Posts tagged ‘judith stein’
July 14, 2016 – The Center for Medicare Advocacy (CMA) is thrilled to be partnering with The John A. Hartford Foundation to improve care for older adults with long-term and chronic conditions. With the Foundation’s generous two-year grant, CMA will be able to focus on solutions for older adults caught in the web of hospital “outpatient” Observation Status, which reduces access to key health and therapeutic care.
Over the two-year grant period, CMA, will gather existing resources and collect stories from beneficiaries, produce and update advocacy materials, and conduct extensive outreach and education that will improve observation status policy through regulatory change, improved federal guidance, and increased awareness by legislators. The grant funding for this project will also strengthen CMA’s advocacy on other important issues, including increasing access to oral health care for older adults.
“Outpatient” Observation Status is a policy created by the Centers for Medicare & Medicaid Services to classify certain very short hospital stays for billing purposes. The intent was to identify, and pay less for, these stays.
Medicare hospital patients are increasingly classified as “outpatients” on Observation Status, rather than admitted inpatients. This is true even for patients who are in the hospital for many days, for diagnosis, tests, nursing, physician care and treatment. Unfortunately, Observation Status results in myriad unintended consequences. For example, Medicare coverage for post-hospital nursing home care is often entirely unavailable for Observation patients since it requires a 3-day prior inpatient hospital stay. Thus, Observation Status “outpatients” are ineligible for Medicare nursing home coverage even if they were in the hospital for many days or weeks.
Hospital Observation Status has profound consequences for the quality and cost of care available for older, vulnerable Medicare patients. It also harms hospitals and nursing homes, the Medicare appeals process, the integrity of the Medicare program – and shifts costs to State Medicaid budgets. With support from The John A. Hartford Foundation, CMA will be able to enhance efforts to reduce the harm caused by Observation Status and to advocate for better care for older adults.
“We are very pleased to support the passionately driven and highly expert staff at CMA, led by the indomitable Judith Stein,” said Terry Fulmer, PhD, RN, FAAN, president of The John A. Hartford Foundation. “As our Foundation works to create age-friendly hospitals and health systems, CMA’s important policy work will raise visibility and diminish the negative impact of the Observation Status classification of older hospitalized adults through outreach and education.”
We agree it’s important to find a permanent solution to the physician payment formula (“Sustainable Growth Rate” or SGR), but the Bill passed by the House of Representatives today is not the answer. It isn’t balanced. It asks too much from beneficiaries without providing enough in return. It asks nothing from pharmaceutical or insurance companies. It continues the ever-increasing privatization of Medicare by increasing costs for beneficiaries for traditional Medicare and Medigap plans. It adds unnecessary costs for the Medicare program and taxpayers.
Of the portion of the SGR costs that will be off set, roughly half (approximately $35 billion of the total $70 billion over 10 years) would come from Medicare beneficiaries through changes that will increase their out-of-pocket costs for health care, including:
• Adding deductibles to Medigap plans purchased by new Medicare beneficiaries starting in 2020;
• Further means-testing premiums for higher-income beneficiaries; and
• Overall increases in Part B premiums.
While the SGR package would make the low-income, Qualified Individual (QI), program permanent, which we strongly support, and would minimally increase and temporarily extend important funding for beneficiary education and outreach, it does not address other key issues that serve as barriers to care. For example, instead of repealing the annual outpatient therapy caps, the process to seek an exception to the cap is extended for another two years. Instead of addressing hospital Observation Status, the Bill further extends enforcement of the so-called “two-midnight” rule.
In short, Medicare beneficiaries would pay too much, with too little in return. Major drug and insurance industries pay nothing, and stand to gain a great deal. As the SGR debate moves to the Senate, we hope further balance and improvements for beneficiaries will be made.
Since 1965, Medicare has opened doors to health care and increased economic security for hundreds of millions of older people, people with disabilities, and their families.
2015 will also usher in a new Congress. Many of its leaders and members will likely champion plans to further privatize Medicare. These proposals will likely surface despite increasing reports that Medicare costs and the federal deficit are declining, and that traditional Medicare costs less than private Medicare. Once again we will likely hear about plans to transform Medicare to “Premium Support” (a voucher towards the purchase of private insurance). We will probably read about proposals to increase the age of Medicare eligibility, decrease the value of Supplemental Medicare Insurance (Medigap), redesign Medicare to make it “simpler” (but less useful for most beneficiaries). We urge you to listen carefully for these and other such plans. And respond!
Since 1986, the Center for Medicare Advocacy has been on the front lines, advocating for people who depend on Medicare and for a comprehensive Medicare program for future generations. As we mark Medicare’s 50th anniversary, help us ensure its promise to advance access to healthcare. Help us explain what’s true and what’s not, where real savings exist, and when the true interests of beneficiaries are at stake. Help us ensure a real Medicare program lasts for another 50 years.
Be part of our Medicare Truth Squad. Ask us if you have questions. Spread the word – on Twitter, Facebook – in conversations! The future of a comprehensive Medicare program may depend on it.
In “Fighting to Honor a Father’s Last Wish: To Die at Home” (the New York Times, September 25, 2014) author Nina Bernstein eloquently lays out the heartbreaking story of Joseph Andrey, whose last year of life was spent shuttling between inadequate care in every possible care setting. Often the services he received were provided in the most expensive available setting, regardless of the wishes of the family. Mr. Andrey finally died back in his home, but that final year of his life, quite likely the lowest quality-of-life year he ever endured, cost over a million dollars in Medicare, Medicaid and private funds.
It doesn’t have to be this way.
Unfortunately, too often it is. I have devoted over 30 years as a lawyer to Medicare advocacy, yet I could not help my uncle when his Medicare coverage was prematurely ended in the hospital and the nursing home. This resulted in his ending up at home with inadequate care, and he, too, experienced many of the dreadful occurrences that befell Mr. Andrey. A day after his death, and almost a year after his premature discharge, we won his Medicare appeal. Like too many others, he died after poor care and unfair denials from his private Medicare plan. Another victim of profits over people.
The Medicare trustees reported good news for Medicare today. The Trustees’ annual report finds the life of the Medicare Trust Fund has been extended another four years since their 2013 report, and an additional 13 years from their last projection before the Affordable Care Act passed. The annual report confirms that Medicare continues to provide cost-effective health insurance for more than 50 million older and disabled beneficiaries – and that the Affordable Care Act strengthened Medicare.
Medicare provides health insurance and access to needed care for most Americans age 65 or older and those with significant disabilities. The 2014 Trustees Report confirms that Medicare is working well and will be in fine shape for the foreseeable future. The Trustees conclude benefits are expected to be payable in full until 2030, four more years than they projected in May 2013.
“The Medicare Trustees’ favorable forecast is attributable to slowing health care costs, the recovering economy and the implementation of the Affordable Care Act. The Trustees Report answers skeptics and demonstrates that Medicare is healthy. It continues to be an efficient, cost-effective program that Americans can count on for future generations. It should be protected as one of our great success stories.” said Judith Stein, executive director of the Center for Medicare Advocacy.
The positive outlook for the Medicare Trust Fund is certainly good news. There are opportunities to further improve Medicare’s well-being without reducing benefits or cutting services. Congress could secure the program’s future even more by reducing wasteful overpayments to private Medicare Advantage plans, and by obtaining the best rates possible for prescription drugs.
Too often people with low and moderate incomes fail to get the health coverage they need. Women are frequently harmed the most. In addition to their own health concerns, they are usually the gender responsible for family-planning and family care-taking.
The Supreme Court’s decision in Hobby Lobby reduces women’s rights and erodes women’s access to health care. In Hobby Lobby, the Court found that “closely held” corporations needn’t provide health insurance for their employees if it would violate their religious beliefs Incredibly, the decision advances corporate rights over women’s rights. And it advances the notion that corporations are people too – with religious beliefs!
Corporations don’t bleed; they don’t get pregnant; they don’t take care of children and parents. Women do.
Congress: Take action. Reconsider the Religious Freedom Restoration Act at the heart of the Hobby Lobby decision.
Women, Men, people who bleed, get sick, and take care of others who do: Speak out against this injustice.
And we quote:
“Private insurers’ Medicare Advantage plans cost Medicare an extra $34.1 billion in 2012
Instead of being more efficient, private insurers have cost Medicare almost $300 billion more over the life of the program
A study published online today finds that the private insurance companies that participate in Medicare under the Medicare Advantage program and its predecessors have cost the publicly funded program for the elderly and disabled an extra $282.6 billion since 1985, most of it over the past eight years. In 2012 alone, private insurers were overpaid $34.1 billion.
That’s wasted money that should have been spent on improving patient care, shoring up Medicare’s trust fund or reducing the federal deficit, the researchers say.
The findings appear in an article published in the International Journal of Health Services by Drs. Ida Hellander, Steffie Woolhandler and David Himmelstein titled “Medicare overpayments to private plans, 1985-2012: Shifting seniors to private plans has already cost Medicare US$282.6 billion.”
Hellander is policy director at Physicians for a National Health Program (PNHP), a nonprofit research and advocacy group. Woolhandler and Himmelstein are professors at the City University of New York School of Public Health, visiting professors at Harvard Medical School and co-founders of PNHP.”