare paid for part of the premiums, therefore the company was reimbursed, theoretically making money, not losing it.
Companies started realizing that they were not making the money on low-income individuals – especially those with serious or chronic illnesses – so they began bidding higher rates so that they would not get chosen to supply this coverage. Last year 1.2 million people had to be moved from one plan to another due to lack of companies providing prescription coverage. This year, the number will be even higher because there are even fewer companies offering low cost prescription coverage for low-income Medicare beneficiaries.
As a result, many of these Medicare enrollees could be left without enough coverage. They could be in a position where not all of their prescriptions are covered, yet they are among the sickest among us, and they cannot afford to be without their medication because it will seriously compromise their health and could lead to fatalities.
Studies have been done showing that this is the case, however, Medicare says that there will still be several choices of companies and prescription plans for low-income Medicare beneficiaries. The government automatically assigns these individuals to a plan that should cover their needs.
If you are on a limited or low income and have prescription drug coverage you can contact Medicare and/or your prescription plan and ask what will be happening for 2009. You are allowed to change plans at any time during the year. Make sure that you are covered. If you are not sure, contact your local Office on Aging, Medicaid Office or talk to your doctor’s billing office to get your questions answered.
We have been hearing a lot about computerized electronic prescriptions lately. The old joke about doctors’ handwriting seems to be true in many cases, and unfortunately, in too many situations, pharmacists can’t decipher the scribble and end up dispensing the wrong medication to patients. This is never a good thing, and though in many cases, the patient catches the mistake or the medication is not harmful to the patient, in a lot of cases the medication is not only harmful but fatal.
The Centers for Medicare and Medicaid Services (CMS) have been trying to get doctors to switch to electronic prescriptions to eliminate the high number of problems with prescription errors due to handwriting, but so far many doctors have been resistant. CMS has offered some bonuses if the doctors will at least give it a try, but there hasn’t been much acceptance of the idea.
Some doctors worry that all the software available to the pharmacies and the physicians will not be compatible, leading to other problems in addition to the handwriting issue. CMS says that Medicare expenses are increasing (as we all know), and that these mistakes due to handwriting issues are increasing expenses even more – especially when the wrong prescription has to be thrown away and a new one has to be filled.
CMS has gotten very serious about making the change to electronic prescriptions. They are offering cash back to the doctors who make the change and are error free. In order to get doctors to switch, which CMS says will make the system better, safer, more effective and efficient and more cost effective, doctors who go electronic will receive a 2% increase in their Medicare payments in 2009 and 2010 and a 1% increase in 2011 and 2012.
Only about 2% of all prescriptions are filled electronically every year. Because this number is so small and most of the rest of the prescriptions are handwritten, over 1.5 million patients – over 530,000 Medicare recipients – are harmed every year due to prescription mistakes. The Pharmacy Board has investigated thousands of prescriptions at random and found that there were high percentages of errors involving the type of medication prescribed, the dosage and wrong or incomplete directions.
At present, the Pharmacy Board is working on 48 different prescription programs. They are working with pharmacies and physicians to work out compatibility issues. In the meantime, if you can get your doctor to at least give you your prescriptions typed into his computer and printed out; there will be less room for error. CMS hopes to begin the electronic program by the end of this year.
Medicare fraud is not a new thing. It has, unfortunately, been going on for years. The problem is that years ago the amount of money at stake was not nearly as high and the Medicare system was not in nearly as much trouble financially. When you put those two factors together in today’s system, fraud is hitting Medicare harder during its most difficult time in the last 60 years.
For one thing, Medicare fraud has become a multi-billion dollar business. There are people making multiple millions of dollars defrauding Medicare every year. With Medicare funding being cut and with lawmakers trying to keep payments to doctors and healthcare professionals competitive enough so that they can afford to continue treating Medicare patients, just eliminating part of the fraud could provide the funding for the shortfall.
CMS, the Centers for Medicare and Medicaid Services, has been looking into the situation for quite some time now and is in the process of enhancing its anti-fraud efforts. They have announced that they will be implementing some aggressive new steps in cracking down on fraud.
Some of the changes CMS will be making include enlisting program integrity contractors who will study billing trends throughout the Medicare system. In doing so, when it finds providers whose billing is higher than or otherwise out of sync with the majority of other providers in their region, these providers will be audited. Since it is impossible for Medicare to look behind every claim, this is a cost effective way to look at any red flags that are going up.
In addition, another way that CMS will fight fraud will be to actually contact beneficiaries to be sure that they received the equipment or supplies that Medicare is being billed for and that these were the right equipment and were in good condition. Billing will be reviewed before and after payment and physicians who order an unusually high number of the same or related item(s) will be audited and/or reviewed as well.
These ideas alone, when implemented, should save Medicare millions of dollars. They should also discourage some individuals from engaging in fraud, as the penalties will be quite stiff and will be handled by local, state and federal law enforcement agencies, including the FBI if necessary. With this new program and the strength of law enforcement, hopefully fraud will decrease and the money saved by Medicare will be used to help the beneficiaries who need it.
Identity theft has become a huge problem in the United States and throughout the world, and it is getting worse. It seems that every day we hear about a new way that fraudsters have figured out to get pertinent information about us that they can use to purchase anything from a car to a home to illegal drugs.
Through the years, Medicare cards have displayed the individual’s name and Social Security number front and center, as well as other information that could help identity thieves to get your information and use it.
It is interesting that Medicare is finally getting around to doing this. Insurance companies and other organizations have begun doing this years ago, and when you talk to most places such as banks, insurance companies, the power company or others on the phone, they only ask for the last 4 digits of your Social Security number and they only have access to those four digits unless they are in a specific department.
More care is being taken to protect our privacy and a substantial part of that protection comes with protecting our Social Security numbers. The Social Security Number Protection Act has been proposed to Congress as a critical issue that needs to be addressed now. The senators who proposed the action have said that the Federal Government should be taking the lead in this area, not lagging behind. They are asking that the removal of Social Security numbers be mandated and that the unnecessary use of Social Security numbers be eliminated.
It is, of course, impossible to eliminate the use of Social Security numbers in many instances, however, there is a difference between using the numbers and going out of the way to protect people’s identity, as opposed to using the numbers and basically flaunting them or leaving them in plain sight as a temptation and easy road to fraud for identity thieves.
With 8.4 million people victims of identity theft last year alone, this is a critical issue. The legislation would give CMS a limited amount of time to remove Social Security numbers from Medicare cards, correspondence and unencrypted information. This should give Medicare recipients some peace of mind.
As Medicare tries to become more effective, efficient and streamlined, eliminating paperwork and unnecessary time, the Centers for Medicare and Medicare Services has planned an online system to help providers enroll to be providers. This system will be available to most states in early 2009, and will also be available in California, New York and Missouri by October 2009.
Not all enrollment materials will be available on the web-based system, however there will be enough to get the process started and move it along more quickly than the old system. In the past it took 90 days – and sometimes much longer – for a provider to complete the enrollment process. With the new online process, it is estimated that it will take 30 to 45 days instead.
One drawback that providers are talking about is the fact that since the system will not recognize online signatures, the online paperwork must be followed by actual paper forms with original signatures sent to employees at CMS who process the paperwork and combine the files. Providers are skeptical about this, as they feel it will continue to take more time, however, CMS says that they can be working on everything in the computer so that the process goes quickly and the original signatures on paper will simply be verified, not re-processed.
Another drawback according to providers is that each provider who wants to enroll as a Medicare provider must enroll in a separate and different system first. The second system is called the Individuals Authorized to Access CMS Computer Services. Providers see this as an extra and cumbersome step and wonder why there cannot be one system that can deal with all of the hoops they must jump through in one complete system.
In addition, providers are skeptical because there have been promises to speed up the enrollment system for quite some time, and this particular system was supposed to be up and running by March, 2008, according to CMS, making the debut over six months late.
Regardless of how the providers feel about some of the issues inherent in the debut of the new system, one thing is true: there is the potential to enroll providers more quickly and the potential to add further services for providers including billing, budgeting, records and more in the future.
For now, we can all wait and see how the system works and if it saves time and expense for CMS, Medicare, providers, as well as Medicare recipients.
It is no secret that there are some serious issues that need to be addressed regarding Medicare. Lawmakers are looking for financial solutions, auditing solutions, quality control solutions and other changes to make sure that the Medicare system becomes sound again and is there to support seniors when they need it.
There have been problems with fraudulent and erroneous claims front and center in the news lately. On top of Medicare paying out billions of dollars that should not have been paid out for claims from phony doctors and patients for phony equipment and services, the Centers for Medicare and Medicaid Services (CMS) has been using their own Medicare officials to do the audits to figure out what types and amounts of fraud were actually perpetrated.
The lawmakers and oversight commissions have come back and stated that the Medicare auditors actually were not the right auditors for the job, were not following the strict guidelines regarding audits and, in the end, needed to be audited themselves because their figures were not accurate. Without following the correct guidelines, much of the fraud was missed. In addition, sending someone from their own agency to audit themselves isn’t a real effective or efficient way to find errors or fraud.
Currently, there are more issues that have arisen. One issue that has created problems for years is the sluggishness of the claims process and the payment process. Medicare beneficiaries and their medical providers are frustrated as they wait month after month for claims to be paid while expenses pile up, making it hard for everyone involved.
The latest situation – which has cost Medicare more money that it doesn’t have to spare and didn’t need to spend – involves overpayments for medication. Because the Medicare system is so slow, Medicare missed the opportunity to pay for less expensive generic drugs rather than brand names. Medicare was so far behind that they did not enter the generic alternatives into their computer systems when they became available, thus paying the higher prices.
One of the main medications, a cancer drug, was paid for at double the generic price because of a two-month delay in entering the new information into the system. The system had no idea that generics were even available for this particular medication, according to the inspector general’s office. There are also overpayments for other drugs that have generic counterparts.
With Medicare’s financial woes, they should be at least working faster to save themselves money. When confronted with the information about the overpayment, Medicare acknowledged that they should input information in a timelier manner so that it will reflect current market prices.
With lawmakers and others trying to save Medicare, it’s time for Medicare to help save itself.
It seems like Medicare continues to have more problems when it comes to keeping records, fraud and audits. We recently reported that there had been an inspection by the Inspector General’s office regarding overpayments, payments for false claims and fraud. That investigation, by the Human Services inspector general’s office originally uncovered what seemed to amount to about $700 million.
The Medicare Officials that conducted the investigation gave these figures. There is only one problem – the information was based on faulty statistics. In fact, the way that Medicare officials conducted the investigation went directly against Medicare rules.
What was supposed to happen was that the billing be matched against purchases, medical records and orders from doctors. They were not handled this way. They were matched against purchases, but limited medical records in only some of the cases and they were essentially not matched against orders from doctors at all. The end result is that many phony purchases were matched against phony billing, leaving much of the substantiating information out of the equation.
As a result of the way that this was handled (remember the fox watching the hen house), Medicare officials investigated their own information and came out with a faulty figure. They determined that the $700 million in fraud that they gave as their figure amounted to about a 7.5% fraud rate.
When looking at the true figures, however, it is actually estimated that the total amount in fraud is actually over $1 billion. The federal report said that if the Medicare officials had made the auditors abide by the rules, the amount of incorrect or fraudulent billing would have been much higher, resulting in the $1 billion mentioned.
With Medicare having the financial problems that we continue to hear about, $700 million was bad enough. Now we are looking at $1 billion. It seems that $1 billion would pay for a lot of prescriptions that the Medicare Advantage donut hole is swallowing up.
Reports have recently revealed that Medicare prescription drug supplements are not being watched very carefully. In fact, there is a fraud prevention program that is supposed to be in effect to deal with the prescription drug coverage offered by private insurance companies.
The Government Accountability Office holds CMS responsible for monitoring and auditing the $39 billion prescription drug programs. That is a great deal of money that could easily be misused. The GAO examined five plans that are unnamed and created a report detailing the shortcomings regarding what CMS is responsible for.
Some of the oversight responsibilities that have not been adhered to by CMS include establishing training programs for employees so that they can recognize fraud and misuse of relevant laws. Only two of the five programs have established such training.
CMS states that though they did not have the training in place, the programs did establish written standards for detection and prevention of fraud and waste. The GAO has strongly suggested that CMS should conduct audits of the prescription drug programs.
CMS says that they have asked the programs to produce self-assessments – (remember the fox watching the hen house, again?) – and said they would use the self-assessment surveys in place of audits for now. They said that they are focusing on complaints, especially since their audit budget was capped at $720 million, stating that this restricted amount makes it difficult, if not impossible, to conduct proper auditing.
This attitude toward auditing fraud, coupled with the fact that CMS has not developed even a streamlined auditing system, might be saving Medicare some tightly budgeted money in the short term, but the billions that are being taken out of Medicare while officials are ignoring the problem, could be saving the country and its Medicare beneficiaries billions. This might be enough to eliminate some of the unaffordable and superfluous supplemental programs and create a Medicare system that is affordable and works for everyone.
Medicare Centers for Medicare and Medicaid Services (CMS) has been working on a pilot program for three years. The pilot program has involved over 250 hospitals and has monitored quality measures in those hospitals during that time, offering rewards for high quality.
This partnership between the hospital consortium and Premier and the CMS spent the three years working on the quality measures in the 250 hospitals that were part of the pilot. Premier reported that the results that were achieved included a 15.8% increase in quality in these hospitals that served 1.1 million patients. Premier President and CEO Richard Norling said, “The findings from the first three years of the project clearly show that transparency with rewards for quality achieves a higher level of performances in American hospitals.
This project actually brought up the performance standards of all hospitals involved to a better level, bringing those on the lower levels closer to the higher levels and closing the gap between them. This is great news, and if the pilot program works to raise quality levels in these 230 hospitals, it would be a tremendous idea to expand the program or at least use the standards and rewards in the pilot to improve quality of more hospitals throughout the country. The money saved because of the improvements of quality and efficiency could be used to fund the pilots or other programs for other hospitals in other areas across the country.
There was an announcement by Acting CMS Administrator Kerry Weems said in a statement, “Given these results it is time for us to take the next step and implement hospital Value Based Purchasing for the Medicare program, so that citizens across the nation can benefit from improved safety and quality [and] get the right care every time.”
It has been about two years since the Deficit Reduction Act went into effect (7/1/06) requiring all immigrants to give proof of legal immigration or citizenship when they are applying for Medicaid for the first time. This applies to children, as well. Most legal immigrants cannot receive Medicaid benefits for the first five years that they are in the U.S. and undocumented immigrants can only receive emergency Medicaid services.
Once the bill became law, it also restricted citizens, as well. Medicaid enrollment has declined since the law was enacted, partially because even U.S. citizens are finding it difficult to locate some of the documents required to enroll for Medicaid services. This is because some of the documents need to be original documents, and it can be difficult to obtain original documents in many cases.
As far as Medicaid goes, they receive matching federal funds to help run the program and pay claims. As a result, even if they wanted to assist individuals without documentation it would be a problem for Medicaid both in a financial sense and in a legal sense.
The rules are so stringent that CMS has instituted a rule that even requires child welfare agencies to document citizenship for children being placed into foster care. There are some issues where people receive extra time to provide documentation, however, they are limited and must adhere to very specific rules and time frames.
Once an individual has completed the documentation process and is approved for coverage, they will be covered retroactively to the date of the application or to the month of the application depending on the state they are living in and a few other variables.
The primary types of identification include a state driver’s license, Certificate of Naturalization, Certificate of Citizenship or a U.S. passport. Secondary types of identification for naturalized citizens include a U.S. Birth Certificate, data verification with Systematic Alien Verification for Entitlements (SAVE) documentation, or documentation and data match with a state verification agency, as well as other documents.
It is important to know the law, your rights, your responsibilities and your entitlements in order to receive the benefits you need. You can research them on the web by going to the CMS website.
With identity theft running rampant throughout the world, guarding Social Security numbers and other personal and pertinent information has become essential.
Private insurers issue identification cards, and they used to place the individual’s Social Security number on the cards as part of the identification or as the identification number itself. In recent years, this practice has been discontinued because too many people have had their numbers and identification stolen.
In fact, Medical Identification Stealing and Fraud has become the fastest growing form of identification theft in recent years. This being the case, Medicare has been asked by the Social Security Administration, Congress and the public to remove these numbers from their identification cards, however, so far, they have resisted doing this.
Why the resistance, especially since others have already willingly complied? One reason is that it is inconvenient. The other is that at this point, the Social Security Administration is not allowed to force Medicare or the Centers for Medicare and Medicaid Services (CMS) to remove this information.
CMS has said that the risk of identity theft by using the individual’s Social Security number on Medicare identification cards and other information is not that great. Yet, statistics show that this is not the case. There is a great risk, and predators are taking advantage of this information constantly. In addition, CMS also says that if they started to issue new Medicare cards all of a sudden, it could worry, startle or upset Medicare beneficiaries.
It seems that if there was a nice letter sent to each beneficiary announcing a newly designed card would be coming in the mail within 10 days or two weeks, it might be accepted as good news, especially if the letter explained that the individual’s Social Security number would no longer be on the Medicare card, thus protecting the individual. It would seem that this would be well received as a positive message and a positive action by a government agency – CMS – whose job it is to look out for the interests of its clients – Medicare beneficiaries.
There seem to be a lot of good options available for government decisions about situations such as this. It doesn’t have to be complicated. It is simply a matter of opting to consider the privacy and safety of Medicare beneficiaries, rather than the convenience for the CMS agency.
Medicare Centers for Medicare and Medicaid Services (CMS) has been working on a pilot program for three years. The pilot program has involved over 250 hospitals and has monitored quality measures in those hospitals during that time, offering rewards for high quality.
This partnership between the hospital consortium and Premier and the CMS spent the three years working on the quality measures in the 250 hospitals that were part of the pilot. Premier reported that the results that were achieved included a 15.8% increase in quality in these hospitals that served 1.1 million patients. Premier President and CEO Richard Norling said, “The findings from the first three years of the project clearly show that transparency with rewards for quality achieves a higher level of performances in American hospitals.
This project actually brought up the performance standards of all hospitals involved to a better level, bringing those on the lower levels closer to the higher levels and closing the gap between them. This is great news, and if the pilot program works to raise quality levels in these 230 hospitals, it would be a tremendous idea to expand the program or at least use the standards and rewards in the pilot to improve quality of more hospitals throughout the country. The money saved because of the improvements of quality and efficiency could be used to fund the pilots or other programs for other hospitals in other areas across the country.
There was an announcement by Acting CMS Administrator Kerry Weems said in a statement, “Given these results it is time for us to take the next step and implement hospital Value Based Purchasing for the Medicare program, so that citizens across the nation can benefit from improved safety and quality [and] get the right care every time.”
Lately there has been a rush to access various personal and confidential medical records for research purposes. The latest information being requested is Medicare prescription drug benefit claims.
The Centers for Medicare and Medicaid Services (CMS) has issued a ruling allowing researchers access to records for only specific purposes. They will be able to study the effectiveness and safety of medication used by elderly and disabled Medicare recipients.
One of the reasons that researchers want to try to explore this information is that elderly and chronically ill patients are often not included in clinical trials and the information that can be obtained through Medicare could help study results of specific medications.
CMS has stated that under the rules, the information regarding the individuals and the identities of prescription drug plans will not be accessible and will remain encrypted. CMS will also combine cost information for Medicare prescription drug plans because not doing so “could negatively affect the ability of plans to negotiate medications, favorable to Medicare beneficiaries and taxpayers.”
There will also be regulations to guide research in what they can do and what they cannot when it comes to the research they are working on. The Kaiser Family Foundation has said that the release of this information is a good thing. Researchers will not have the ability to access certain claims data, nor will it be able to discover the amount of rebates that Medicare prescription drug plans receive from pharmaceutical companies and the amount they charge beneficiaries.
One important part of the research will be allowing researches to determine how many beneficiaries reach the “donut hole” amount where there is a gap in prescription coverage, but they will not be able to identify which plan they are enrolled in. Determining the gap in coverage at the “donut hole” may help many avoid financial traps in the future by identifying a way to avoid that trap.
In some respects, if handled appropriately, this research can certainly be helpful to many parties involved.
Individuals with terminal illnesses have the right to choose their end-of-life care. That has long been an issue that has received attention from individuals, families, the public, hospitals, insurance companies and more.
The Center for Medicare and Medicaid Services (CMS) has now put this information in writing, including it in the outline of a new regulation regarding this issue. CMS will publish and release the outline later this year.
Previously, there was no specific language regarding individual patient’s rights in regulations. This new regulation is the first update since 1983, when Hospice care and end-of-life rights were not as wide an issue as they have become now.
Many Hospice patients are already very involved in their rights, care and treatment, as well as their wishes as they come to the end of their life, however, now that there is a specific regulation with language in place which details and reinforces those rights, there is stronger protection for those who might want to explain their wishes but need the support to do so.
Some of the rights of individuals involved in Hospice care or palliative care include participation in their treatment plan, the right to effective pain management, the right to refuse treatment and the right to choose their own physician.
Hospice care can be chosen when a patient decides that curative care is no longer an option for them. By choosing Hospice care, they are choosing to receive care that will provide comfort and care to themselves and sometimes to the family members, as well. This type of care can be provided at home as well as in an inpatient setting. Nearly one million Medicare beneficiaries are receiving Hospice care at any given time.
Updating the regulation and reinforcing patients rights – on paper – is an important step in making sure that the individuals who are making decisions about end-of-life issues do not have to struggle with the emotional issues involving deciding on care and receiving support.
A regulation that was proposed and backed by President Bush to cut $5 billion in Medicaid funds for public hospitals over the ext five years was blocked by a federal judge Friday. This gives some Bay Area public hospitals a break and will let them breathe a sigh of relief for the time being.
Without this ruling, the funds would have started to be reduced starting Sunday, the day before Memorial Day. Temporarily, at least, the funds are still available, but this is only a temporary fix.
If the regulation eventually takes effect over 22 public hospitals will lose a total of approximately $600 million annually for the next six years. The California Association of Public Hospitals and Health systems located in Oakland, CA, is fighting hard to extend the moratorium on the cuts.
Alameda County Medical Center in the town of Alameda, a suburb of Oakland, serves a high number of patients and would lose about 20% of its total income and operating budget if the moratorium is not extended. This amounts to almost $100 million annually.
Other hospitals stand to lose millions as well. Santa Clara Valley Medical Center would lose nearly $38 million annually, San Mateo Medical Center, $11 million annually, Contra Costa Regional Medical Center, $9 million annually, and San Francisco General Hospital $29 million. This is just five hospitals that take care of a great number of individuals that have no other place to go for medical care.
In addition, University of California hospitals would lose $116 million annually.
The reason that the court blocked the regulation is that the court feels that the Bush Administration acted improperly in conjunction with CMS in trying to eliminate coverage that is the lifeline to many low-income individuals and families who depend on this coverage and assistance.
At this point, Congress, CMS, several governors and Mike Leavitt, head of department of Health and Human Services, have agreed to work together to try to solve some of the problems that have led to this point. Hopefully they will find a way to keep enough money available to these public hospitals that are in many cases the only lifeline low income individuals have.
Recently, we have written about comparisons between premiums for Medicare Supplement Policies, prescription drug policies and the coverage itself. In this piece we will address a study comparing hospitals and Medicare coverage.
The Centers for Medicaid and Medicare (CMS) has created an advertising campaign to the tune of $2 million to help people across the country compare hospitals – in their local area and nationwide.
The internet site is www.hospitalcompare.hhs.gov gives the average amount that Medicare has paid for specific health issues, such as a heart attack. For instance, in Dallas area hospitals, Medicare paid a Denton, TX hospital $10,461. By comparison, for the same treatment, Medicare paid an Irving, TX hospital $4,164.
Why the difference? There are many factors that contribute to the reasons that there are different payments to different medical centers and hospitals for various operations and procedures. A couple of factors that impact price and payments are whether a hospital is a teaching hospital, which incurs more expenses because of the teaching aspect, which can be costly. A second factor can be the financial implications if a hospital treats a high percentage of low-income patients. This becomes a factor because statistics show that often these hospitals are paid less because they depend on Medicare/Medicaid payments which are usually lower than insurance company payments or private payment.
In addition, because of being limited in coverage and finances, low income individuals and/or families often have poorer health.
One of the areas that the site comparing hospitals addresses, is the quality of care in hospitals. For instance, Baylor’s Heart and Vascular Hospital is listed as best at giving patients antibiotics one hour before surgery, following the proven information and statistics that show that doing so saves lives. The site also shows that Baylor has scored high customer satisfaction for is giving patients help and other items that they ask for – quickly – and not making them wait for a long time.
Other areas that the hospital compare program will address are the areas involving chronic lung illness and diabetes. In June, the site will begin reporting the numbers and percentages of deaths from pneumonia, which causes a substantial number of deaths in hospitalizations for many reasons.
There will be more comparisons of diseases and conditions added to the site based on how common the diseases or conditions are and the amount of information available.
If you find yourself in a situation where you may have to go into the hospital, or if you just want to be prepared in case the situation ever presents itself, log on to the hospital compare site at www.hospitalcompare.gov, and compare all the hospitals in your surrounding area. This will tell you how well patients are treated, how well they do after treatment, surgery or other procedures, and which hospitals are being paid how much for the procedure you might be needing. You have information available for free that can help you make one of the most important choices you may ever have to make.
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