Medicare officials have just announced rate increases in prescription drug premiums for beneficiaries in stand-alone Part D plans. Starting next year, the average monthly premium will mean $3 more per month for beneficiaries out of pocket. CMS is quick to buttress news of this increase with the acknowledgement that the popular program continues to function in the financial black.
There are three reasons behind the premium increase, [Kerry Weems, acting administrator of the U.S. Centers for Medicare and Medicaid Services] said.
“First, there is a trend in prescription drug cost growth generally — prices tend to increase because of price increases for existing drugs, the growth in the average number of prescriptions per person, and the introduction of new drugs,” he said.
Second, the 2008 premiums were calculated as part of a demonstration project that has now expired. This project resulted in premiums being 50 cents less in 2008 than had been projected.
“That change is now reflected in the 2009 premium,” Weems said.
Third, drug distributors participating in Part D have found coverage for catastrophic care to be higher than expected. “So they have adjusted their 2009 bids to reflect those higher-than-anticipated costs,” Weems said.
According to a recent poll commissioned by a prominent health insurance lobby, the percentage of Medicare beneficiaries satisfied with their Medicare Part D coverage approached 87%, and that 75% spent less on formulary drugs after Part D was enacted in 2006.
Did someone forget to tell Rep. Dennis Kucinich this?
Rep. Dennis Kucinich (D-Ohio) recently introduced a bill that would replace the Medicare prescription drug benefit with a new program in an effort to reduce costs, CQ HealthBeat reports. The legislation would require Medicare to negotiate directly with pharmaceutical companies for discounts on prescription drugs and eliminate copayments, premiums and deductibles for medications for beneficiaries.
Just how healthy is the healthcare marketplace? If you ask the insurance companies, business couldn’t be brisker, even if it involves fraudulent activity cloaked within the invisibility of the homeless. Just ask the CEO of a Los Angeles County hospital.
FBI agents arrested Rudra Sabaratnam, 64, the owner and top executive of a hospital, and Estill Mitts, 64, the operator of a homeless “assessment center” in the city’s Skid Row area. They enticed homeless people with the promise of payments to act as hospital patients, an indictment alleges. The homeless people are said to have received medical treatment, and the government was billed for the services. The unnecessary hospital treatments were then billed to Medicare and Medi-Cal in a scheme that began in August 2004 and lasted until about October 2007, the indictment states.
[Medicare Policy] — Posted by Michael Douglas, MD, MBA on 4 August 2008 at 5:04 PM
NEWSFLASH: Medicare has just approved the sale of durable medical equipment maintained by fake supply companies set up by the FBI. The GAO provided false statements to CMS to cover products such as wheelchairs and lifts, eventually billing them for almost 4.5 million dollars for non-delivery. The companies pocketed just under half that amount. Sounds like a pretty cruel joke. Actually the prank was a sting operation of sorts concocted by the FBI to “trap” Medicare into making payments in an effort to uncover gaps in the way it processes claims. Looks like they hit paydirt. Thank goodness this time taxpayers aren’t responsible for the tab. | LINK
It’s a familiar refrain, and one Minnesota senator is making it this time; that is, the call for certain reform of the Medicare payment reimbursement system. In an op-ed, the Democratic senator pushes quality over quantity as the sole parameter for the assignment of Medicare dollars. Although the concept is familiar, Sen. Amy Klobuchar argues, the aggressive adoption of quality claims reporting will result in streamlined payments for “standards of care” which can be applied equally in disparate care settings.
Making Medicare a purchaser of quality, rather than just an indiscriminant government guarantor of entitled healthcare to certain patient populations is a step in that direction, according to Klobuchar. The problem is — this is known already. The initial fixes must reach beyond establishing vague quality parameters to stimulate change among those on the frontlines of healthcare quality — the physicians. Adoption by this critical segment of healthcare delivery in this country will be hard to achieve without discrete, concrete goals. Unfortunately, for the providers on the front lines of healthcare (primary care), getting paid is the immediate quality concern. | LINK
In an effort to assuage the increasing antipathy of medical lobbyists and physicians against the recent GOP-led campaign to enforce Medicare reimbursement cuts to healthcare providers, Republican leaders recently held a private meeting with top healthcare thought leaders to mend a relationship which has increasingly favored Democrats as of late. The last time Republicans seemed as though they were in the good graces of the medical leadership community was in 2003, when George W. Bush held his own against those in the medical provider cohort who were being bruised by unfair tort practices nationwide. That was also the year in which bold GOP initiatives were easily passed and yielded, among other things, a complete overhaul in how the government, Pharma, and patients later obtained prescription medications — under Medicare Part D.
However, recent spikes in the number of uninsured and a general sense of healthcare management malaise on the part of legislators on both sides of the ideological divide have made a tenuous relationship even more fragile. Can the Republicans make it up to physicians this time?
In the run-up to the 2006 midterm elections, doctors and the groups that represent them gave 62 percent of their combined $52.4 million war chest to Republicans, compared with 37 percent to Democrats, according to the Center for Responsive Politics. That breakdown mirrors previous cycles since Bush entered the White House. But since 2006, doctors and related groups have given Democrats 53 percent of their combined $53 million in campaign contributions, according to the watchdog group. The switch is even more stark for the AMA. In the run-up to the 2006 election, the AMA’s political action committee gave Republicans 70 percent of its campaign cash, according to the Center for Responsive Politics. In 2004, the AMA’s PAC contributed 80 percent of its total donations to Republican lawmakers and candidates. Since 2006, that PAC has directed 53 percent of its contributions to Democrats.
If the current state of re-election possibilities continues to wane for the GOP, don’t bet on it. | LINK
For all of its perceived blessings and shortcomings, here’s one thing everyone can agree on when it comes to Medicare legislation. The government guarantor of healthcare to the elderly turns 43 today. On July 30, 1965, Lyndon Johnson signed the bill into law, capping a movement of healthcare reform that — up until that point — pitted the medical establishment against the need to address the growing burden of healthcare costs in a rapidly and technologically evolving medical environment. No one benefited sooner than recent former president Harry Truman as the program’s first recipient of services. | LINK
It’s inevitable. Electronic prescribing may be a early-adopter niche-driven tech blip on the EHR tableau, but it is here to stay; and the government is getting in on the act. Medicare will now provide incentives for physicians who wish to incorporate this method of prescribing into their practices. Makes sense. The days of physicians getting a free pass on illegible prescriptions and healthcare’s expectations of working within this potentially dangerous construct are numbered — from a patient safety standpoint. | LINK
It looks like the state of Louisiana gets it. As the discipline of primary care medicine becomes known more for cuts in Medicare and Medicaid reimbursements than for treatment and prevention of disease, the state — whose brush with hurricane Katrina in 2005 has done more for its sense of healthcare activism than in many other southern states — is being proactive in overhauling its healthcare delivery systems to its un- and underinsured. How is Louisiana approaching primary care reform? By lobbying hard for government pilot projects that emphasize parity among provider networks in the delivery of chronic disease management, while giving traditional fee-for-service Medicaid programs a run for their money. | LINK
[Medicare Policy] — Posted by Michael Douglas, MD, MBA on 15 July 2008 at 12:17 PM
Today, the president is expected to veto the current law (passed by the Senate last week) which prohibits a projected 10.6% cut in Medicare reimbursements to physicians. This much is certain. A congressional override appears to be certain, also. What seems to be clear is that the fight between sides in this important issue will continue. What is less apparent, however, is what passage of the bill would ultimately mean for healthcare costs to the taxpayer over the next five to ten years.
Unsurprisingly, the Democrats are accused of being shortsighted by the Repubs — that grabbing the “low hanging fruit” of stabilized reimbursement doesn’t compensate for projected increases in overall Medicare covered healthcare costs yet to come. Of course, the Democrats are hurling barbs at the Republicans who criticize the bill’s “loophole” provision allowing for the influence of lobbyists on currently restricted formularies under Medicare Part D. Confused yet? | LINK
UPDATE: Both houses of Congress wasted no time in promptly overriding President Bush’s veto. | LINK
With organized medicine promoting the popular measure in an election year, Republicans broke heavily from the White House. A total of 153 House Republicans voted to defy the White House, an additional 24 Republicans from a June 24 vote that started the momentum toward passage of the Medicare doctors’ bill Tuesday. Twenty-one Senate Republicans voted for the bill this time, including four senators who had voted “nay” in the two previous Medicare votes.
As many are expecting the fate of a recent bill blocking cuts in Medicare reimbursements to physicians to head straight to veto, pundits from the healthcare policy sphere debate what the intended goals of its passage would have brought (or, will bring) to the overall business of healthcare. Will shifting payments from physicians to payers give seniors more choice in their healthcare, as Republicans suggest; or, will this action limit access to care because of physician disenrollment — a concern of Democrats? | LINK
Sen. Edward Kennedy added even more drama to the bill that aims to cut Medicare reimbursements to physicians.
Casting his vote so that the bill blocking those pending cuts passed the Senate proved to be, at the very least, a symbolic victory….that is, until it gets to George W Bush’s desk where he has promised to veto it. Now, even if the President proceeds with a promised veto, the Democrats can claim they saved the day for 44 million seniors on Medicare and fault Republicans for not being sufficiently interested in the health care needs of elderly Americans.
That may suit the party’s purpose in the upcoming election, but the reality is far more complicated. Kennedy’s vote doesn’t automatically fix the troubled government healthcare guarantor; it merely opens a window into what may be just around the corner if universal healthcare financed completely by the government becomes reality: Congress becomes the arbiter of those health care budgets, every special interest group – including doctors – will press for higher payments, without fail. And experience tells us, Congress won’t have the courage to resist. Chaos? You bet. | LINK
[Medicare Policy] — Posted by Michael Douglas, MD, MBA on 8 July 2008 at 11:03 PM
It’s a scam whose backstory is so irresistible, it could have come straight from a Robin Cook novel. I can see the Publisher’s Weekly review already: “Medicare scammers will stop at nothing to pillage senior citizens whose only fallibilities arise out of their naive trust in our current overburdened healthcare system. The loathsome miscreants are so adept at their crimes, the services their elderly victims trust to be delivered with their very lives come courtesy of physicians who, in a cruel irony, have already given their life to the practice of medicine….”
According to a recent poll commissioned by a prominent health insurance lobby, the percentage of Medicare beneficiaries satisfied with their Medicare Part D coverage approached 87%, and that 75% spent less on formulary drugs after Part D was enacted in 2006.
It’s a familiar refrain, and one Minnesota senator is making it this time; that is, the call for certain reform of the Medicare payment reimbursement system. In an op-ed, the Democratic senator pushes quality over quantity as the sole parameter for the assignment of Medicare dollars. Although the concept is familiar, Sen. Amy Klobuchar argues, the aggressive adoption of quality claims reporting will result in streamlined payments for “standards of care” which can be applied equally in disparate care settings.
It looks like the state of Louisiana gets it. As the discipline of primary care medicine becomes known more for cuts in Medicare and Medicaid reimbursements than for treatment and prevention of disease, the state — whose brush with hurricane Katrina in 2005 has done more for its sense of healthcare activism than in many other southern states — is being proactive in overhauling its healthcare delivery systems to its un- and underinsured. How is Louisiana approaching primary care reform? By lobbying hard for government pilot projects that emphasize parity among provider networks in the delivery of chronic disease management, while giving traditional fee-for-service Medicaid programs a run for their money. | 