Hospital Observation Care Can Be Costly For Medicare Patients

http://khn.org/news/observation-care-faq/

Image result for hospital observation careImage result for hospital observation care

http://khn.org/news/hospital-surprise-medicares-observation-care/

Some seniors think Medicare made a mistake.  Others are stunned when they find out that being in a hospital even for a couple of days doesn’t always mean they were actually admitted.

Instead, they received observation care, considered by Medicare to be an outpatient service. The observation designation means they can have higher out-of-pocket expenses and fewer Medicare benefits. Yet, a government investigation found that observation patients often have the same health problems as those who are admitted.

Medicare officials are working to finalize a notice that will inform patients that they are receiving observation care. That is required under a federal law that went into effect in August, and hospitals will likely begin using the notices in January. Some states already require that patients be told about their status.

More Medicare beneficiaries are entering hospitals as observation patients every year. The number doubled since 2006 to nearly 1.9 million in 2014, according to figures from the Centers for Medicare & Medicaid Services. At the same time, enrollment in traditional Medicare grew by 5 percent.

Here are some common questions and answers about observation care and the coverage gap that can result. (Seniors enrolled in Medicare Advantage should ask their plans about their observation care rules since they can vary.)

There’s a simple fix for Obamacare’s current woes: the public option

http://www.vox.com/2016/8/18/12520820/public-option-health-care-obamacare

THE REALITY IS THAT COMPETITION AMONG PRIVATE INSURERS HAS NEVER LIVED UP TO THE RHETORIC PUT FORTH BY THE INDUSTRY OR FREE MARKET FUNDAMENTALISTS

This week, Aetna announced it would stop selling insurance plans in all but four Obamacare exchanges, the state-run markets set up under the 2010 Affordable Care Act. Aetna, which now covers more than 800,000 people in 15 exchanges, said it had been hemorrhaging money on the plans. (A fight with the government over an acquisition of the insurance company Humana may have played a role, too.)

Aetna’s exit, following similar departures by UnitedHealth and Humana, means that a growing number of US counties — 20 to 25 percent, according to the Kaiser Family Foundation — now have only a single private insurer offering coverage on the exchanges, a development that essentially eliminates consumer choice. One county in Arizona now has no insurers. Even before Aetna’s decision, more than half of state exchanges had four or fewer insurers, with DC, Vermont, Connecticut, and Rhode Island having only two.

It’s enough to make a frazzled health care consumer in one of those feeble markets wish there were another option — perhaps even (dare one say it?) a public option. Does the phrase ring a bell? That’s the health care policy that some policymakers pushed to include in the 2010 law.

CBO: Aging population, drugs driving federal healthcare spending

http://www.healthcaredive.com/news/cbo-aging-population-drugs-driving-federal-healthcare-spending/425062/

The country’s aging population, which is using more Social Security and requiring more Medicare coverage, is driving most of the spending increases, according to the report. Compared to 50 years ago, the number of people who are 65 years old and older has more than doubled, CBO found. As a result, Medicare outlays will remain at about 3% of GDP until 2018 but then increase on an annual basis through 2026.

“Over the next decade, as members of the baby-boom generation age and as life expectancy continues to increase, that number is expected to rise by more than one-third, boosting the number of beneficiaries of those programs,” the report states, adding, “As a result, projected spending for people age 65 or older in three large programs — Social Security, Medicare, and Medicaid — increases from roughly one-third of all federal noninterest spending in 2016 to about 40% in 2026.”

Fewer than one-third of ACOs qualify for Medicare bonuses

http://www.fiercehealthcare.com/payer/cms-acos-generated-466m-savings-2015?mkt_tok=eyJpIjoiTXpNd1lqZGlNR0U1WkRJeCIsInQiOiJLOWhzWGhXZ2FrUHdBMEg5d1VNTnppNTR6TEh5XC9tQjI1bDgxcVlUUWNcL1wvSWt0SkRUck9vYm90K1VuSlZJUGFpQ3RubDhPdjFFTWZFUEF1S3RDTUlpZ0VQbmtJRmYyOVg5ZHk0T3RiUUZYRT0ifQ%3D%3D&mrkid=959610&utm_medium=nl&utm_source=internal

CMSCMS

Fewer than one-third of Accountable Care Organizations qualified for bonuses from Medicare in 2015.

And just 31 percent of ACOs generated savings of $466 million, according to a CMS announcement released Thursday.

CMS and Congress must “take swift and decisive action to solidify the foundation of the Medicare ACO program,” Clif Gaus, CEO of the National Association of ACOs, said in a response (.pdf) to the findings.

The savings were accumulated from 392 Medicare Shared Savings Program participants and 12 Pioneer ACO participants, according to CMS. Total savings grew 13 percent from 2014, when ACOs recognized $411 million in total savings.

The National Association of ACOS “was disappointed not to find stronger financial results that reflect the extensive financial and personal contributions invested by ACOs,” Clif Gaus told FierceHealthcare via email, adding, “the ACO program has strong, bipartisan support and is considered a model for the transition from fee-for-service to value-based payment.”

Pasadena doctor who falsely claimed patients were terminally ill is sentenced to four years for fraud

http://www.latimes.com/local/lanow/la-me-ln-pasadena-doctor-prison-20160824-snap-story.html?utm_campaign=CHL%3A+Daily+Edition&utm_source=hs_email&utm_medium=email&utm_content=33409508&_hsenc=p2ANqtz–KDKuU4PH1yztKbkXarPsY58B6-80M433Uz-u6qd86BDE6zJ4zbv5sPgwskL5rfPSDgOeUJw0jeuHlEK79jrfz4jh2Jg&_hsmi=33409508

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A Pasadena doctor convicted of falsely certifying that more than 79 patients were terminally ill as part of a scheme to bilk Medicare and Medi-Cal was sentenced by a federal judge to four years in prison.

U.S. District Judge S. James Otero also ordered Boyao Huang, 43, to pay $1,344,204 in restitution last week. In May, Huang was found guilty of four counts of healthcare fraud at the conclusion of a two-week trial that centered on a ploy to defraud the government of $8.8 million by making it pay for hospice-related services. Huang could have received up to 10 years in prison for each of the counts.

Eleven ways MACRA will impact your business

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/eleven-ways-macra-will-impact-your-business?GUID=A13E56ED-9529-4BD1-98E9-318F5373C18F&rememberme=1&ts=24082016

The Medicare Access and CHIP Reauthorization Act, known as MACRA, is one of the most significant payment changes since Medicare’s inception in 1965.

“Physicians and other clinicians payments will be at risk, beginning with a plus or minus swing of 4% in 2019, that increases to plus or minus 9% by 2023,” says Chester A. Speed, JD, LLM, vice president, public policy, AMGA.

To be successful under MACRA, providers will have to consider the clinical, financial and cultural changes they need to make to do well under risk, according to Speed.

“And while providers can rightfully say they’ve seen this before in the 1990s, risk, or value-based payments are now written into law and they are here to stay,” he says.

What impact will MACRA have on your organization? We asked experts to tell us.

Presidential election: 4 things managed care should watch

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/presidential-election-4-things-managed-care-should-watch?GUID=A13E56ED-9529-4BD1-98E9-318F5373C18F&rememberme=1&ts=24082016

As the 2016 presidential election approaches, analysts and experts are advising healthcare executives to watch and monitor certain issues, such as pharmaceutical spending and healthcare reform, which will surely impact the health insurance industry. Here’s a look at what they recommend keeping a close eye on in particular.

New York Hospitals Facing Fiscal Code Blue

http://www.bloomberg.com/politics/articles/2016-08-22/new-york-city-hospitals-seen-unwilling-to-take-stronger-medicine?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=33278487&_hsenc=p2ANqtz–Ua5Q-PC5Hs3i1ni8bTaDNOfHhzF8R8meSEL9ZdWL6LejSQMUC3wLCDN9J_cuBB9IHRmZmF7BdmyqhMlNtFPa8KBOrzA&_hsmi=33278487

New York City’s public hospitals are in critical condition with rising costs and plummeting revenue. There’s no dispute about that diagnosis. The problem is with Mayor Bill de Blasio’s proposed cure, according to health policy makers, hospital administrators and budget watchdogs.

As NYC Health + Hospitals President Ram Raju describes it, the largest U.S. municipal-healthcare provider is an ailing system of 11 hospitals that’s losing revenue because of increased competition from non-profit hospitals for Medicaid patients and drastic cuts in federal and state aid for indigents.

His prescription: shift its 40,000-plus employees into a system of neighborhood clinics and transform campuses into affordable housing and long-term care, build enrollment of its MetroPlus insurance plan and persuade federal and state governments to spend more. That aid is projected to fall by almost $1 billion -– from $2.2 billion in FY16 to $1.4 billion in 2020.

Drug and Device Makers Pay Thousands of Docs with Disciplinary Records

http://www.healthleadersmedia.com/physician-leaders/drug-and-device-makers-pay-thousands-docs-disciplinary-records?spMailingID=9400653&spUserID=MTMyMzQyMDQxMTkyS0&spJobID=981898992&spReportId=OTgxODk4OTkyS0

Physicians whose state boards have sanctioned them for harming patients, unnecessarily prescribing addictive drugs, bilking federal insurance programs, and even sexual misconduct nonetheless continue to receive payments for consulting, giving talks about products, and more.

Cut Healthcare Spending or Face the Public Option

http://www.healthleadersmedia.com/finance/cut-healthcare-spending-or-face-public-option?spMailingID=9394331&spUserID=MTMyMzQyMDQxMTkyS0&spJobID=981810720&spReportId=OTgxODEwNzIwS0#

“If we don’t get a handle on spending at some point, we will have a government-financed system,” predicts the head of the Pacific Business Group on Health.”