Category Archives: Medicare

Bonuses and penalties fail to boost quality of hospital care, GAO


Physician and Nurse Pushing Gurney

By Jordan Rau

Medicare’s quality incentive program for hospitals, which provides bonuses and penalties based on performance, has not led to demonstrated improvements in its first three years, according to a federal report released Thursday. Continue reading


If you’re 60 or over, you need the shingles vaccine


 Don’t wait, vaccinate! Learn about shingles.By Kory B. Fowler, M.D.
Medical Director, Intermountain Region

Shingles is not fun.  In fact, it’s downright awful.  It starts with a tingling or burning sensation on the skin along one side of the body, followed by an extremely painful rash consisting of bumps, blisters or crusting. Hundreds of thousands of Americans 60 or over suffer from shingles each year, and the worst part is they don’t have to. Continue reading


Medicare yet to save money through heralded ACO medical payment model


By Jordan Rau and Jenny Gold

A high-profile Medicare experiment pushing doctors and hospitals to join together to operate more efficiently has yet to save the government money, with nearly half of the groups costing more than the government estimated their patients would normally cost, federal records show. Continue reading


Accountable Care Organizations, explained


Question Q&ABy Jenny Gold

One of the main ways the Affordable Care Act seeks to reduce health care costs is by encouraging doctors, hospitals and other health care providers to form networks that coordinate patient care and become eligible for bonuses when they deliver that care more efficiently.

The law takes a carrot-and-stick approach by encouraging the formation of accountable care organizations (ACOs) in the Medicare program. Providers make more if they keep their patients healthy.

About 6 million Medicare beneficiaries are now in an ACO, and, combined with the private sector, at least 744 organizations have become ACOs since 2011. An estimated 23.5 million Americans are now being served by an ACO. You may even be in one and not know it. Continue reading


Half of US hospitals hit with a total of $420m in Medicare’s readmission penalties


Sign for an emergency room.By Jordan Rau

Once again, the majority of the nation’s hospitals are being penalized by Medicare for having patients frequently return within a month of discharge — this time losing a combined $420 million, government records show.

In the fourth year of federal readmission penalties, 2,592 hospitals will receive lower payments for every Medicare patient that stays in the hospital — readmitted or not — starting in October.

Overall, Medicare’s punishments are slightly less severe than they were last year, both in the amount of the average fine and the number of hospitals penalized.

The Hospital Readmissions Reduction Program, created by the Affordable Care Act, was designed to make hospitals pay closer attention to what happens to their patients after they get discharged.

Since the fines began, national readmission rates have dropped, but roughly one of every five Medicare patients sent to the hospital ends up returning within a month.

Some hospitals view the punishments as unfair because they can lose money even if they had fewer readmissions than they did in previous years. All but 209 of the hospitals penalized in this round were also punished last year, a Kaiser Health News analysis of the records found. Continue reading


Happy 50th birthday, Medicare. Your patients are getting healthier


Photo: Courtesy of Ed g2s under Creative Commons license

The past 15 years have seen a marked drop in deaths and hospitalizations among Medicare patients — people 65 and older. Teasing out why is tricky, but it seems a good trend for the 50-year-old program.


Medicare turns 50 but big challenges await

President Lyndon B. Johnson signed the bill creating Medicare and Medicaid at the library of former President Harry Truman, who was in attendance, on July 30, 1965. (Photos courtesy of Truman Library) Truman: Harry Truman's application for Medicare (Photo courtesy of the Truman Library)

President Lyndon B. Johnson signed the bill creating Medicare and Medicaid at the library of former President Harry Truman, who was in attendance, on July 30, 1965. (Photos courtesy of Truman Library) Truman: Harry Truman’s application for Medicare (Photo courtesy of the Truman Library)

By Mary Agnes Carey

Medicare, the federal health insurance program for the elderly and disabled, has come a long way since its creation in 1965 when nearly half of all seniors were uninsured.  Now the program covers 55 million people, providing insurance to one in six Americans.

With that in mind, Medicare faces a host of challenges in the decades to come.  Here’s a look at some of them

Financing – While Medicare spending growth has slowed in recent years – a trend that may continue into the future – 10,000 people a day are becoming eligible for Medicare as the trend-setting baby boomers age. Yet the number of workers paying taxes to help fund the program is decreasing.  That means Medicare will consume a greater share of the federal budget and beneficiaries’ share of the tab will likely climb. Continue reading


Five challenges facing Medicaid at 50


By Phil Galewitz


President Lyndon B. Johnson signed the bill creating Medicare and Medicaid at the library of former President Harry Truman, who was in attendance, on July 30, 1965. (Photo courtesy of Truman Library)

A “sleeper” provision when Congress created Medicare in 1965 to cover health care for seniors, Medicaid now provides coverage to nearly 1 in 4 Americans, at an annual cost of more than $500 billion.

Today, it is the workhorse of the U.S. health system, covering nearly half of all births, one-third of children and two-thirds of people in nursing homes.

Enrollment has soared to more than 70 million people since 2014 when the Affordable Care Act began providing billions to states that chose to expand eligibility to low-income adults under age 65. Previously, the program mainly covered children, pregnant women and the disabled.

Unlike Medicare, which is mostly funded by the federal government (with beneficiaries paying some costs), Medicaid is a state-federal hybrid. States share in the cost, and within broad federal parameters, have flexibility to set benefits and eligibility rules.

Though it provides a vital safety net, Medicaid faces five big challenges to providing good care and control costs into the future: Continue reading


Medicare rates home health agencies


Star full faceHome Health Agencies Get Medicare’s Star Treatment

By Jordan Rau

The federal government released on Thursday a new five-star rating system for home health agencies, hoping to bring clarity to a fast-growing but fragmented corner of the medical industry where it’s often difficult to distinguish good from bad.

Medicare applied the new quality measure to more than 9,000 agencies based on how quickly visits began and how often patients improved while under their care. Nearly half received average scores, with the government sparingly doling out top and bottom ratings.

The elderly tend to be less familiar with the reputation of home health agencies than they are with hospitals and other institutions.

The star ratings come as home health agencies play an increasingly important role in caring for the elderly.

Last year 3.4 million Medicare beneficiaries received home health services, with nurses, aides, and physical and occupational therapists treating them in the home.

Medicare spends about $18 billion on the home health benefit, which provides skilled services that must be authorized by a doctor, not housekeeping care that some elderly pay for privately. Continue reading


Medicare slow to adopt telemedicine due to cost concerns


telemedicine-5701By Phil Galewitz

Donna Miles didn’t feel like getting dressed and driving to her physician’s office or to a retailer’s health clinic near her Cincinnati home.

For several days, she had thought she had thrush, a mouth infection that made her tongue sore and discolored with raised white spots. When Miles, 68, awoke on a wintry February morning and the pain had not subsided, she decided to see a doctor.

Nearly 20 years after such videoconferencing technology has been available for health services, fewer than 1 percent of Medicare beneficiaries use it.

So she turned on her computer and logged on to, a service offered by her Medicare Advantage plan, Anthem BlueCross BlueShield of Ohio. She spoke to a physician, who used her computer’s camera to peer into her mouth and who then sent a prescription to her pharmacy.

“This was so easy,” Miles said.

For Medicare patients, it’s also incredibly rare. Continue reading


A new focus on family caregivers


A younger man holds an elderly man's handBy Susan Milligan

Iraq war veteran Doug Mercer had been home in McAlester, Oklahoma, for just four days when he was in a motorcycle accident that left him broken and brain-damaged.

His wife Michelle became his caregiver after he left the hospital, but nobody there explained how to transport him safely.  A few weeks later, Michelle struggled as she tried to get Doug from the car to his wheelchair, breaking his leg.

“They’re sending you home, and you’re thinking, ‘What?’ Nobody instructs you, and says, ‘This is what’s coming home with you and how to use it,’” she said.

The Mercers’ story was a driving force behind an Oklahoma law that took effect in November that requires hospitals to train a designated family caregiver to tend to the medical needs of a released patient.

As many as 42 million Americans take care of a family member at any given time.

Since then, 12 more states (Arkansas, Colorado, Connecticut, Indiana, Mississippi, New Hampshire, New Jersey, New Mexico, Nevada, Oregon, Virginia and West Virginia) have approved similar laws. In Illinois and New York, legislation is awaiting the governor’s signature.

As many as 42 million Americans take care of a family member at any given time. Traditionally, family caregivers provide assistance with bathing, dressing and eating. They shop for groceries and manage finances.

But as the number of elderly Americans with chronic conditions has grown, family caregivers have taken on medical tasks once provided only in hospitals, nursing homes or by home care professionals.

In an AARP survey released in 2012, nearly half of family caregivers said they administered multiple medications, cared for wounds, prepared food for special diets, used monitors or operated specialized medical equipment. Continue reading


One Nation, Under Sedation: Medicare Paid for Nearly 40 Million Tranquilizer Prescriptions in 2013



Three red and white capsulesBy Charles Ornstein

This story was co-published with the Boston Globe, the Miami Herald and Health News Florida.

In 2012, Medicare’s massive prescription drug program didn’t spend a penny on popular tranquilizers such as Valium, Xanax and Ativan.

The following year, it doled out more than $377 million for the drugs.

Screen Shot 2015-06-10 at 8.59.21 AMWhile it might appear that an epidemic of anxiety swept the nation’s Medicare enrollees, the spike actually reflects a failed policy initiative by Congress.

More than a decade ago, when lawmakers created Medicare’s drug program, called Part D, they decided not to pay for anti-anxiety medications.

Some of these drugs, known as benzodiazepines, had been linked to abuse and an increased risk of falls and fractures among the elderly, who make up most of the Medicare population.

But doctors didn’t stop prescribing the drugs to Medicare enrollees. Patients just found other ways to pay for them.

When Congress later reversed the payment policy under pressure from patient groups and medical societies, it swiftly became clear that a huge swath of Medicare’s patients were already using the drugs despite the lack of coverage.

In 2013, the year Medicare started covering benzodiazepines, it paid for nearly 40 million prescriptions, a ProPublica analysis of recently released federal data shows.

Generic versions of the drugs 2014 alprazolam (which goes by the trade name of Xanax), lorazepam (Ativan) and clonazepam (Klonopin) 2014 were among the top 32 most-prescribed medications in Medicare Part D that year.

And it appears these were not new prescriptions. Continue reading


Social Security announces new online service for replacement Medicare cards


From the Office of the Insurance Commissioner

apple-touch-iconThe Social Security Administration introduced the expansion of online services available through its my Social Security portal.

Medicare beneficiaries can now get a replacement card if they’ve lost, damaged, or simply need to replace it using a my Social Security online account.

Medicare beneficiaries can now get a replacement card if they’ve lost, damaged, or simply need to replace it using a my Social Security online account.

Requesting a replacement card through my Social Security account is a convenient, cost-effective and secure way to ensure you have a critical piece of identification available when required by medical providers as proof of Medicare coverage.

You can access your online my Social Security account and select the “Replacement Documents” tab.

Then select “Mail my replacement Medicare card.” After you request a card, it will arrive in the mail in approximately 30 days.

For more information about my Social Security or to establish an account, go to:


A top-rated nursing home is hard to find in Texas, 10 other states


Natalie Anne Sealy's headshot.

Natalie Sealy (Photo courtesy of Billie Pender)

LOCKHART, Texas — The call from the nursing home came just before dawn, jolting Martha Sherwood awake.

During the night, fire ants had swarmed over her 85-year-old mother, injecting their stinging venom into Natalie Sealy’s face, arms, hands and chest.

“She was just lying there being eaten alive,” said daughter Billie Pender, who said she and her sister had repeatedly complained about a broken windowsill in their mother’s room at Parkview Nursing and Rehabilitation Center.

In 11 states, 40 percent or more of nursing homes get Medicare’s lowest two lowest rating.

The Sept. 2 attack devastated Sealy, a retired bank teller with dementia. “She went steadily downhill,” dying in late March, said Sherwood, who brought a lawsuit against the home.

Their mother had chosen the for-profit facility two years earlier because it was near her adult children. The family didn’t know that Parkview scored poorly on staffing and other quality measures.

This year, Medicare rates it one star out of a possible five stars — the lowest rating possible — on Nursing Home Compare, which was designed by the federal government to help consumers choose a long-term care facility.

The problem for Sealy’s family and residents of many parts of the country is they have few, if any, higher-rated options if they want their loved ones close by.

In 11 states, 40 percent or more of nursing homes get the two lowest ratings, according to an analysis by the Kaiser Family Foundation.  (Kaiser Health News is an editorially independent program of the foundation.)


Texas has the highest percentage of one-and two-star homes in the country: 51 percent of its nursing homes are rated “below average,” or “much below average,” on Nursing Home Compare, according to the analysis. Louisiana is close behind at 49 percent, with Oklahoma, Georgia and West Virginia tying for third at 46 percent. Continue reading