Fundamental Changes To Medicare Proposed By Elder Law Expert

House Budget Committee Chairman Paul Ryan's proposal to change Medicare for those under age 55 is nothing short of a complete reconceptualization of the health insurance program, says a University of Illinois elder law expert.

Richard L. Kaplan, a professor of law and expert on retirement issues, says the Ryan proposal would scrap Medicare's current defined-benefit program in favor of a defined-contribution arrangement in which the government would provide seniors with a stipulated amount of money to purchase health insurance from private insurers.

"The Ryan proposal would eliminate the package of benefits that everyone receives but would allow seniors to choose from a variety of plans with different benefits, different premiums and different co-payment obligations," Kaplan said.

Kaplan, the Peer and Sarah Pedersen Professor of Law at Illinois, says that what Rep. Ryan is proposing isn't a radically new idea, as a broadly similar plan was first considered at length during the Clinton administration.

"It was proposed under the title of 'premium support,' though occasionally it has been described as vouchers," he said. "Essentially, it's the same concept - provide seniors with a designated amount of money and let them shop for the plan that best meets their needs."

While there may be nothing new under the sun in Washington, that doesn't mean that some seniors won't come out ahead under the Ryan proposal.

"Some seniors will benefit, because they will be able to use their Medicare dollars for benefits that they prefer," Kaplan said. "For example, Medicare currently pays for individual hospital stays of 60 to 90 days in length. But the average hospital stay for someone 65 years and older is less than six days. So a prospective Medicare enrollee might choose a plan in the proposed system that provides shorter hospital stay coverage but more extensive home health care coverage than Medicare currently includes."

The chief motivator of the Ryan plan is to, plain and simple, save the government money, Kaplan said.

"As medical costs increase, Medicare's costs rise accordingly," he said. "Under the Ryan plan, Medicare's costs would be fixed and known in advance. Increases in medical costs over whatever cost-of-living increase the government dictates for Medicare will not be borne by Medicare, but by those seniors who choose more comprehensive benefit plans."

Although last year's health care reform law left the basic structure of Medicare intact, the Ryan proposal would transform Medicare to make it resemble the types of health insurance plans that many employers offer to their employees. Although this would represent a dramatic change, Kaplan said, such changes to Medicare are not wholly unprecedented.

"Actually, Medicare Part D, which provides coverage for prescription drugs, operates on a very similar basis - private insurers receive government subsidies to provide various drug plans, and seniors select among the options that are available, paying more for greater coverage," Kaplan said.

But in a different health insurance paradigm, the downside is that seniors will almost certainly face more complexity.

"If our experience with Medicare Part D's drug plans is any indication, older Americans will confront a new array of insurance plans under Medicare, some of which may change their components annually," Kaplan said.

But Kaplan is quick to note that the present system is no walk in the park either.

"Presently, most seniors sign up for hospital coverage under Medicare Part A, then decide whether they want to purchase Medicare Part B coverage for physicians' charges, and then decide whether to add a Medicare Part D plan to cover their prescription medication needs," he said. " Then they must consider whether to buy a private Medigap insurance plan to pay for the deductibles and co-payment or co-insurance obligations of Medicare Parts A and B. So, in many ways, the new system of integrated benefit plans will be simpler and more intuitive. But the transition to this new environment will certainly be challenging."

Not all seniors will be affected by the change; adults 55 years and older would be largely unaffected by Ryan's proposal, Kaplan said.

"Unless an option is provided to let them switch, which may or may not be incorporated into the final plan, anyone who is in Medicare presently will not be affected by his proposal," Kaplan said. "Those seniors who are already familiar with Medicare's component parts need not bother with this legislation."

Source:
Phil Ciciora
University of Illinois at Urbana-Champaign

ACA Webinar on Care Transitions in Action: From Hospital to Home in Two Communities

On Wednesday, March 30, the Administration on Aging (AoA) will continue its series of webinars focused on the Patient Protection and Affordable Care Act of 2010 (also known as the Affordable Care Act, or ACA) and its impact on the aging network, taking a closer look at two communities actively engaged in care transitions work. 

Title:  Care Transitions in Action: From Hospital to Home in Two Communities

Date:  Wednesday, March 30, 2:00-3:30 p.m. Eastern

Description:
This next session in our ACA webinar series will explore care transitions partnerships between hospitals and area agencies on aging in two communities in more depth.  How did their partnerships develop?  What have their successes and challenges been? And finally, what do their results look like?

Speakers:
Kyle Allen, D.O., AGSF, Summa Health System, Akron, OH

Robyn Golden, LCSW, Rush University Medical Center, Chicago, IL

Robert Mapes, AgeOptions, Oak Park, IL

Joseph Ruby, Area Agency on Aging 10B, Inc., Uniontown, OH
   
Moderator:     Marisa Scala-Foley, Administration on Aging


-------------------------------------------------------
To register for the online event
-------------------------------------------------------
1. Go to https://aoa-events.webex.com/aoa-events/onstage/g.php?d=663084836&t=a
2. Click "Register".
3. On the registration form, enter your information and then click "Submit".

Once your registration is approved, you will receive a confirmation email message with instructions on how to join the event.

Please note: Space is limited, so please register as early as possible.  This webinar will also be recorded and posted on the AoA web site (www.AoA.gov) soon after the webinar.   

National Quality Strategy Will Promote Better Health, Quality Care for Americans

Image via WikipediaCreated under the Affordable Care Act, first-ever strategy will guide local, state and national efforts to improve quality of care The U.S. Department of Health and Human Services (HHS) today released the National Strategy for Quality Improvement in Health Care (National Quality Strategy).

The strategy was called for under the Affordable Care Act and is the first effort to create national aims and priorities to guide local, state, and national efforts to improve the quality of health care in the United States.

"The Affordable Care Act sets America on a path toward a higher quality health care system so we stop doing things that don't work for patients and start doing more of the things that do work," said HHS Secretary Kathleen Sebelius. "American hospitals, doctors, nurses and other health care providers are among the best in the world. With this ground-breaking strategy, we are working with local communities and health care providers to help patients and improve the health of all Americans."

The National Quality Strategy will promote quality health care that is focused on the needs of patients, families, and communities. At the same time, the strategy is designed to move the system to work better for doctors and other health care providers - reducing their administrative burdens and helping them collaborate to improve care. The strategy presents three aims for the health care system:

. Better Care: Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe.

. Healthy People and Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher-quality care.

. Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government.

To help achieve these aims, the strategy also establishes six priorities, to help focus efforts by public and private partners. Those priorities are:

. Making care safer by reducing harm caused in the delivery of care.

. Ensuring that each person and family are engaged as partners in their care.

. Promoting effective communication and coordination of care.

. Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease.

. Working with communities to promote wide use of best practices to enable healthy living.

. Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models.

The strategy was developed both through evidence-based results of the latest research and a collaborative transparent process that included input from a wide range of stakeholders across the health care system, including federal and state agencies, local communities, provider organizations, clinicians, patients, businesses, employers, and payers. This process of engagement will continue in 2011 and beyond.

The National Quality Strategy is designed to be an evolving guide for the nation as we continue to move forward with efforts to measure and improve health and health care quality. HHS will continue to work with stakeholders to create specific quantitative goals and measures for each of these priorities. In addition, as different communities have different needs and assets, the strategy and HHS will empower them to take different paths to achieving these goals.

The National Quality Strategy is just one piece of a broader effort by the Obama Administration to improve the quality of health care, and will serve as a tool to better coordinate quality initiatives between public and private partners. For example, the Affordable Care Act established a new Center for Medicare and Medicaid Innovation that will test innovative care and service delivery models. These new models are being tested to determine if they will improve the quality of care and reduce program expenditures for Medicare, Medicaid, and the Children's Health Insurance Program (CHIP).

Read the report at www.HealthCare.gov/center/reports.

For more information about the National Quality Strategy, visit www.ahrq.gov/workingforquality/.

Implementation Timeline - Kaiser Health Reform

The implementation timeline is an interactive tool designed to explain how and when the provisions of the health reform law will be implemented over the next several years.

You can show or hide all the changes occurring in a year by clicking on that year. Click on a provision to get more information about it. Customize the timeline by checking and unchecking specific topics.
More/Link to Interactive Tool

Health Business Blog » Blog Archive » HealthEdge COO Desrochers on ICD-10 (podcast)

by David E Williams

ICD-10 is a health care coding scheme that increases the number of diagnosis and procedure codes by an order of magnitude, permitting much more granularity for payers and providers. In this podcast interview, HealthEdge COO Ray Desrochers describes ICD-10 and why it’s taking plans so long to implement, and explains why ICD-10 implementation is the Y2K of health care. Ray’s optimistic that a combination of health care reform efforts, ICD-10 implementation and value based benefit design will finally begin to constrain the growth of health care costs.

Health Business Blog » Blog Archive » HealthEdge COO Desrochers on ICD-10 (podcast)

Governors Want Reform Law Changed So They Can Reduce Medicaid Coverage | Hospital Financial and Business News

 Written by Leigh Page

Republican governors are demanding changes in the healthcare reform law so that states would be able to cut Medicaid enrollment and balance their budgets, according to a report by the Wall Street Journal.

Thirty-three Republican governors and governors-elect plan to send a letter to the White House and congressional leaders today requesting the change. Currently, the reform law would remove federal funding from states that drop Medicaid enrollees.
Full Article

More Details on Doughnut Hole, Income-Related Part D Premiums

In just a few short weeks, the doughnut hole will begin to close in earnest. Until now, consumers who reached the doughnut hole—the coverage gap in Medicare’s prescription drug benefit—have been responsible for paying the full cost of their drugs. But starting next year, these consumers will receive a discount on drugs they purchase while in the gap. This change to the Medicare drug benefit, also known as Part D, is the result of the Affordable Care Act (ACA), which gradually phases out the doughnut hole through the year 2020, when it will be completely eliminated. In 2011, people who enter the gap will receive a 50 percent discount on brand-name drugs and a 7 percent discount on both generic drugs and drugs compounded at the pharmacy. Furthermore, the 50 percent discount will count toward consumers’ out-of-pocket limit, which is used to determine when they get out of the doughnut hole and enter catastrophic coverage. This means Medicare consumers will spend less while in the doughnut hole.

Also as a result of the ACA, the Social Security Administration (SSA) published an interim final rule regarding the assessment of higher Part D premiums for higher-income Medicare consumers beginning next year. From 2011 through 2019 individuals who have modified adjusted gross income (MAGI) at or above $85,000 per year and couples whose MAGI is at or above 170,000 per year will be subject to additional premiums for Part D. The premiums will be assessed on a sliding scale that is pegged to income levels. The extra amount will, in most cases, be directly deducted from the individual’s Social Security check. While the income thresholds of $85,000 and $170,000 will be frozen through 2019, SSA may change them after that year.  

The formula used to calculate MAGI is based on federal taxes filed two years prior to the year when the income-related premium assessment takes place. As under Part B, the rule states that individuals may request that SSA use more current tax data to calculate MAGI if they have experienced a major life-changing event, as defined by the regulations, or may appeal the misapplication of an income-related premium expense. 

Read the Medicare Rights Center’s fact sheet: Health Reform and Medicare: The Doughnut Hole in 2011.

Read more about income-related Part D premiums.

Read the interim final rule on income-related Part D premiums.

Will Congress Repeal Health Care Reform?

by Barbara O'Brian


As soon as Republicans knew they had won a majority of House seats in the midterm elections, GOP leaders vowed to repeal health care reform. Can they do this? And should they?

Frankly, chances that the health care reform bill could be repealed completely are remote, especially since such repeal would have to override President Obama's veto, and the Senate still has a Democratic majority.

House Republicans say they have some tricks up their sleeves, such as refusing to provide funds in the budget to implement health care reform. However, provisions of the law that will expand Medicaid and help subsidize private insurance won't kick in until 2014. Until then, there's not much the House can do to the budget to stop health care reform from going forward, short of defunding the entire Health and Human Services department.

Another "trick" might be to dismantle the bill piece by piece. One provision that many people want to remove is the individual mandate, which will require most Americans to obtain health insurance or pay a tax penalty. This provision also kicks in in 2014, and it's one that Baby Boomers in particular will want to fight to keep.

Here's why: Beginning in 2014, private insurance companies will no longer be able to refuse to insure someone because of a pre-existing condition. But without an individual mandate, there will be no incentive for younger and healthier people to purchase health insurance until the time comes when they need it. This means those left in the insurance "risk pool" will be older, and that drives up the cost of insurance.

By the time we reach 50, nearly all of us have "pre-existing conditions." Some of our conditions are common, and some are not -- mesothelioma, for example, is rarely diagnosed in patients younger than 50. And without Medicare or other good insurance, mesothelioma treatment would be financially devastating.

But without the individual mandate requiring that healthier people share in the cost of insuring all of us, the health insurance premium bills for people aged 50 to 65 will be ruinous. We can scrap health care reform entirely, of course, but keep in mind that if you lose your insurance before you reach Medicare age you may not be able to purchase insurance at all, at any price, if you have a pre-existing condition.

Related articles

• No Mandate For Repeal Of Healthcare Law (alan.com)
• Eric Cantor: Never Mind On That Health Care Reform Repeal (oliverwillis.com)
• Health-law advocates fear effect of repeal (dispatch.com)
• Cantor: We'll have a preexisting conditions provision in our new health-care plan too (hotair.com)
• Wendell Potter: Why Health Care Reform Will Survive (crooksandliars.com)
• The 1099 Logjam and the Future of Health Reform (swampland.blogs.time.com)

Massachusetts pressing for shift to global payment system :: American Medical News

Image via WikipediaBy Emily Berry, amednews staff

More than a year after a special commission recommended that all Massachusetts insurers leave behind the fee-for-service health care payment model, state officials are pressing for legislative action as soon as January 2011. Physicians with the state medical society are again warning against ushering in change too quickly.

At a Sept. 21 meeting on national health reform, the state's secretary for health and human resources, JudyAnn Bigby, MD, said she expects legislation to be drafted and introduced as early as January that would shift the state to a global payment system. Such a system would pay physicians a flat montly fee per patient, adjusted for each patient's health status and other factors.

Proponents say this would improve health and hold down costs because it would encourage doctors and patients to focus on overall health and move away from a fee-for-service system, which Gov. Deval Patrick's office described as encouraging the "overuse and misuse of services."

Full Article

Anger, Seniors And Ad Campaigns: Health Reform Politics

A poll released Tuesday shows most seniors in Medicare's prescription drug benefit program don't know that the health law "closes Part D's coverage gap," The Hill's Healthwatch blog reports. "The findings are bad news for Democrats, who are hoping that seniors - among the most reliable voters in midterm elections - will flock to the polls next month in support of the party who backed the new benefits. Yet just 20 percent of Part D beneficiaries are aware that the law cuts the cost of name-brand drug in half next year through the donut hole, according to the survey, conducted by KRC Research for the Medicare Today coalition, an advocacy group" (Lillis, 10/12).

Full Article

Future of Aging · Medicare and Long-term Care: Reaching “Top Speed”

by Larry Minnix

You don’t often hear about cars at a health policy briefing, but that’s just what Centers for Medicare and Medicaid Services Administrator Don Berwick talked about to begin a conversation on Medicare and long-term care (LTC) hosted by the Kaiser Family Foundation that I spoke at this morning. He made the analogy that health care systems, like cars, are designed to reach a top speed (or in the case of health care systems, maximum quality). Nothing a driver or doctor can change it. Whether you’re talking about Mustangs or Medicare, the system must be changed to reach top speed.

So, what needs to be changed in Medicare relating to long-term care? The answer can be found in two studies conducted by Kaiser and Lake Research Partners. The first study, a quantitative analysis of Medicare beneficiaries living in long-term care facilities, found that these individuals account for a disproportionate share of Medicare spending compared to individuals living at home.
Full Article

Health Care Reform Explained - AARP Bulletin

Image by Getty Images via @daylifeby: Susan Jaffe | from: AARP Bulletin

Confused about the new health care reforms? You’re not alone. The legislation is full of new benefits, rules, penalties and projects, spread out over several years.
To help you understand what the health care law means for you, the AARP Bulletin is answering your questions about:

Access to Coverage

Q. I'm 58 and retired. I understand the new reform law helps employers offer health care coverage to their early retirees ... More
Q. I'm over 50 and have been turned away by insurers because of my health problems ... More
Q. I'm 62. If I retire this year, what type of medical coverage can I get before Medicare kicks in? ... More
Q. My insurance company told me my 23 year old daughter could no longer be on my family plan. I've heard I can insure her now... More
Q. I'm disabled, in my 50s, and over the eligibility line for Medicaid. But I can’t afford health insurance ... More
Q. Does the new health care reform law eliminate annual and lifetime limits on health care coverage in insurance policies? ... More

Access to Care

Q. I'm having trouble finding a primary care doctor now. Will it be harder for me to get one when millions more people ... More
Q. Does the law limit the treatment my doctor can give me? Will some faceless bureaucrat decide I'm "too old" for surgery? ... More
Q. If we use wellness programs, can we get a discount on our insurance costs? ... More
Q. Must insurance companies offer free cancer screenings and other preventive health benefits? ... More
Q. What does health reform do to help people with mental illness get the treatment they need? ... More

Rules and Requirements

Q. Will I be forced to buy insurance? What if I can't afford it? ... More
Q. We own a small business. Will the law force us to provide our part-time employees with health insurance? ... More
Q. What does it mean if my health plan is "grandfathered"? ... More
Q. Will a Muslim be required to buy health insurance? There are lots of rumors on the Internet about this ... More
Q. I heard the IRS is hiring 16,500 agents just to make sure we buy insurance ... More

Savings and Costs

Q. President Obama says health care reform will save us money, but others say we'll pay more in taxes ... More
Q. Will the new law help us afford better insurance? ... More
Q. How does health care reform lower our insurance costs? ... More
Q. My premium for an individual health insurance policy is going up 22 percent. Can they do that?... More
Q. What health care reforms start Sept. 23, 2010, and what's so magical about that date? ... More
Q. Is there a big new tax on home sales that is supposed to raise money to pay for health reform? More

Medicare, Medicaid and Other Insurance

Q. I have many health problems, low income, no insurance and don't qualify for Medicaid. Will the new law help people like me? ... More
Q. I've heard that government payments to Medicare Advantage will be reduced or stopped altogether ... More
Q. Will the new law make it easier to get long-term care health insurance? ... More
Q. I'm a Marine Corps veteran with health coverage through TriCare and the V.A. Will there be changes to my coverage ... More
Q. How does the new law strengthen Medicare while reducing its funds? ... More
Q. Will Medicare provide free services to help quit smoking? ... More
Q. How does the law stop Medicare and Medicaid fraud? ... More

Full Article

Efforts To Expand Adult Day Care Programs Threatened By Recession-Driven Cuts - Kaiser Health News

Kaiser Health News, in a story produced in collaboration with The Washington Post, reports on adult day care. It "may soon become harder to find and afford. The almost 4,000 state-licensed centers around the country rely heavily on funding from state legislatures and charities, which have been hit hard by the recession. Advocates for adult day-care programs are pushing to include them in federal health-care overhaul legislation while also lobbying state legislatures and suing state regulators to keep centers from shutting their doors" (12/2). Read entire story.

AMNews: Sept. 7, 2009. AMA takes health reform message on the road ... American Medical News

Image via Wikipedia

By Chris Silva, AMNews staff

White House officials and lawmakers were not the only ones who took the health system reform debate out of Washington, D.C., during the August congressional recess, spotlighting communities reeling from the recession and making the case that reform is the key to helping them.

The American Medical Association drew attention to the plight of physicians and patients in Michigan during a recent visit as part of its "House Call" program.

Read More

The Health Care Blog: Health Care Reform's Deeper Problems

By BRIAN KLEPPER and DAVID C. KIBBE

We were asked by Northeast Florida's regional newspaper, the Florida Times-Union, to write a piece for lay audiences distilling our thoughts on what's behind the reform curtain. This piece was published the other day and, while we doubt much of it will be news to THCB’s readers, we wanted to offer it up as a summary statement.
Read More

Get the facts about the stability and security you get from health insurance reform | Health Insurance Reform Reality Check

The White House recently launched the "Reality Check" web page to combat lies being spread about health care reform. One of the most prominently featured clips addresses concerns about the benefits of health care reform for the disability community. Michael Strautmanis, Chief of Staff for Valerie Jarrett and father of a child with a disability, discusses his personal stake in making sure health insurance reform is fair and useful for people with disabilities. Get the facts about the stability and security you get from health insurance reform | Health Insurance Reform Reality Check

Kaiser Family Foundation: Setting Medicare Payment Policy: Is There a Role for an Independent Entity?

Image via Wikipedia

One of the issues that has recently emerged in health reform discussions concerns how to bring about change in the Medicare program to improve efficiency and control health care cost growth. The Obama Administration and some Congressional leaders have proposed establishing a new independent entity that would be given authority to recommend changes in Medicare policy to be implemented by the Administration, subject to Congressional review. This concept represents a significant departure from current practices. This issue brief considers questions associated with the establishment of a new entity to set Medicare payment policy and the implications for beneficiaries, other stakeholders, and program spending. It also explains the way Medicare payments are set under current law, including the advisory role currently played by the Medicare Payment Advisory Commission (MedPAC), as well as various options under consideration to create an independent Medicare payment entity. Download Issue Brief

Related articles by Zemanta

• MedPAC Releases Health Spending/Medicare Program Data Book (medicareupdate.typepad.com)
• Obama Proposal to Create Medicare Panel Meets With Resistance (nytimes.com)
• Obama Administration May Exert More Control Over Medicare Payment Changes (medicareupdate.typepad.com)
• Obama Administration Releases Independent Medicare Advisory Council Act of 2009 (medicareupdate.typepad.com)

1306_McCarthy_Mayo_case study.pdf (application/pdf Object)

Image via Wikipedia

The Mayo Clinic is the world’s oldest and largest integrated multispecialty group medical practice, combining clinical practice, education, and research at the regional, national, and international levels for the benefit of individuals with routine as well as complex health care needs. Mayo’s model of integrated care is one of multidisciplinary practice with salary-based compensation that fosters team-oriented patient care and peer accountability, a supportive infrastructure allowing physicians and other caregivers to excel at clinical work, and a physician-led governance structure promoting a patient-centered culture. Full integration of the hospital and clinic and the use of a shared electronic medical record across inpatient and outpatient settings also have been critical to realizing efficiencies and promoting clinical excellence. Mayo fosters a learning environment in which teams of medical professionals use information technology and systems engineering to learn from each other and improve care in tandem with clinical practice. Read More

Understanding How Americans View Health Care Reform | Health Care Reform 2009

by Robert J. Blendon, Sc.D., and John M. Benson, M.A. - Now that Congress has adjourned and most members are back in their own states or districts, they will be listening to what their constituents have to say about the debate over health care reform. We examined the results of 22 recent nationwide public opinion polls (see Recent Opinion Polls on Health Care Reform; polls are cited parenthetically hereafter), working with support from the Kaiser Family Foundation and the Robert Wood Johnson Foundation, to find out what our legislators might be hearing. Read More