Tag Archive for Medicare News

Lucy Dylan | 07/08/2010
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Electronic Medical Record Use On the Rise

By 2014, each and every American will have an electronic medical record of their own.  Electronic medical records (EMR) are “paperless paperwork,” or computerized copies of patient records, and the federal government hopes to make wide use of them to cut down health costs. The Obama administration’s health information technology program plans on offering incentives and subsidies to medical providers who make use of electronic records.  By 2014, all doctors will be required to have Health IT or will face a penalty.

Electronic Medical Records On the Rise

Electronic Medical Records On the Rise

Doctors are notorious for their messy, often illegible handwriting that can often produce doctor errors.  One optometrist, Meera Sutaria, reported that investing in such technology increased her office’s efficiency.  Because there were fewer issues with paperwork, Sutaria was able to spend more quality time with patients. Computerized records save paper, and make it easier for other doctors to read and access patient information, especially in the emergency room, where doctors often have limited access to patient information.  One Wisconsin doctor, Dr. Ashok Rai, has waited for hours just to receive faxes for his out-of-network E.R. patients, which could easily have been avoided had other doctors outside his hospital made use of electronic records.

Proponents of EMRs point to the reduction of paperwork and increased readability as a great way to streamline and manage healthcare. In a world where health care costs are exploding, saving money is incredibly important.  Kaiser Permanente, a company that revolutionized medical records, found that computerized records helped track vaccine safety in a study of young children. In this society, where patients can be seeing multiple doctors and specialists, it is necessary to have a way to quickly share information with other providers.  Electronic medical records can improve quality of care for patients, ensuring that they do not undergo duplicate or unnecessary procedures. Plus, electronic medical records might be able to streamline the insurance claims process, paying doctors instantly in real time.

Not all doctors or hospitals make use of computerized records today.  In fact, electronic medical records are in the minority rather than the majority.  Providers who do use such medical technology may use it in different ways or to different extents. However, I feel that an expanded, unified system will truly be able to streamline care if (and only if) it is executed properly.

Opponents of Health IT argue that the shift from paper to computer may actually result in higher costs. Providers may charge patients to afford new health information technology. Other providers, including Kaiser Permanente—a Health IT leader—fear that they won’t qualify for subsidies under the government’s new meaningful care standard, which may be too strict to start off with. However, so long as the government places guidelines that ensure high quality of care for patients, poor quality can be avoided.  Servers and databases must be guaranteed secure in order to prevent hacking and identity theft.

Ultimately, I feel that widespread adoption of electronic medical records will only be helpful for the health care industry. First of all, the government must ensure the safety of patients’ personal information. And providers need to step up their efforts in modernizing now so that they can benefit from the subsidies.

Category: Medicare News | Tags: , , , , , , , , ,
Mona Lisa Vito | 07/06/2010
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CT Investigates CVS Rx Plan Termination Threat

At the end of June, Richard Blumenthal – our Connecticut Attorney General – announced he would be investigating CVS Caremark pharmacy for threatening to end their discount drug program known as Health Savings Pass. The discount program asks customers to pay $10 per year for access to 3 month supplies of 400 different generic drugs at reduced prices ($9.99 per refill), in addition to other benefits. The Attorney General’s office argues that state law obligates pharmacies to charge Medicaid the lowest drug price they offer (which in CVS’s case would be this programs $10 per year per customer fee). Therefore, Blumenthal contends that CVS must offer this discount drug program to Medicaid customers too. In a company statement released Wednesday June 23 CVS disagreed and threatened to end the program in Connecticut if it were required to give this discount to Medicaid recipients because doing so would make the program “economically unfeasible to continue.”

CVS Pharmacy Subpoenaed Regarding Discount Drug Program

CVS Pharmacy Subpoenaed Regarding Discount Drug Program

CVS and the Connecticut Attorney General’s office have sparred on this issue once before. Last session, when CVS officials disagreed with the state’s interpretation of the law the General Assembly passed a bill which clarified the requirement that pharmacies charge CT Medicaid the lowest price offered to consumers. But even now, with little ambiguity left in the law, CVS claims it should not be required to fulfill this obligation because the program was originally developed for uninsured and underinsured individuals, not with Medicaid recipients in mind. Because CVS on its member enrollment forms reserves the right to cancel the voluntary program for any reason, and because it is not required to continue the program by law, the company may indeed terminate the program if Blumenthal continues to push CVS.

CVS has until July 9 to comply with the Attorney General’s subpoena for information on CVS’s threat to cancel the program in Connecticut, which Blumenthal claims is inconsistent with the company’s practices in other states where CVS and other pharmacies have extended their discount drug program to Medicaid beneficiaries. Blumenthal – currently a candidate for Senate to replace retiring Senator Christopher Dodd (D-CT) – hopes his office will be able to force CVS to comply with the law and its practices in other states, as extending this program to Medicaid enrollees would save thousands of pharmaceutical cost dollars, helping to rein in out of control health care costs.

If Blumenthal is unsuccessful, the thousands of uninsured under-65′s and Medicare beneficiaries who rely on the program to stay out of the donut hole coverage gap may find their discount prescription drugs in jeopardy.

Category: Medicare News, Prescription Drug Coverage | Tags: , ,
Lucy Dylan | 07/01/2010
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What Will the New Medicare Advantage Plan Ranking System Look Like?

Susan Jaffe recently published a great read on Medicare Advantage plan ranking systems. Although the Advantage ratings purportedly help seniors weed out the best possible plans, the ratings system is flawed and most seniors rely on a combination of plan costs and benefits to determine which plan they want. The impending Medicare reforms will be rewarding top-ranked Advantage plans with bonuses, despite the obvious flaws within the system. The Center for Medicare Services (CMS) plans on using the current system at first, and later evaluating which factors work and which do not.  Programs with 4 or 5 star ratings will receive higher bonuses from Medicare.

What will the new MAPD ranking system look like?

What will the new MAPD ranking system look like?

I feel that improving the ratings system is integral to Medicare reform. While costs and coverage are indeed incredibly important facets of every Advantage plan, quality of care and benefits are equally important for seniors. Relying on price alone may net a senior an affordable plan while sacrificing quality.  Unfortunately, many seniors do rely on price. According to Jaffe, over 75% of Advantage plan beneficiaries select plans with less than 3 stars.  Improving the ratings system can make seniors more aware of the quality of their Advantage plan, and possibly provide them with improved health care.  Adding the incentive to perform better could ultimately help seniors out.  However, that incentive needs to be clear and the ratings system needs to be solid.

Another part to the issue raised by Jaffe is that not all plans are rated, and not all areas boast 4 or 5 star rated plans.  By expanding the ratings system, and breaking down all the benefits and coverage associated with the plan, perhaps CMS can provide more comprehensive analyses to facilitate Advantage plan selection for seniors. At the same time, plans need the opportunity to improve their ratings and quality. Improvement should be recognized as a factor in the ratings.   Perhaps adding incentives for improvement in addition to overall rating might be helpful, although not necessarily cost-effective. By making providers accountable for their services and seniors more aware of the ins-and-outs of Advantage plans, perhaps there can be genuine improvements in the Medicare system.

At the same time, I feel that it might be difficult for the bonus system to work as it should, especially because standards of care vary across the country.  Jaffe quotes Vicki Gottlich of the Center for Medicare Advocacy, who raises the concern that a simple average score might bury a plan’s deficiencies beneath its stronger points. And is it really fair to rate a 3 star plan in say, Idaho, to a 5 star plan in Florida? How can the rating system be most effective when there are so many variables involved?

Although the new bonuses may help improve the quality of care available for Medicare, CMS must ensure that all the wrinkles in the rating system are ironed out before applying the ratings to all plans. Perhaps a better path for CMS to follow would be to improve the ratings, helping out both consumers and providers, before analyzing each Medicare Advantage plan.

Category: Medicare Advantage, Medicare News, Medicare Tips | Tags: , ,
Lucy Dylan | 06/24/2010
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Closing the Doughnut Hole

Medicare prescription drug coverage can be tricky to understand.  Part D of Medicare covers drugs for seniors who already have Medicare at an additional monthly premium. Still, the doughnut hole coverage gap forces seniors to pay out of pocket once their drug costs hit a certain amount. Recent health care reforms have focused on the doughnut hall as a way to cut costs. Here are the top 6 things to know about the doughnut hole for seniors, their relatives, and their friends.

The president will be using these to close your coverage gap.

The president will be using these to close your coverage gap.

1.)    The phrase “doughnut hole,” or “donut hole” if you prefer Dunkin Donuts to your average breakfast fare, refers to the coverage gap for seniors on Medicare prescription drug plans. After a prescription drug plan (PDP) pays a certain amount of cash for a beneficiary’s medication, the beneficiary is then responsible for paying out of pocket until they reach spending that requires catastrophic coverage, after which the plan will help cover prescriptions for the rest of the year.

2.)    AARP’s Doughnut Hole Calculator is a great tool that can help you avoid the doughnut hole. Type in the specifics about the drugs you need to generate a report for the year that will tell you if you are likely to hit the gap. If you are deemed likely to hit the gap, the calculator can show you alternatives that can reduce costs. It isn’t an instant cure-all, but knowing your needs can work wonders in closing your personal doughnut hole.

3.)    Some prescription drug plans cover generics within the gap, but often come with more expensive premiums. Remember, not all plans cover generics in the gap, so it’s crucial to understand what exactly your PDP or Medicare Advantage page covers.

4.)    In early June, the Department of Health and Human Sources sent out $250 doughnut hole rebates to seniors who fall into the coverage gap.  You’ll receive the checks automatically after you enter the doughnut hole, but keep record of prescription medication as backup just in case you don’t receive your rebate for some reason.

5.)    Scammers are preying beneficiaries who receive doughnut hole checks—which I like to think of as Munchkins. Remember, you don’t need to get your money through a third party, and you don’t have to tell anyone any personal information to receive a check. The Consumer Reports Money blog has a great overview of these scams. Help yourself or a loved one avoid fraud.

6.)    By 2020, the government hopes to close the doughnut hole completely. In 2011, the government will begin providing drug discounts to beneficiaries enrolled in Part D plans. Discounts will increase until 2020, when the doughnut hole will look more like a Boston cream doughnut than a regular ring doughnut.

While prescription drug plans can sometimes control costs, the wide expanse of the doughnut hole can really put a hurting on your wallet. Hopefully health care reforms will truly eliminate the coverage gap for seniors. Until then, the government will be taking baby steps to reduce drug costs for people with Medicare.

Category: Medicare News, Medicare Tips, Prescription Drug Coverage | Tags: , , , , ,
Bill Stapleton | 02/24/2010
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Crackdown on Medicare Fraud

NPR did an interesting story looking at Medicare frauds growing numbers, and how the government is working to crack down on those abusing the system.

Medicare fraud is among the most common types of health care fraud. The Obama administration has requested a funding increase in an effort to cut down the Medicare fraud. These efforts have been successful in the Miami area, which has the highest rates of both Medicare fraud and prosecutions.

Recently, the fraud teams have been set up in cities like Detroit and Brooklyn, area’s where Medicare fraud was starting to turn up more. Many of those cases were developed by the same Miami criminals who were looking to move to an area where there was less crackdown and scrutiny.

The schemes are constantly changing, however, making catching those involved difficult. One of the first popular scams was based on durable medical equipment like wheelchairs and walkers. Then HIV infusion clinics and home health care were targeted. The enforcement teams are often left simply trying to play catch up with the constantly changing schemes and locations.

It is very important to make sure you are using a legitimate carrier for your health plan and a reliable source for your health care needs. This is why choosing a plan is such an important decision. By going though MedicareSolutions.com you know you can trust your plan, we only represent the best rated carriers. You can be sure that any plan you buy through us is a genuine plan. You can call our representatives at 800-328-7305.

NPR – Miami Serves As Model In Medicare Fraud Crackdown

Category: Medicare News, Medicare Tips | Tags: , , ,
Bill Stapleton | 02/19/2010
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Cigna PFFS Plan to Close

Effective February 1, 2010, Cigna is closing their CIGNA Medicare Access PFFS plans to OEP enrollments.

CIGNA will still accept clients enrolling during their individual election period (those aging in to Medicare or newly eligible to Medicare) and those with a Special Enrollment Period. Current clients who have CIGNA Medicare Access PFFS will not see a change in their 2010 benefits. They will continue to have coverage for the entire year. There will be no changes in benefits due to this decision.

Please note this does not effect plans such as CIGNA Medicare Rx, CIGNA Medicare Select Plus Rx, or any of CIGNA’s other medical or pharmacy plans.

Category: Medicare News | Tags: , , , , ,
Bill Stapleton | 01/27/2010
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CMS and MIPPA Rules

After going through another Medicare Annual Enrollment season, it is hard to believe just how many rules are listed and enforced by CMS. You can read the rules on CMS’s website, but below is a taste for some of these rules:

The following are considered “unsolicited contacts and in violation of MIPPA:”

  • Generally, use of old lists or consents to satisfy the new MIPPA rules regarding unsolicited contacts
  • Referrals of beneficiaries and/or their contact information resulting in an unsolicited contact are prohibited by the new guidance.
  • Members who are voluntarily disenrolling from a plan should not be contacted for sales purposes or be asked to consent in any formant to further sales contacts

Provider Marketing

It is “inappropriate for providers to be involved in any of the following actions”:

  • offering sales/appointment forms,
  • mailing marketing materials on behalf of plans,
  • making phone calls or steering beneficiaries, in any way, to a limited number of plans
Category: Medicare News, Medicare Tips | Tags: , , ,
Bill Stapleton | 01/08/2010
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Avoiding Medicare Insolvency in 2016

The recent Senate bill entitled “The Patient Protection and Affordable Care Act” is intended to bring insurance to many uninsured Americans and to help the Medicare program avoid insolvency, which is projected to happen in 6 years. Unfortunately, the bill will probably have just the opposite effect.

In addition to making draconian cuts to the Medicare Advantage program, the bill largely increases the number and cost of beneficiaries in Medicare. For example, both the House and Senate bills reduce the coverage gap, or “doughnut hole” in Part D coverage by $500 beginning in 2010. Other additions include increased benefits for dual Medicare-Medicaid eligible and eliminating cost-sharing for preventative services (beneficiaries will not have to pay for any of the cost). Such great cost reduction is certainly an enormous benefit for any senior, but puts a new strain on the need for more Medicare funds.

Additionally, the Senate bill plans to tax companies receiving prescription drug subsidies. Since 2003, companies that continued to provide their own prescription drug benefits qualified for a 28% tax-free subsidy (about $600 per year per retiree). The advantage for companies was the ability to list the subsidy as a reduction to their retiree health liability. The Senate bill will tax the subsidy, thus increasing companies’ tax liabilities and companies will be required to register the change as a loss in earnings.

The response expected from these companies will be to no long provide prescription drug benefits on their own. Thus, the cost falls back on Medicare who will see a dramatic increase in Part D beneficiaries. Increasing the number of Medicare eligibles will only add fuel to the fire: these change merely bring the day of reckoning for Medicare closer than 2016.

Category: Medicare Advantage, Medicare News | Tags: , , , ,
Sophie Callahan | 07/31/2009
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Americans Spending on Alternative Medicine

The National Institutes of Health (NIH) recently announced that Americans spent $33.9 billion on complementary and alternative medicines in 2007. These results come from a study which surveyed more than 70,000 across America and inquired into 36 forms of alternative medicine. These findings suggest that Americans spend more than 10% of their out-of-pocket health care dollars on alternative medicines and services which include chiropractors, acupuncturists, massage therapists and herbal remedies.

The usefulness and effectiveness of these alternative medicines isn’t always evident. Some of them are promising, but others could be more harmful than helpful to your health. About half of the people who used alternative medicine do so because they cannot afford conventional care. This includes a significant amount of senior citizens who chose to turn to alternative medicine once they hit the Medicare gap and can no longer afford conventional alternatives. One report found that over one-third of adults use some form of alternative medicine.

The main reason behind why people tried alternative therapies like chiropractic care and massages was for pain. The most popular supplements used were glucosamine (which is supposed to reduce joint pain) and fish oil (which is supposed to reduce the risk of heart disease).

Although not all alternative medicine is covered by health insurance, it was found that about 43 percent of alternative medicine in 2007 was paid for by private insurance and about 31 percent was paid for by public insurance. The remainder was paid by the patients.

 

Category: Medicare News, Senior Healthy Living, Supplement Medigap | Tags: , ,
Sophie Callahan | 07/17/2009
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Proposal Suggests Formation of A New Agency To Set Medicare Pay Rates

The White House has recently been circulating draft legislation that would create an executive agency for the purpose of overseeing Medicare reimbursement rates and policy changes. Under the proposal, there would be a paid five-member Independent Medicare Advisory Council whose members would serve five-year terms. They would be nominated by the president and subject to approval by the Senate. In all likelihood, the members of the council would be doctors, or other people who are highly skilled in health policy.

The members of the council would be given the authority to make broad recommendations about Medicare, but they would focus on setting appropriate payment rates for Medicare Part A and Part B. The council would give two annual recommendation reports: the one due by October 1st of each year would deal with Medicare Part A and the one due by December 31st of each year would address Part B. These recommendations would be sent to the White House for the president’s approval before being brought before Congress. This legislation, if enacted will go into effect after Obama’s first term as president on September 15, 2014.

Other proposals are also being given consideration with respect to Medicare. In particular, the Obama administration wants to give the Medicare Payment Advisory Commission (MedPAC) the authority to determine cuts and makes other changes to Medicare.

Category: Medicare News, Original Medicare | Tags: , , ,
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