The health of 44M seniors is jeopardized by cuts to Medicare lab services

PAMA

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The Protecting Access to Medicare Act (PAMA)

Congress passed the Protecting Access to Medicare Act (PAMA) in 2014 to help safeguard Medicare beneficiaries’ access to needed health services, including laboratory tests. Unfortunately, the U.S. Department of Health and Human Services (HHS) has taken a flawed and misguided approach to PAMA implementation. As a result of the Department’s actions, seniors will face an estimated $670 million in cuts to critical lab services this year alone, leaving the health of 57 million Medicare beneficiaries hanging in the balance.

PAMA cuts will be particularly burdensome to the most vulnerable seniors, such as those in skilled nursing facilities, those managing chronic conditions, and seniors living in medically underserved communities. The American Clinical Laboratory Association has raised significant concerns about the impact of Medicare lab cuts on seniors and their access to lifesaving diagnostics and lab services.

Learn more about the harm posed by these cuts on seniors here. Read the lawsuit ACLA has filed against HHS here.

WHAT’S AT STAKE


In 2016, seniors enrolled in Medicare received an average of

16 individual lab tests per year

Test tubes

People

80% of seniors

have at least one chronic disease and 77% have at least two—successful disease monitoring and management requires reliable access to routine testing

House

1 million

seniors are living in assisted living or skilled nursing homes

Hands

3.5 million

homebound seniors
rely on skilled home health care services

Map pin

An estimated

10 million

seniors live in rural areas

LACK OF ACCESS TO LAB TESTS

can result in undiagnosed conditions, lack of treatment for sick patients, and the failure to monitor and treat chronic conditions before they become worse—
resulting in a decline in overall health and longevity.

The PAMA cuts will also have a broad impact on laboratories across the country. Those that will face the brunt of the cuts are the very labs and providers that are uniquely positioned to provide services—like house-calls, 24-hour emergency STAT testing, and in-facility services at skilled nursing facilities—that are particularly important to seniors who are more likely to be homebound, managing multiple chronic conditions, or living in rural areas that are medically underserved.

 

 

 

 

 

Why the U.S. Needs Medicaid

http://www.commonwealthfund.org/publications/blog/2016/oct/value-of-medicaid?omnicid=EALERT1104254&mid=henrykotula@yahoo.com

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While most news stories about Medicaid focus on states’ decisions on whether to expand eligibility, the collective impact of the program on beneficiaries, health providers and systems, and state economies is rarely discussed. Given the large share of federal funds devoted to Medicaid, it’s reasonable to assume that policymakers on both sides of the aisle will be considering programmatic or financing changes for the program—or both—early in a new presidential administration. To inform that process, it’s helpful to look at the multifaceted role Medicaid plays in our health system.

When it was signed into law in 1965 as an extension of welfare, few would have anticipated Medicaid would evolve into the nation’s largest health insurer, covering nearly 73 million Americans.1 Today, Medicaid is at the center of the American health care safety net, providing benefits to adults and children otherwise unable to afford care—and helping to support and drive innovation in the hospitals and clinics that treat these patients, as well as supporting state economies.

Medicaid provides people with good insurance. While the program can vary somewhat by state, a growing body of evidence finds that Medicaid provides a comprehensive set of benefits as well as strong financial protections. A 2015 analysis of the Commonwealth Fund Biennial Health Insurance Survey suggests that people with Medicaid coverage have better access to health care services, including proven preventive care, and fewer medically related financial burdens than those who lack insurance (Exhibit 1). The same study found that Medicaid enrollees have nearly equivalent access to care as those with private coverage in many areas.

Hospital Observation Care Can Be Costly For Medicare Patients

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

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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.)

Bundled Payments’ Disruptive Effects Detailed

http://www.healthleadersmedia.com/content/HEP-318510/Bundled-Payments-Disruptive-Effects-Detailed

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Mandatory bundled payments for hip and knee surgeries would shutter one in four skilled nursing facilities and trigger “demand destruction in areas such as diagnostic testing, hospital stays, and avoidable readmissions,” says a former CMS official.

Complex observation-status rules complicate patient care

http://www.fiercehealthfinance.com/story/complex-observation-status-rules-complicate-patient-care/2015-04-21

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