Health Business Blog » Since When Is a Co-pay The Cure For Fraud?

by David E. Williams

Medicare coverage for home care visits has a checkered history. The original rationale for including home care in Medicare was straightforward and compelling: it’s much cheaper, healthier and pleasant for a patient to be at home receiving skilled care than to stay in a hospital for lack of enough support in the home environment. That logic remains solid. Unfortunately it doesn’t mean Medicare spending has dropped with home care coverage in place. That’s because operators of home care agencies don’t see it as their job to reduce Medicare spending and neither do hospitals. Both want to make as much money as possible under the fee-for-service system. Home care ended up being an additional cost to the system, not a cheaper substitute for the hospital.

There have been various attempts to control home care spending. The latest is a 13-1 recommendation by the Medicare Payment Advisory Commission to impose co-payments to discourage unneeded use of home care services.
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Seniors May Have to Pay for Medicare Home Health

Image via CrunchBase
By RICARDO ALONSO-ZALDIVAR, Associated Press
Medicare recipients could see a sizable new out-of-pocket charge for home health visits if Congress follows through on a recommendation issued Thursday by its own advisory panel. Until now, home health visits from nurses and other providers have been free of charge to patients. But the Medicare Payment Advisory Commission says a copayment is needed to discourage overuse of a service whose cost to taxpayers is nearing $20 billion a year amid concerns that fraudsters are also taking advantage. The panel did not prescribe an amount, but its staff has suggested the charge be $150 for a series of related visits. Medicare requires copays for many other services, so home health has been the exception, not the rule.
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A Health Plan Work in Progress: Hospital-Physician Price and Quality Transparency

Center for Studying Health System Change Research Brief No. 7 August 2008Ann Tynan, Allison Liebhaber, Paul B. Ginsburg Responding to large employers’ interest in greater health care price and quality transparency, health plans are developing consumer tools to compare price and quality information across hospitals and physicians, but the tools’ pervasiveness and usefulness are limited, according to findings from the Center for Studying Health System Change’s (HSC) 2007 site visits to 12 nationally representative metropolitan communities. Many large employers view price and quality transparency as key to a broader consumerism strategy, where employees take more responsibility for medical costs, lifestyle choices and treatment decisions. Some health plans believe providing price and quality information to enrollees is a competitive advantage, while others are skeptical about the benefits and are proceeding cautiously to avoid potential unintended consequences. Health plans are in various stages of making price information available to enrollees. Plans generally provide some type of price information on inpatient and outpatient procedures and services from data based on their own negotiated prices or through aggregated health plan claims data obtained through a vendor; few plans provide price information on services in physician offices. However, the information provided often lacks specificity about individual providers, and its availability is often limited to enrollees in specific geographic areas. Health plans generally rely on third-party sources to package publicly available quality information instead of using information gleaned from their own claims or other data. Health plans’ ability to advance price and quality comparison tools to the point where a critical mass of consumers trust and use the information to choose physicians and hospitals will likely have considerable influence on the ultimate success of broader health consumerism efforts. Download Copy of Report

Medical bills pinch elderly

Thomas Goldsmith, Staff Writer Raleigh News & Observer Costs not covered by Medicare can eat up their income, assets and even the house Jake Smith, a man who's good for what he owes, sold his paid-off home of 33 years recently to settle about $15,000 in medical debt that wasn't covered by Medicare. Smith, 80, a retired truck driver who volunteered for the Navy at age 17, is among the more than one in 10 older Americans whose only medical insurance is basic Medicare. The federal program pays a portion of doctor and hospital bills, but leaves the rest to patients. .... Jake Smith's wife, Christine, died of cancer last year. Selling the home they shared -- and moving to senior housing downtown -- was the only way he could catch up on the bills from doctors and Duke Hospital for her past care. ... Older people in North Carolina are increasingly faced with high out-of-pocket health-care costs even though they are covered by Medicare, the federal health-care insurance for seniors. State health-insurance counselors say the number of questions they receive about coverage under basic Medicare has more than doubled -- to more than 1,200 a month -- during the past three years.

H.R. 6445: To prohibit the Secretary of Veterans Affairs.from collecting certain copayments ..

To amend title 38, United States Code, to prohibit the Secretary of Veterans Affairs from collecting certain copayments from veterans who are catastrophically disabled. Introduced by Rep. Donald Cazayoux [D-LA] Bill text is not yet available.