Author Archive
We Told You So…
The New York Times recently printed an article by Robert Pear entitled “Medicare Standards are Too Strict, 2 Courts Find.”
We’ve been telling people that for years.
The Times article refers to two decisions, Anderson v. Sebelius and Papciak v. Sebelius, both regarding the Medicare “Improvement Standard.” For anyone not familiar, this is an arbitrary rule of thumb which essentially says that if the beneficiary won’t improve, Medicare won’t cover certain services.
The Improvement Standard has been used for years by Medicare contractors to improperly deny coverage.
However, per these two recent decisions, Medicare must adhere to the law as written, and pay for services if they are needed to maintain a person’s condition or to prevent deterioration of the person’s condition. The courts stated that Medicare beneficiaries do not have to prove that their condition will improve, as the government generally contends.
The rulings are potentially significant for many people with chronic conditions and disabilities like multiple sclerosis and Alzheimer’s disease; conditions which, by their very nature, simply will not improve. In the words of one judge, patients “need not risk a deterioration of [their] fragile health” to justify continuation of coverage for skilled care.
Center for Medicare Advocacy Director of litigation Gill Deford acted as co-counsel in one of the two cases. The Center has launched a campaign to end the Improvement Standard, and these decisions represent a significant victory.
Health Reform Hits Main Street
Confused about how the new health reform law really works? This short, animated movie, written and produced by the Kaiser Family Foundation and narrated by Cokie Roberts, explains the problems with the current health care system, the changes that are happening now, and the big changes coming in 2014.
You’re not in the hospital. You’re in observation!
When Mrs. Lee Barrows was told that her husband Larry, whom she’d been visiting in the hospital for a week was not an in-patient, she asked, then “Who the hell have I been visiting?” This scene in Connecticut is being repeated daily in acute care hospitals all over the country. Medicare beneficiaries – although placed in hospital beds (often, from the emergency room) and given medications, tests, therapies, medical and nursing services, food, and a wrist-band – are told they aren’t in-patients; they’re just receiving observation services as outpatients. Patients often learn about their out-patient status just as they are leaving the hospital for the skilled nursing facility – which won’t be covered by the Medicare program because they weren’t in-patients for three consecutive days!
The Center for Medicare Advocacy has been hearing this story with increasing frequency over the last year. We’ve been writing about it (see our 5/24 post), and now, the media is reporting on it.
Bloomberg News published an article by Drew Armstrong on its website and in Business Week – “Medicare Fraud Effort Gives Elderly Surprise Hospital Bills” (July 12, 2010), http://www.bloomberg.com/news/print/2010-07-12/hospital-fraud-audits-spur-unintended-cash-penalty-to-elderly-on-medicare.html
The Philadelphia Inquirer also addressed this pressing issue in its article “High cost, rigorous rules can trap Medicare patients” (July 4, 2010), http://www.philly.com/inquirer/health_science/daily/20100704_High_cost__rigorous_rules_can_trap_Medicare_patients.html
The Center has lots of information on this issue. Please go to http://www.medicareadvocacy.org/InfoByTopic/ObservationStatus/ObservationMain.htm
And let us hear from you, too! What is happening to you and your friends and relatives in the hospital?
Seize The Day!
The Center for Medicare Advocacy urges Congress to pass health care reform now. According to Judith Stein, the Center’s Executive Director “We are the closest we have ever been to fixing our unfair and ineffective health care system. We must seize this opportunity to pass health reform. The status quo is not an option; we simply can’t afford to put this off yet again.”
Ms. Stein stressed that health care reform will strengthen and improve guaranteed benefits in Medicare and protect the integrity of the Medicare program by extending the life of the Medicare Trust Fund. “More specifically, health care reform will improve the Medicare program for beneficiaries by slowing the growth of premiums and other out-of-pocket expenses, improving preventive benefits, and closing the gap in prescription drug coverage,” said Ms. Stein.
Moreover, the legislation promotes delivery system reforms to encourage high quality, coordinated health care. “Most of the Center’s clients have chronic conditions – as do nearly all Medicare beneficiaries. We know from experience that well coordinated care is critical to our clients’ well-being. The Center has been advocating about this issue for many years,” said Ms. Stein.
Ms. Stein stated that the Center for Medicare Advocacy strongly supports the goals of comprehensive health reform legislation, which expands coverage to millions of Americans, helps them purchase insurance, and ends discriminatory practices by insurance companies. “Everyone wins, including Medicare beneficiaries when all Americans have access to quality, affordable health care,” she said.
The Center for Medicare Advocacy urges Congress to pass health reform now. Passing this legislation will strengthen Medicare, bring a similar promise of health coverage to younger people, and increase the economic security of all Americans.
Judith Stein is available for comment and questions.
Extend the Life of Medicare: Pass Health Care Reform Now
If you have Medicare and want to keep it, you should be in favor of health care reform.
Recently the non-partisan Medicare Advisory Payment Commission (MedPAC) released its biannual report to Congress, which for the fifth consecutive year advised Congress to equalize reimbursements to Medicare Advantage plans with the traditional Medicare fee-for-service program.
According to non-partisan Congressional Budget Office (CBO) estimates, equalizing payments between Medicare Advantage programs and the traditional Medicare programs will generate $170 billion in savings over the next ten years.
MedPAC’s report concluded that the “Commission has consistently supported the concept of financial neutrality between payment rates for the fee-for-service program and private plans.” Under the current reimbursement system, Medicare Advantage plans are reimbursed on average 14 percent more than traditional Medicare plans. These extra costs are born by beneficiaries in the traditional Medicare program and all taxpayers.
The health care reform bills passed by both the House and the Senate, and the proposals by President Obama, would reduce wasteful Medicare Advantage spending – saving money for Medicare beneficiaries and taxpayers alike, and extending the solvency of the Medicare program. We urge Congress to pass health care reform now!
Fool Me Once…
Newt Gingrich, staunch supporter of Medicare? That’s why he’s opposed to health care reform? If you read just the opening paragraph of Paul Krugman’s February 12, 2010 Op-Ed article, you might believe this. Well, you might believe it if you haven’t been paying attention to anything Gingrich and his fellow conservatives have been doing for the last couple of decades.
Gingrich himself is the man who enthusiastically declared in 1995, as Republicans pushed for Draconian cuts to the Medicare program, that Medicare would thus “wither on the vine.”
Yet, here we are 15 years later, and Mr. Gingrich is crying, according to Krugman, that “the reform bills passed by the House and Senate cut Medicare by approximately $500 billion. This is wrong.”
No, Mr. Gingrich, what’s wrong is the gall of hypocrites who will grasp any tactic to frighten people and fight the real health care reform our country so desperately needs.
Senators: Listen to US Economist and Nobel Laureate
Like we’ve been saying, if you care about fiscal responsibility and the future of Medicare, support health care reform! Paul Krugman explains why in today’s New York Times.
Kaiser Family Foundation Ad Audit: Message Sacrifices Truth About Health Bills And Medicare
AD TITLE: “Greatest Generation“
SPONSOR: The 60 Plus Association
SUMMARY: A conservative advocacy group uses testimony from sympathetic older Americans to warn that a health care overhaul would impair Medicare, the government health care program for the elderly. The ad says older Americans should be shielded from spending cuts because of their great sacrifices for the country. But it’s truth that’s sacrificed here: the ad exaggerates the impact of proposed Medicare cuts and ignores some improvements in Medicare benefits included in the main Democratic bills before Congress.
BACKGROUND: The 60 Plus Association, a nonprofit advocacy group that bills itself as a conservative counterweight to AARP, favors lower taxes and less government. The group says it is has purchased $2 million in airtime in eight states that are homes to key senators: Alaska, Arkansas, Connecticut, Louisiana, Maine, Nebraska, North Dakota and South Dakota. The ads come in 30-second and 60-second versions.
POLITICS: The ad is part of a broader effort to increase concerns among older Americans about pending health care legislation. The insurance industry’s main lobbying group, America’s Health Insurance Plans, made a similar argument in ads last month. Both AHIP and 60 Plus are upset about proposals to create government-run insurance that would compete with private companies in selling coverage to people under age 65. Since many surveys show substantial support for the public option, however, the opponents are focusing on something else: The bills’ potential impact on the popular Medicare program.
ACCURACY: The health bills would reduce Medicare spending, but it’s highly unlikely medical care for the elderly would suffer, many health analysts say. “This ad is clearly intended to frighten people with a great deal of misinformation,” says Judith Stein, executive director of the Center for Medicare Advocacy, a Connecticut-based nonprofit that helps people secure Medicare benefits.
Under the Senate Finance Committee bill, Medicare spending, on net, would be $379 billion less over a decade, or about 5 percent of program expenditures, than under current law. In both that bill and the House proposal, a big chunk of the cuts would involve Medicare Advantage plans that are run by private insurers and often provide additional benefits beyond what traditional fee-for-service Medicare offers. The Finance bill targets Medicare Advantage for $117 billion in cutbacks over a decade; the House bill, $170 billion, according to the Congressional Budget Office.
Congress is eyeing Medicare Advantage plans largely because they spend an average of about 14 percent more on their members than traditional Medicare spends on its beneficiaries. If the cuts are enacted, the number of Medicare Advantage plans might decline. In addition, those that survive might pare back some of the extra benefits they offer, such as low or zero monthly premiums, dental care and free gym memberships. But no one would be denied basic Medicare benefits.
On the other hand, not all the proposed reductions would be painless – especially for the providers who would bear the brunt of other Medicare cuts. Overall, though, the cuts would be substantially less than the reductions approved by Congress in 1997 to balance the federal budget deficit, according to Tricia Neuman, a Medicare expert at the Kaiser Family Foundation. (KHN is a part of the foundation.) Congress ended up restoring some of that money a few years later. Lawmakers were worried some of the reductions, including those for skilled nursing facilities, were too severe. “It’s hard to anticipate changes in the health care system,” Neuman says. “Ongoing tweaks may be necessary.”
The ad’s warning about the rationing of ”potentially life-saving drugs” lacks support. The 60 Plus Association tries to back up this claim by citing a few news stories about patients in England and Canada denied drugs by government insurers. But far from restricting access to drugs, “ironically, there are enhancements to the Medicare drug benefits” in the health overhaul bills, says Paul Ginsburg, president of the Center for Studying Health System Change, a Washington research group.
The bills being debated would eliminate co-payments for preventive services. In addition, the House bill would provide a 50 percent discount on brand-name drugs purchased when beneficiaries hit the coverage gap known as the “doughnut hole,” and it would gradually eliminate the gap. The Senate Finance bill would not close the doughnut hole, but it would provide the discount, which was negotiated with the Obama administration and the pharmaceutical lobby earlier this year. The House bill also would require Medicare to cover immunosuppressive drugs for as long as kidney transplant recipients need them, rather than for the current 36 months.
Overall the ad’s argument is built on a logical inconsistency: It raises the specter of “government-run health care” to increase concerns among both young and old. But at the same time it extols Medicare – which is government-run health care for people 65 and older.
Source: Kaiser Health News, Jordan Rau, KHN Staff Writer
Medicare Private Insurance Companies Are At It Again
Late last week Humana, one of the largest private insurance companies offering Medicare Advantage and prescription drug plans under Medicare, sent a letter to the Medicare beneficiaries enrolled in their HMOs and other Medicare Advantage plans. The outside envelope warned that the letter contained important information about their Medicare benefits. The letter itself said that Congress was considering cuts to Medicare in its health care reform legislation, these cuts would result in reduced benefits for Humana plan enrollees, and enrollees should contact their members of Congress to protest the cuts.
This is not the first time that private Medicare plans have written their enrollees with misinformation about alleged Medicare cuts. The Center for Medicare Advocacy and a number of other beneficiary organizations have been concerned for years about these kinds of mailings by private Medicare plans. We recently asked CMS to modify its guidance to private Medicare plans in order to specifically identify these communications as marketing materials, which are subject to CMS oversight and review. We said in our comments:
We are very concerned about plan sponsors soliciting their enrollees to join “grassroots” efforts to influence Medicare policy via member newsletters and other means. …We believe there should be a prohibition on plan sponsors soliciting members’ participation in political activities, particularly those that benefit the plan sponsor, and urge CMS to analyze whether such activity already violates current law.
CMS did not amend its guidance to plans per our suggestion, but it did take swift action against Humana. CMS sent a letter to Humana yesterday telling the organization to stop sending misleading and confusing communications, and that it believed such communications are potentially contrary to federal regulations and guidance. CMS further advised that the agency takes this matter very seriously and could pursue compliance and enforcement actions. CMS also sent a comparable memo to all private insurance companies telling them not to send similar communications.
We thank CMS for acting so swiftly to curb misleading and confusing communications to people in their Medicare plans. While we are pleased that the government is exercising its oversight and enforcement authority, we see this incident as another example of how reliance on private insurance companies can generate confusion and fear for Medicare beneficiaries. This happens because the interests of private Medicare plans are not always in accord with the interests of Medicare beneficiaries.
