Medicare News

Time to Prepare for Medicare’s Open Enrollment Season – Original or Advantage?

Medicare Rights Center outlines things senior citizens should consider

Sept. 17, 2007 - It’s fall again, the season when health insurance companies begin marketing Medicare private health plans. Each year, from November 15 to March 31, everyone with Medicare has the option to change their Medicare coverage, either to Original Medicare or to one of the private health plans known as Medicare Advantage plans. Read more...

Congress Must Standardize Medicare Private Health Plans like Medigap Plans

Report by consumer groups says it will help informed consumer choices

Sept. 17, 2007 -  Congress must require that the dizzying array of benefit packages available through Medicare private health plans be standardized, to help Americans with Medicare make informed decisions about choosing a health plan and to protect them from unexpected, high out-of-pocket costs, according to the California Health Advocates and Medicare Rights Center in a new report. Read more...

Inequities for Poor, Minorities in Medicare’s Private Health Plans, Report Says

Medicare Rights Center says payments to private health plans don’t make sense

Sept. 10, 2007 - Low-income people enrolled in Medicare private fee-for-service plans pay more for their health care in some counties than people enrolled in the same plans in neighboring, more affluent counties, according to a new Medicare Rights Center report. Read more...

Results Published on Efforts to Reduce Drug Errors Among Medicare Patients

State-by-state report on QIOs published in Managed Care

Sept. 7, 2007 – Reducing the number of deaths among Medicare patients from adverse drug events is a goal of the Quality Improvement Organizations and a report on their progress has just been published. The state by state details of how America’s QIOs are working in partnership with Medicare Part D prescription drug plans (PDPs) and Medicare Advantage plans (MA-PDs) to improve the quality of prescription drug therapy for Medicare beneficiaries are reported in a supplement to the July/August Journal of Managed Care Pharmacy. Read more...

New Medicare Rule to Stop Physicians from Referring Patients to Businesses Where They Profit

Final step of physician self-referral prohibition known as the Stark law

Aug. 28, 2007 – The Centers for Medicare and Medicaid Services today issued final regulations prohibiting physicians from referring Medicare patients for certain items, services and tests provided by businesses in which they or their immediate family members have a financial interest. Read more...

National Effort to Improve Health of Hispanic Elderly Begins in Eight Cities

More Medicare participation and diabetes care are major targets

Aug. 24, 2007 – Eight communities – mostly large metropolitan markets – have been selected to participate in a Health and Human Services pilot initiative aimed at improving the health and quality of life for Hispanic senior citizens. Read more...

Medicare’s Refusal to Pay Hospitals for Their Own Mistakes Draws Editorials

When an auto mechanic breaks one part while fixing another, would you pay for it?

Aug. 24, 2007 - Not only do hospitals use their financial muscle to get state and federal lawmakers to protect them from law suits brought by the errors they commit, they also want Medicare and insurance companies to pay their bills, even if the cost was due to their mistake. Medicare has said no more and the insurance industry may do the same. The action drew mostly praise from U.S. newspapers. Read more...

Medicare Will Not Pay for Preventable Conditions Acquired at Hospitals

Most notable are infections; insurance companies may follow suit

Aug. 20, 2007 - Medicare no longer will reimburse hospitals for the treatment of preventable errors, injuries and infections that occur in the facilities under a new rule scheduled for publication this week, a move that CMS officials said could save lives and millions of dollars, the New York Times reports. Read more...

Senior Citizens Deceived by Medicare Private Health Plans Can Leave Plans

Medicare Rights Center says CMS fails to explain disenrollment

Aug. 6, 2007 - People in private Medicare health plans can disenroll from their plans if they signed up after receiving misleading information, according to the Centers for Medicare and Medicaid Services (CMS). To date, however, neither CMS nor the insurance companies that operate Medicare private health plans have informed people enrolled in these plans that they can leave if they were duped into signing up. Read more...

Senior Citizens Turning to Internet for Medicare, Medicaid Information

'Telehealth' gap could be narrowing for older, poorer Americans

Aug. 3, 2007 - Despite fears that the elderly and poor might be missing out on health information on the Internet, a new study shows that those most in need are bridging the telehealth gap. In fact, older and poor Americans are likely to use the Internet to seek out Medicare and Medicaid information, according to researchers Mary Schmeida. Ph.D., and Ramona McNeal, Ph.D. Read more...

Senior Citizen Alerts

Medicare Advantage Plans by America’s Health Choice Terminated in Florida

Centers for Medicare & Medicaid Services cite delays and denials

July 25, 2007 - CMS on Friday terminated Medicare Advantage plans run by America's Health Choice of Vero Beach, Fla., citing delays and denials of medical care, the South Florida Sun-Sentinel reports. The termination, which affects about 12,000 beneficiaries, is the first CMS has made for quality-of-care reasons. Read more...

Fraud of Senior Citizens by Home Health Agencies is Target for Government Initiative

Initial efforts to focus on Greater Los Angeles and Houston areas

July 17, 2007 – An alarm about fraud of senior citizens by home health care providers was raised today by an announcement that Health and Human Services will begin an initiative designed to protect Medicare beneficiaries from fraudulent Home Health Agency (HHA) providers. Read more...

Medicare Declares Major Success in Project Treating Costly Chronic Disease

University of Michigan saved CMS $3.5 million and improved care

July 12, 2007 – One out of four senior citizens in Medicare suffers with five or more chronic conditions and they account for 68 percent of Medicare spending. Medicare declared yesterday that all participating physician groups participating in a demonstration project aimed at better managing the health care of those with these chronic conditions have improved the clinical management of diabetes patients in the first year of the three-year Medicare Physician Group Practice (PGP) Demonstration. Diabetes is a major chronic disease among seniors. Read more...

Lowering Age for Medicare May Help Offset Later Cost of Caring for Uninsured

Older adults with chronic disease but no previous insurance are costly to Medicare, study finds

July 11, 2007 – A new study suggests that lowering the age to become covered by Medicare would be at least partially offset by avoiding the additional cost for the government of caring for those with serious chronic disease that had no insurance before reaching age 65 and joining Medicare. It may also suggest the value of some other national health care program that would assure adequate care for people in the earliest stages of their illness. Read more...

Disenrolling From Medicare Advantage Plans Difficult for Many Senior Citizens

Medicare Rights Center: no effective, seamless process to do so

July 11, 2007 - The AP/Lexington Herald-Leader on Monday examined problems experienced by Medicare beneficiaries who try to switch their private Medicare Advantage health insurance plans. "[H]undreds" of elderly residents have contacted the Medicare Rights Center because they cannot disenroll from a private MA plan purchased "as a result of misleading sales tactics," according to the AP/Herald-Leader. Read more...

Fraudulent Medicare Practices by Medical Equipment Suppliers Targeted by HHS

South Florida and Southern California are focus of effort

July 10, 2007 - A two-year effort designed to further protect Medicare beneficiaries from fraudulent suppliers of durable medical equipment, prosthetics and orthotics supplies (DMEPOS) was announced today by Mike Leavitt, Secretary of Health and Human Services. The initiative is focused on preventing deceptive companies from operating in South Florida and Southern California. Read more...

Medicare, Medicaid to Consume 20% of Gross National Product by 2050

Medicare Advantage subsidy making problem worse: Director Congressional Budget Office

June 22, 2007 - Congressional Budget Office Director Peter Orszag on Thursday at a hearing of the Senate Budget Committee said that federal spending on Medicare and Medicaid would increase from about 4.5% to about 20% of U.S. gross domestic product by 2050, CongressDaily reports. Read more...

Senior Citizens Can Now Learn More about Local Hospital Services

Medicare improves Hospital Compare tools; adds new information on cost of elective hospital procedures

June 21, 2007 – The Centers for Medicare & Medicaid Services today unveiled a new version of the Hospital Compare Website that the agency says gives senior citizens and other consumers better insight into the quality of care provided by their local hospitals. CMS also announced the first annual update of pricing and volume information for certain elective hospital procedures is online. Read more...

AARP Finds Minorities Not Taking Full Advantage of Medicare Services

Many senior minorities passing up free flu, pneumonia shots

June 21, 2007 – African-Americans nor Hispanics take advantage of Medicare’s free flu and pneumonia immunization at any where near the rate of their white senior citizen counterparts, although, these shots can be life-saving. The statistics were revealed today by AARP at is Diversity and Aging n the 21st Century Conference in Los Angeles. Read more...

Medicare to Help Senior Citizens Better Manage Their Health Care Online

Pilot program to test the use of personal health records online

June 21, 2007 – A pilot program aimed at encouraging senior citizens to take advantage of Internet-based tools to track their health care services and to provide them with other resources to better communicate with health care providers, was announced yesterday by Medicare. Read more...

Bariatric Surgery Appears as Safe for Selected Medicare Patients as Other Adults, Despite Deaths

Study says ‘surgery should not be denied solely based on age or Medicare status’

June 18, 2007 – When Medicare began covering bariatric surgery for severe obesity, there was an alarming number of deaths reported. A new study, says, however, that complications after the surgery appear to be similar between Medicare recipients and non-recipients. They also conclude problems are the same for those under age 60 as for those passed 60. Read more...

Congress Advised to Cut Subsidy to Medicare Advantage Fee-For-Service Plans

Voluntary suspension of marketing the plans warmly received in Washington

June 18, 2007 – On Friday, seven health insurance companies under fire for the tactics they were using to convince senior citizens to buy their Medicare Advantage fee-for-service plans agreed to stop their marketing until corrections can be made. KaiserNetwork.org today looks at the reactions and also reports that the Medicare Payment Advisory Commission on Friday sent a report to Congress recommending equalization of reimbursement rates for private Medicare Advantage plans that are heavily subsidized by the government. Read more...

Medicare Advantage Fee-For-Service Plans Pledge to Correct Marketing Ahead of Schedule

President of America's Health Insurance Plans issues statement

June 16, 2006 – The seven insurance companies that voluntarily suspended the marketing of their Medicare Advantage fee-for-service plans in an agreement with the Centers for Medicare and Medicaid Services have pledged to correct their questionable marketing tactics "ahead of schedule," according to a statement from the president of the leading association of insurance companies. Read more...

Seven Companies Suspend Marketing Medicare Advantage Fee-For-Service Plans

CMS lays down ‘strict guidelines’ to stop deceptive marketing

June 16, 2007 - Seven companies have agreed to voluntarily suspend the marketing of their Medicare plans known as Private-Fee-For-Service plans, according to the Centers for Medicare and Medicaid Services. The action late Friday comes months after senior citizens, advocacy groups and members of Congress began complaining about the marketing tactics of these private insurance companies. CMS responded with an investigation that included a “secret shopper” program to learn the marketing tactics of the companies. Read more...

Hispanic Senior Citizens Urged to Use Medicare More by New HHS Program

Hispanic elderly falling behind non-Hispanic whites in health, study finds

June 15, 2007 – Studies find a growing disparity between the health of Hispanic senior citizens and the non-Hispanic white elderly population. Several agencies within Health and Human Services have joined together to launch a program to encourage Hispanic elders and their families to take advantage of more Medicare benefits, including prescription drug coverage, flu shots, diabetes screening and self-management, cardiovascular screening, cancer screening services and smoking cessation programs. Read more...

Senior Citizens' Medicare Bill Could Quadruple by 2020 as Boomers Join, Says Medicare Trustee

Restrictions on health care spending can reduce Medicare debt up to 40,   says study for private enterprise think tank

June 13, 2007 - Medicare's costs are rising so rapidly that substantial tax increases, benefit cuts, or a combination of the two will be necessary, says a Medicare trustee in a study published by a non-profit group that advocates entrepreneurial private sector alternatives to government regulation and control. If senior citizens bear the burden, monthly premiums in constant dollars would have to more than quadruple by 2020. Read more...

Oncologists Criticize Proposal to Reduce Medicare Pay for Anemia Medications

CMS is accepting public comments on the proposal until June 13

June 8, 2007 - A number of physicians attending the American Society of Clinical Oncology annual meeting in Chicago this week expressed concern that CMS "has gone too far" with its proposal to limit Medicare reimbursements for the treatment of cancer patients with anemia medications manufactured by Amgen and Johnson & Johnson, Dow Jones reports. Read more...

Little Care Improvement by Hospitals in Medicare Pay-for-Performance Program

Bonuses of $17.6 million were awarded to 238 hospitals in two years

June 6, 2007 - Hospitals participating in a Medicare pay-for-performance pilot program were not significantly more likely than non-participating hospitals to provide better treatment, according to a three-year study published in the Journal of the American Medical Association, the Wall Street Journal reports. Read more...

AMA Survey Says Physicians Won't Take Medicare Patients if Pay Gets Cut

Campaign to stop physician payment cuts says senior citizens lose

June 4, 2007 - Medicare patients’ ability to get in and see the doctor will be severely hampered next year by a steep Medicare cut to physicians, according to a new survey released today by the American Medical Association (AMA). Read more...

Hospital Groups Outraged with Medicare Rule They Say Will Reduce Pay Increase

‘Back-door budget slashing’ and would cost hospitals $2.4 billion

June 4, 2007 - Hospital associations are "in a state of outrage" over a Medicare rule proposed by CMS that they say would reduce a scheduled increase in hospital reimbursements by assuming hospitals will "game the new system," the Philadelphia Inquirer reports. Read more...

Debate over Reducing Medicare Advantage Plan Payments Continues

CMS Administrator says they offer better preventive health benefits than traditional Medicare

May 30, 2007 - Lawmakers continue to debate whether to reduce federal payments to private insurers that administer the fastest-growing type of Medicare Advantage plans -- private fee-for-service plans, the AP/Atlanta Journal-Constitution reports. Read more...

Congress, AMA, Advocates All Targeting Medicare Advantage Private Fee-for-Service Plans

AMA says most members report their patients were denied coverage

May 24, 2007 – The spotlight in Congress and in Medicare advocacy circles is increasing the focus on problems in the Medicare Advantage Private Fee-for-Service Plans. A powerful House member says he wants to cut the questionable high fees paid to these plans and the American Medical Association released a survey saying most of the physicians report that their patients in a Medicare Advantage HMO or PPO plan were denied coverage of services typically covered in the traditional Medicare. Read more...

Understanding of Medicare Advantage Private Fee-for-Service Gained from New Report

Center for Medicare Advocacy finds problems with access, consumer protections

May 24, 2007 – A timely new report from the Center for Medicare Advocacy describes the Medicare Advantage Fee-for-Service Plans, the rules and regulations in which they operate and compares these to those for other Medicare Advantage (MA) plans. It also reviews PFFS plans in three states and compares the cost-sharing expense with traditional Medicare and with traditional Medicare plus a Medigap policy. Read more...

Hospital Death Rates for Heart Attack, Failure in Medicare Patients to be Published by CMS

Centers for Medicare & Medicaid Services provides seniors 'Hospital Compare'

May 24, 2007 - CMS in June will post the first broad comparison of hospital mortality rates for heart attack and heart failure in Medicare beneficiaries on the Hospital Compare Web site, USA Today reports. Hospital mortality rates currently "are among the best-kept secrets in American medicine" and remain "closely guarded," according to USA Today. Read more...

Medicare Advantage Marketing Tactics Get Scrutiny of Senate Aging Committee

Chairman Kohl notes some plans have announced reforms

May 16, 2007 – Amidst growing concern about the aggressive marketing tactics of Medicare Advantage plans, the Senate Select Committee on Aging held a hearing today that shed new light on the problem from the point of view of the senior citizen consumer, the Centers for Medicare and Medicaid and the insurance companies. Read more...

CMS Questions Marketing Tactics of Medicare Advantage Plans

They fail to tell seniors they are not 'traditional' Medicare

May 8, 2007 - The Wall Street Journal on Tuesday examined how Medicare Advantage private fee-for-service plans are "coming under increasing fire" from CMS officials "worried about tactics used to market them" and from lawmakers who believe the plans receive "exorbitant government payments." Read more...

Medicare Rights Center Finds Problems with Care from Private Health Plans

Advocacy group calls for Congress to end the 'Overpayments'

April 30, 2007 – Senior citizens and disabled Americans discover a host of problems, including unanticipated costs and barriers to getting care, when they get sick and need care through their Medicare private health plans, according to a new report from the Medicare Rights Center. Read more...

Medicare Trustees Annual Report Requires Response from Bush on Funding Problem

Second year projecting over 45% must be funded by general revenues

April 23, 2007 – The Medicare Trustees released their annual report today, which as expected, projects program costs financed by general revenues, rather than dedicated revenue, are expected to exceed 45% in 2013. Because this was the second consecutive year of such a projection, it triggers a funding warning that requires President Bush to propose legislation to respond to the issue within 15 days following the release of the Fiscal Year 2009 Budget, which will be in early February, 2008. There were pieces of good news, however, including cost projections for the Part D drug program that are 13% lower than last year. Read more...

Medicare Proposes Adjusting Hospital Payments Based on Severity of Illness

Specialty hospitals are a particular focus of the proposal

April 16, 2007 - CMS on Friday announced a proposed rule that would increase the Medicare inpatient reimbursement rate for hospitals that report data on quality of care to the agency and base payments on the severity of beneficiaries' illnesses, CQ HealthBeat reports. Read more...

Medicare Commission Wants Independent Research on Services

Also calls for reducing confusion on drugs covered in Part D

April 16, 2007 - The Medicare Payment Advisory Commission on Thursday voted to include a recommendation in a June report to Congress that lawmakers "charge an independent entity to sponsor credible research on comparative effectiveness of health care services and disseminate this information to patients, providers and public and private payers," CQ HealthBeat reports. Read more...

Medicare Opinion

Three Cheers for Medicare Abdominal Aortic Aneurysm Screenings

Astounding 80% of AAA found in men, mostly over age 55

By Barry Thomas

April 12, 2007 - Each year, nearly 200,000 people in the United States are diagnosed with abdominal aortic aneurysms (AAAs), a life-threatening, yet typically asymptomatic, weakness in the wall of the aorta. AAA is a disease that occurs when the walls of the aorta, the body’s largest blood vessel, weaken and expand.  Over time, the aneurysm may continue to grow.  If this happens, the aorta’s walls can become thin and lose their ability to stretch. Read more...

Medicare News

Medicare Gives SHIPS $30 Million in New Funds for Local Counseling

State programs provide local personalized counseling on health programs, insurance

April 11, 2007 - State Health Insurance Assistance Programs (SHIPS), which grew in prominence following the funding of the Medicare drug program, will receive $30 million in new grant funds from the Centers for Medicare and Medicaid Services. SHIPS provide free personalized counseling to senior citizens and disabled persons about health insurance and health programs. Read more...

Medicare Releases Quality Measures for Physician Bonus Program

Physician Quality Reporting Initiative will include 74 measures

April 5, 2007 - The Centers for Medicare and Medicaid Services took a big step forward this week in the 2007 Physician Quality Reporting Initiative, which will pay bonuses for voluntary reporting, by publishing the detailed specifications for the 74 measures to be used. Read more...

New Medicare Bidding Process to Provide Seniors Better Quality, Prices

For certain durable medical equipment, prosthetics, orthotics, and supplies

April 2, 2007 - The Centers for Medicare & Medicaid Services (CMS) yesterday issued a final rule that will reduce beneficiary out-of-pocket costs, improve the accuracy of Medicare’s payments for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), help combat supplier fraud, and ensure beneficiary access to high quality DMEPOS items and services through a new competitive bidding program. Read more...

Senior Citizens May Gain More Access to Temporary Mechanical Hearts

Medicare changes rules that should gain approval for more hospitals

March 30, 2007 – Senior citizens may have greater access to temporary mechanical hearts due to action by the Centers for Medicare & Medicaid Services (CMS) today that should help additional hospitals become Medicare approved for ventricular assist device (VAD) implantations. Read more...

Medicare '45 Percent Rule' Attacked by Families USA Before Annual Trustees Report

Health care consumer advocates fear drastic action to be triggered by 'faulty rule'

March 29, 2007 – Anticipating drastic actions that will impact people on Medicare resulting from the Medicare Trustee's annual report due to be released by May 1, the Families USA organization has released a report detailing why the "45 percent threshold" has no "real significance." Current law mandates the government take corrective action when the trustees project that 45% of the program must be financed by the general fund. Read more...

Medicare Tightening Rules for Transplant Center Approvals

Goal to ensure effective oversight of transplant centers

March 23, 2007 – Transplant centers will face tighter acceptance regulations on approval of a final rule published today at the Office of the Federal Registry by the Centers for Medicare & Medicaid Services. Read more...

Medicare Advocacy Center Says Check Social Security 1099 Carefully

Problems in 2006 prompt warning from advocacy group

March 21, 2007 - Medicare beneficiaries with Social Security income have been receiving their Social Security 1099 forms, which report income received in 2006 and deductions taken from that income, including Medicare premiums. The Medicare Advocacy Center says senior citizens should check them carefully, based on bad experiences in 2006. Read more...

Two Medicare Enrollment Periods Will Close at End of March

Medicare Advocacy Center offers a guide of the various enrollment periods

March 19, 2007 – Two open enrollment periods for Medicare will close at the end of March – the General Enrollment Period for those who did not add Part B earlier, and the Open Enrollment Period for those who want to enroll, cancel or change a Medicare Advantage Plan. The Medicare enrollment periods have become extremely confusing for many senior citizens but, below, the Medicare Advocacy Center attempts go provide an understandable road map. Read more...

Medicare Reacts to 'Black Box' Warning About Anemia Medicines by FDA

Chance of serious, life-threatening side effects found with ESAs

March 15, 2007 - An alert and health advisory issued by the Food and Drug Administration last Friday has caused the Centers for Medicare and Medicaid Services to begin a review of Medicare policies related to Erythropoiesis Stimulating Agents used in the treatment of anemia. Read more...

Medicare Says California Group Latest to Join Information Sharing Initiative

Physician quality and cost to be made public

March 14, 2007 – A California collaborative is the latest group to join the national network being established by the Centers for Medicare and Medicaid Services to share local data with insurers to produce public reports on physician performance. Read more...

Democrats Consider Eliminating Extra Pay to Medicare Advantage Plans to Raise Physician Pay

Medicare Payment Advisory Commission's report under fire on docs’ pay

March 7, 2007 - Democrats this year are making "concerted efforts" to cut Medicare Advantage payment rates "as a way to finance other spending priorities," such as fixing a scheduled 10% reduction in Medicare physician payments, CQ HealthBeat reports.  Read more...

Senior Citizens in the Middle Again of Fight Between Medicare Advantage Providers and Congress

Medicare Advantage fight a lot like Medicare+Choice debacle

Feb. 28, 2007 – Senior citizens are once again caught in the middle of a funding fight between insurance companies and the federal government over the Medicare Advantage Program, which was known as Medicare+Choice in the last battle in 2003. Today, there are more than eight million seniors enrolled in this program that provides more services at a lower cost than traditional Medicare, but are often more limited in the health care providers available. Congress previously approved $13 billion in cuts for these programs this year and the new Congress is considering even more. The insurance companies are saying this will lead to higher premiums for their senior customers. Read more...

National Network of Local Groups to Monitor Health Care is Launched by HHS

'Value Exchanges' will make quality and cost findings public

Feb. 28, 2007 – Health & Human Services today announced an ambitious program to establish local "collaborative organizations," which will be call "Value Exchanges," to assess the performance of local health care providers and make the findings public. They will use "nationally-recognized standards" to measure and improve quality of care in their areas and will eventually form a nation-wide network, according to HHS Secretary Mike Leavitt. It is the latest move in the government's effort to make health care cost and performance more transparent. Read more...

Medicare Begins Program to Help Seniors Choose Best Quality Doctors

Begins comparing physician performance data with insurance companies

Feb. 15, 2007 – Medicare today announced a program to combine data from insurance companies with that of Medicare patients to produce information on the performance of health care providers, which the Centers for Medicare & Medicaid Services says will "benefit" Medicare beneficiaries by helping them choose the best performing doctors. Read more...

Senior Citizens to See Record Medicare Part B Premium Increase in 2008

For many seniors the jump will be larger than Social Security COLA

Feb. 13, 2007 - Medicare Part B premiums are forecast to increase by $15.90 in 2008, the largest amount in the history of the program, according to a new analysis by TREA Senior Citizens League. Part B covers doctors' visits, tests, and outpatient hospital care. The 2008 Part B premium would represent a 17 percent increase, from the current $93.50 to $109.40 per month. And, for many, this increase will eat up all of the increase from Social Security expected next year. Read more...

Medicare Colon Cancer Screening Misses Many Minorities, Poor, Less Educated

Older patients also less likely to be screened

Feb. 13, 2007 – The expanded Medicare coverage for colorectal cancer screening has made this critical testing equally available to all senior citizens, but, like is often the case in disease screening, minorities, the poor and the less educated are less likely to be screened. And, somewhat surprising, the study found women less likely to get a colonoscopy. Read more...

Senior Citizen Politics

Higher Income Seniors to Pay More for Medicare Drug Plans in New Budget

Higher premiums based on income began this year for Part B

Feb 4, 2007 – Higher income senior citizens will pay higher premiums in Medicare's drug program next year, if a budget proposal by President Bush is approved. It was reported last week that President Bush will propose reducing $70 billion from Medicare and Medicaid in his new budget to be released Monday. The New York Times reports today that one part of the Bush plan is to impose a surcharge on premiums for Medicare’s prescription drug benefit, as he did this year for those in Medicare Part B. Read more...

Medicare News

Medicare Proposes Expanding Coverage for Carotid Artery Stenting

Special restrictions for those age 80 and older

February 2, 2007 - Medicare is proposing to expand coverage for carotid artery stenting to patients who have greater than 80 percent constriction or narrowing of the carotid artery. Medicare is also proposing to restrict coverage for patients who are 80 years of age and older to certain approved procedures. Approximately 70 percent of all strokes occur in people age 65 and older, and it is the third leading cause of death in the United States and the leading cause of serious, long-term disability. Read more...

Senior Citizens with Vision Loss Cost Medicare Billions, Say Ophthalmologists

Eye docs want more emphasis on preventive care by Medicare, insurance plans

February 1, 2007 - Senior citizens with vision problems are costing Medicare more than $2 billion per year in "non-eye related maladies and healthcare needs," says a study in the journal Ophthalmology. The American Academy of Ophthalmology, that publishes the magazine only for its members, responded with a call for Medicare and insurance plans to put stronger emphasis on preventive eye care. Read more...

Medicare Rules Possibly Violated by Agents Selling Fee-for-Service Plans

Medicare releases new pay rates for long-term care hospitals, lawmakers want them certified

January 29, 2007 - Health care advocates say that some insurance agents might have violated Medicare rules by soliciting fee-for-service plans to businesses door-to-door and that some agents are targeting beneficiaries with cognitive problems or limited English skills, the San Francisco Chronicle reports. Read more...

Controversy Develops Over Medicare’s Pay-for-Performance to Hospitals

CMS says improvement ‘substantial,’ study call it ‘modest’

January 29, 2007 – A news release hailing the success of a two-year project to pay hospitals a bonus for better performance was issued by the Centers for Medicare & Medicaid Services last week, but others looking at the results are not so sure of its success. CMS said it was “substantial improvement” but an independent study calls the results “Modest,” despite the $8.7 million paid out. Read more...

Cash Rewards Make Substantial Improvement in Hospital Care Finds CMS

CMS pays out almost $9 million to top hospitals in demonstration

January 28, 2007 – If you want better quality care from hospitals, give them a cash incentive. The Centers for Medicare & Medicaid Services says it has produced "substantial improvement" in a demonstration project it has operated for two years. But, it took a lot of cash - the reward payments have been a whooping $8,690,447 for the 115 top performing hospitals. Read more...

Medicare Solvency Ranked Third in Health Care Priorities by Opinion Leaders

Most want Congress to cover uninsured, reduce health care costs

January 8, 2007 – The top health care priority over the next five years for Congress should be expanding coverage for the uninsured, says a new survey. Reforming Medicare to ensure it's long-term solvency came in third, just below the priority of moderating rising health care costs. The Commonwealth Fund released the survey today of what it says are "leading health care experts." Read more...

Senior Citizen Health & Medicine

Hospital Performance Guidelines for Heart Failure are Failing Senior Citizens

Medicare & Medicaid pay-for-performance programs may not work

January 2, 2007 – It sounds like a good idea. Experts devise a set of performance standards for hospitals that, if followed, are expected to assure better results in the treatment of the 3.6 million senior citizens hospitalized each year with heart failure. Since this is the leading cause of hospitalization for senior citizens covered by Medicare, it makes sense for Medicare to pay a little more to the hospitals willing to use the standards. But, like many good ideas, this one, too, has run into a problem - four of five hospital performance measures for heart failure do not appear to accurately reflect the quality of care provided. Read more...

Medicare News

More Senior Citizens Diagnosed at Earlier Stage of Colon Cancer Due to Medicare Screening Coverage

About 60,000 cases of colorectal cancer annually among senior citizens

December 20, 2006 – Although it makes logical sense, it is good to have hard evidence that since Medicare raised the amount it will reimburse for colon cancer screening in 1998, there has been an increase in use of colonoscopies by Medicare beneficiaries, and a rise in the proportion of patients being diagnosed with colon cancer at an early stage, when it is most treatable. Read more...

Final Bill of this Congress Saved Physicians from Big Medicare Pay Cut

AMA says it will help avert a potential sharp decline in access for America’s senior citizens

December 10, 2006 – Sometime shortly before 4 a.m. Saturday the Congress finally managed to pass legislation that will stop Medicare from cutting what it pays physicians. On January 1, a 5.1 percent pay cut was to take affect. The measure passed by large margins in both the senate and house but was packaged with a number of other items the congressional leadership wanted to get passed before this Congress ended. Read more...

Docs Still Face Medicare Pay Cut as Congress Winds Down Without Agreement

Veterans stuck too in fight for more health care funding

December 8, 2006 – Certainly this last day of the lame-duck Congress will continue into the weekend, but as of late Friday the physicians still do not have a vote on the bill that would stop a 5.1 percent pay cut by Medicare that is to become effective on January 1. The House was expected to vote today on HR 6408 but it had not reached the floor by 5 p.m.  Read more...

Congress Nears Agreement on Stopping Medicare's Reduction of Physician Pay

Action needed today if it is to happen before cut kicks in

December 7, 2006 – There appears to be little doubt this morning that the lame-duck Congress will set aside the pay cut for doctors that has been mandated by Medicare. Physician reimbursements will decrease by 5.1% on January 1, without the Congressional override. Doctors appear to be sincerely concerned about this pay cut, which will be more than 5.1% in some cases. Read more...

Lame-Duck Congress Still Wrestling with How to Reverse Medicare's Proposed Pay Cut for Doctors

December 6, 2006 – The long and costly battle over Medicare proposed cut in pay to physicians was expected to be settled in this lame-duck session of Congress but it has hit a snag – how to make up for the lost funds if the 5.1% pay cut is reversed.  Read more...

Medicare Issues Getting Much Attention in Closing Days of Congress

Diabetes treatment, review of anemia medication rules top list

December 6, 2006 – The final days of this Congress are seeing considerable focus on Medicare issues. A group of senators have asked Health & Human Services to make diabetes screening and prevention a "top priority" for Medicare. Tomorrow, the House Ways and Means Committee will consider Medicare's coverage of anemia medication used to treat patients with end-stage renal disease. And, outside Congress, a meeting of advocates expressed their desire to see "patient-centered care" linked to Medicare reimbursements with pay-for-performance measures. Read more...

Medicare Making Changes, Expanding Preventive Care Services to Fight Diabetes

Expanding access in rural areas, encouraging physician discussion

December 4, 2006 – Medicare has announced expanded preventive services and other changes beginning January 1, that will affect millions of senior citizens battling diabetes. Diabetes screening was first added to preventive services in 2005, but the agency says it is making additions and changes that can help seniors with the disease or even those at risk of diabetes. Below are the highlights. Read more...

Medicare Advantage Plans Cost $5.2 Billion More than Fee-for-Service in 2005

Eliminating extra payments could help pay for enhanced benefits

December 1, 2006 - A report that is sure to add new ammunition for the Democrats, who want to put an end to the money Medicare is paying to private Medicare Advantage plans, says the MA plans were paid an average 12.4% more per enrollee in 2005 compared with what the same enrollees would have cost in the traditional Medicare fee-for-service program. Read more... 

Senior Citizens with Higher Incomes May Face Problems Getting Info on New Income-Based Medicare Premiums

HHS wants IRS to help identify seniors eligible for drug program subsidy

November 22, 2006 – The new income-based Medicare Part B premiums, which means higher premiums for higher income Americans, is headed for a problem, according to the KaiserNet.org daily report on Medicare. The Social Security Administration may not have enough people to answer the questions. And, on the other end of the income scale, Health and Human Services wants the Internal Revenue Service to provide records to help identify senior citizens eligible for assistance with the Medicare drug program. Read more...

Medicare Posts Pay to Physicians, Hospitals for Common Treatments as Consumer Guide

November 21, 2006 – The Centers for Medicare & Medicaid Services has made another step forward in providing consumers with information on the cost of healthcare services, which is aimed at helping them make better healthcare decisions. The latest data online is the payment information for physician and hospital outpatient services. Read more...

Coalition Pressures Congress to Stop Medicare’s Therapy Cap

Removing cap allows seniors to apply for rehab care above limit

November 13, 2006 – The high profile battles over Medicare rules that have been taken to Congress for relief have been the physicians and power wheelchair advocates trying to avoid pay cuts by Medicare. In less than 50 days, however, one in seven Medicare beneficiaries will be subject to an “arbitrary financial limit” on outpatient rehabilitation services, unless a coalition formed by the American Physical Therapy Association can get help from Congress. Read more...

Power Wheelchair Industry, Advocates Winning Battle over Payment Cuts by CMS

November 10, 2006 – The power wheelchair industry, and many advocate groups that joined them, seem to be headed for a significant victory over the rule by the Centers for Medicare & Medicaid Services that was to make a substantial cut in the payments for these devices on November 15. Tara Raeber, advocacy communications specialist at the National Multiple Sclerosis Society's Public Policy Office, said the new policy reported yesterday for Group 3 devices is "a victory for the disability community." Read more...

Senior Citizen Politics

Medicare is Target for Change by Democrats and Republicans in Weeks Ahead

Republicans may revoke physician pay cut, Democrats HMO subsidy

November 10, 2006 – A flurry of activity impacting Medicare is expected in the remaining days of the lame duck Republican Congress and the early days of the new Democratic Congress. A major battle is already shaping up over a powerful Democrat’s proposal that Medicare stop subsidy payments to HMOs. The pay cut for physicians in 2007 that Medicare has declared looks likely to face a move by Republicans to eliminate the cut or modify it, which may have Democratic support. Read more...

Medicare News

Pay-for-Performance Incentives Used for Physicians and Hospitals by Most HMOs

Medicare eyeing this system by 2009 to increase healthcare quality

November 6, 2006 – "Pay-for-Performance" is a term most senior citizens are not familiar with in their healthcare setting, but this concept of basing financial rewards for doctors and hospitals on their ability to meet certain goals is projected to become a part of how Medicare does business by 2009. Most HMOs are already using this compensation system, according to the Agency for Healthcare Research and Quality. Read more...

Power Wheelchair Industry Lines Up 44 House Members Opposing Medicare Fee Cut

They say cuts up to 41 percent will restrict access for senior citizens

November 3, 2006 – The power wheelchair industry has lined up a bi-partisan group of 44 House members have asked Health and Human Services (HHS) Secretary Michael Leavitt to delay Medicare cuts to power wheelchairs, which the group says will make it difficult for senior citizens and other beneficiaries to receive mobility equipment. This battle will join the effort by the American Medical Association to stop a five percent pay cut by Medicare on the Congressional agenda after the election recess. Read more...

Medicare Final Rule Cuts Physician Pay Five Percent for 2007

CMS says rule encourages more physician-patient communication

November 3, 2006 – The 5.1 percent cut in pay for physicians in 2007 proposed by Medicare has been reduced to something closer to 5 percent, according to the final rule issued by the Centers for Medicare & Medicaid Services this week. The war may not be over, however, since the American Medical Association was still pressing Congress to override the pay cut when they took their election recess. (See AMA reaction in sidebar.) Read more...

Medicare Announces Preventive Services Available for Senior Citizens in 2007

November 2, 2006 – Medicare has released the list of preventive services that will be offered in 2007 to senior citizens enrolled in Medicare Part B. There is at least one addition to the "Welcome to Medicare" initial exam - in 2007, people who are at risk for abdominal aortic aneurysms may get a referral for a one-time screening ultrasound. Read more...

Medicare, Medicaid News

Leslie Norwalk Takes Over as Acting Administrator of Centers for Medicare & Medicaid Services

Out-going administrator Mark McClellan says he improved quality of care in Medicare

October 16, 2006 – Leslie V. Norwalk became the acting administrator for the Centers of Medicare & Medicaid Services today, as Dr. Mark McClellan, left the office this weekend as he had announced on September 5 that he would do. Norwalk, an attorney, has been serving CMS as deputy administrator. Read more...

Senior Citizen Health & Medicine

Senior Citizens on Medicare Substantially Lower Death Risk by Choosing 5-Star Hospitals

HealthGrades 2007 hospital-quality study looked a 40.6 million Medicare records

October 16, 2006 – Senior citizens can lower their death risk during a hospitalization by 69 percent by getting their treatment at a top-rated hospital ("5-star") rather than a 1-star rated hospital. This conclusion was released today as part of the largest annual study of hospital quality in America by HealthGrades. This "quality chasm" between the best and poorest-performing hospitals has grown by approximately 5 percent since last year's study, even as overall mortality rates have improved by nearly 8 percent. Read more...

Medicare News

Mobility Industry Predicts Dire Circumstances if Medicare Proceeds with Pay Cuts for Power Wheelchairs

On Nov.15 Medicare will reduce reimbursements for power wheelchairs by about an average of 35%

October 11, 2006 - The Scooter Store announced today that the Centers for Medicare and Medicaid Services' decision to cut reimbursements by up to 41 percent for most power wheelchairs "will be devastating" for senior citizens and people living with physical impairments. And, Black Bear Medical, a leading supplier of durable medical equipment, said that the cut by Medicare will likely force lay-offs at their company, as well as other suppliers. Read more...

Medicare Says it Saved Over $2 Billion in Fraudulent Claims by Providers

Using new contractors to help identify fraud, waste and abuse

October 11, 2006 – The Centers for Medicare & Medicaid Services said today it has save over $2 billion in claims through aggressive local oversight and specially targeted fraud and abuse initiatives. Much of the savings have come from focusing on charges by Independent Diagnostic Testing Facilities. More than 980 referrals have been made to law enforcement since October 2004. Read more...

Medicare Preventive Care for Senior Citizen Men is Topic of Podcast

Former HHS Sec. Tommy Thompson is on MensHealthNetwork.com

September 28, 2006 – Encouraging senior citizen men to increase their use of the services provided by Medicare to prevent illness is the first topic in a series of audio podcasts being made by Tommy Thompson, former Secretary of Health and Human Services and Governor of Wisconsin. This first of installments planned each Thursday is available today. The program is named "Medicare's Preventative Services." Read more...

Government Paying 60 Percent of Nation's $790 Billion Hospital Bill

Older Americans in Medicare, Medicaid drive up the cost

September 23, 2006 – The U.S.A. may not need to adopt legislation establishing a national health care plan – it may just happen. A new report says the nation's hospitals billed for $790 billion in 2004, with 60 percent paid by either the federal or state governments. Read more...

Medicare Drug Program & Medicare News

Medicare Doughnut Hole and Physician Pay Cuts Get Attention in House Ways and Means

Congressional session nears end, members try to tie up loose ends

September 21, 2006 – Two of the hottest Medicare discussion topics received attention in the House Ways and Means Committee yesterday – how to plug the drug program "doughnut hole" and how to make the doctors happy with cuts in their Medicare pay. Democrats released a report showing the vast majority of those in stand-along drug plans do not have any coverage when they fall into the doughnut hole. Republicans were trying to convince physicians to accept quality-of-care data reporting in exchange for reducing or eliminating their pay cut. Read more...

Even Wealthy Seniors Concerned About Health Care Costs, Medicare

Most wealthy adults doubt children will benefit from Medicare

Jan. 23, 2006 - Even wealthy Americans are concerned that rising heath care costs will eat up their financial assets, according to survey findings released today. Nearly four in 10 wealthy Americans, including one quarter of senior citizens over age 65, say affording health care for their families is a top financial concern. But, the most disturbing finding was that one in three (36 percent) of respondents said, "health care costs will ultimately consume a major portion of my financial assets." Read more...

Homecare Industry Rallying Support to Kill Reconciliation Act

Senate bill going back to House for final vote freezes pay rate at 2005 level

Jan. 22, 2006 – Among the most active in fighting to kill the Budget Reconciliation Act is the American Association for Homecare, the industry group for home health care providers and those who use this service. Despite home health care being a popular option with senior citizens and studies showing it can be the least costly way to care for the elderly, the bill has several provisions that negatively impact the service. The most critical is a freeze on their pay rate for services from the Centers for Medicare and Medicaid Services. Read more...