Category Archives: Medicare

Turning 65? Know your Medicare options – Guest column

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Center for Medicare & Medicaid ServicesMedicare tips from Oraida Roman, president of Senior Products for Humana’s Intermountain Region

Approximately 11,000 adults become eligible for Medicare every day, reflecting a dramatically increasing senior population, and that number is only going to grow.

The U.S. Census Bureau predicts there will be nearly 47 million seniors age 65 and up in 2015 and about 72.1 million seniors – nearly 20 percent of the population – by 2030.,

Here in Washington, the 65 and older population is expected to increase from 13.9 percent of the overall population in 2015 to 18.1 percent of the overall population by 2030.

Health concerns are a major issue for seniors, with nine of 10 older adults living with at least one chronic condition, such as diabetes, arthritis, hypertension or lung disease, according to the National Council on Aging.

Making matters worse, these conditions place a significant financial burden on seniors and, sometimes, their caregivers. As a result, there’s a clear need for access to affordable health care that meets the needs of individuals as they age.

As Seattle residents approach their 65th birthday, it is important for them to know their Medicare options, including when they can enroll and the types of health plans available. Continue reading

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Suspicious HIV drug prescriptions abound in Medicare

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propublica thumbnailThe inspector general of the U.S. Department of Health and Human Services finds Medicare spent tens of millions of dollars in 2012 for HIV drugs there’s little evidence patients needed. A 77-year-old woman with no record of HIV got $33,500 of medication.

By Charles Ornstein
ProPublica

Medicare spent more than $30 million in 2012 on questionable HIV medication costs, the inspector general of the U.S. Department of Health and Human Services said in a report set for release Wednesday.

The report offers a litany of possible fraud schemes, all paid for by Medicare’s prescription drug program known as Part D.

Among the most egregious:

In Detroit, a 77-year-old woman purportedly filled $33,500 worth of prescriptions for 10 different HIV medications. But there’s no record she had HIV or that she had visited the doctors who wrote the scripts.

A 48-year-old in Miami went to 28 different pharmacies to pick up HIV drugs worth nearly $200,000, almost 10 times what average patients get in a year. The prescriptions were supposedly written by 16 health providers, an unusually high number.

And on a single day, a third patient received $17,500 of HIV drugs — and none the rest of the year. She got more than twice the recommended dose of five HIV drug ingredients. Continue reading

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Medicare experiment could signal sea change for hospice

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Diane Meier 176By Michelle Andrews
KHN / JUL 29, 2014

Diane Meier is the director of the Center to Advance Palliative Care, a national organization that aims to increase the number of palliative care programs in hospitals and elsewhere for patients with serious illnesses.

Meier is also a professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York City.

We spoke about a recently launched pilot program under the health law that allows hospice patients participating in the pilot to continue to receive life-prolonging treatment. This is an edited version of that conversation.

Q. There’s a lot of confusion about how hospice care differs from palliative care. Maybe we should start by clearing up what those terms mean. Continue reading

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Good News for Boomers: Medicare’s Hospital Trust Fund flush until 2030

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Medicare’s Hospital Insurance Trust Fund, which finances about half the health program for seniors and the disabled, won’t run out of money until 2030, the program’s trustees said Monday.

That’s four years later than projected last year and 13 years later than projected the year before the passage of the Affordable Care Act. Continue reading

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Does selling your home affect eligibility for assisted living?

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Q. I’m a realtor who’s listing a client’s home. She is on Social Security and is moving into assisted-living housing. Will the proceeds from the sale of her home affect her eligibility for housing, which is based on her income?

A. This is an unusual question because assisted-living facilities typically do not have special eligibility criteria for low-income residents, experts say. Continue reading

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Putting the Home in a nursing home

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Mealtime. Naptime. Bath time. Bedtime. Everything is on a schedule for residents in a traditional nursing home, leaving little flexibility for personal decision making.

But LaVrene Norton is working to change that.

Norton is founder and president of Action Pact, a national consulting firm. It specializes in helping retirement communities and nursing homes train staff and design their facilities to feel and be more like living at home.

Since beginning work on the “household model” in 1984, Norton has helped design hundreds of these communities. Continue reading

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Without federal action, states move on long-term care

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Some states are taking steps to ensure that more seniors can get the kind of long-term care they want — without becoming poor to get it.

A younger man holds an elderly man's handBy Michael Ollove
Stateline

Three years after the demise of the long-term care piece of the Affordable Care Act, some states are retooling their Medicaid programs to maximize the number of people who can get care at home and minimize the number who have to become poor to receive help.

They also are trying to save state dollars. Medicaid is a joint state-federal program, and long-term care for the elderly is putting an ever greater burden on state budgets: Total Medicaid spending for long-term services rose from $113 billion in 2007 to nearly $140 billion in 2012. Continue reading

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More than 750 hospitals face Medicare crackdown on patient injuries

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During a hernia operation, Dorothea Handron’s surgeon unknowingly pierced her bowel. It took five days for doctors to determine she had an infection.

By the time they operated on her again, she was so weakened that she was placed in a medically induced coma at Vidant Medical Center in Greenville, North Carolina.

Comatose and on a respirator for six weeks, she contracted pneumonia. “When they stopped the sedation and I woke up, I had no idea what had happened to me,” said Handron, 60. “I kind of felt like Rip Van Winkle.”

Because of complications like Handron’s, Vidant, an academic medical center in eastern North Carolina, is likely to have its Medicare payments docked this fall through the government’s toughest effort yet to crack down on infections and other patient injuries, federal records show. Continue reading

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Medicare billing outliers often have disciplinary problems

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Doctors with unusual billing patterns often have been disciplined by their state medical boards or have faced accusations against their licenses.Stethoscope Doctor

By Charles Ornstein
ProPublica, June 20, 2014

Over the past couple months, media organizations including ProPublica have been busy dissecting data released by Medicare on payments made to health professionals in 2012.

We’ve uncovered unusual billing patterns :Doctors who only bill for the most complicated and high-priced office visits, and ambulance companies in New Jersey who ferry patients to and from dialysis appointments dozens of times a year.

But one thread connecting various stories by us and others is how often doctors with unusual billing patterns have been disciplined by their state medical boards or have faced accusations against their licenses. Continue reading

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Washington among top-ranked states for long-term care

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A younger man's hand holding the hand of an elderly manThe state with the highest marks long-term services and support for the elderly, disabled and their caregivers was Minnesota, followed by Washington, Oregon, Colorado and Alaska.

The lowest ranked states were: Indiana, Tennessee, Mississippi and Alabama, and, coming in last, Kentucky, according to a new report.

The report “Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities and Family Caregivers,” evaluates 26 indicators in five key dimensions that make up the Long-Term Services and Supports (LTSS) system in each state. It was produced by  AARP, The Commonwealth Fund and The SCAN Foundation.

Major Findings

Minnesota, Washington, Oregon, Colorado, Alaska, Hawaii, Vermont, and Wisconsin, in this order, ranked the highest across all five dimensions of the scorecard..

These eight states clearly established a level of performance at a higher tier than other states—even other states in the top quartile. But even these top states have ample room to improve.

The cost of long sterm continues to outpace affordability for middle-income families, and private long-term care insurance is not filling the gap. Continue reading

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Observation care can be costly

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 FAQ: Hospital Observation Care Can Be Costly For Medicare Patients

hospital magnify thumbnailThe number of Medicare patients hospitalized for observation – and ineligible for follow-up nursing home coverage – beyond 48 hours has increased five-fold in the past six years. This updated FAQ explains how to avoid observation care and what you need to know if you can’t

By Susan Jaffee
KHN

Some seniors think Medicare made a mistake.  Others are stunned when they find out that being in a hospital for days doesn’t always mean they were actually admitted.

Instead, they received observation care, considered by Medicare to be an outpatient service. The observation designation means they can have higher out-of-pocket expenses and fewer Medicare benefits.

Yet, a  government investigation found that observation patients often have the same health problems as those who are admitted.

More Medicare beneficiaries are entering hospitals as observation patients every year. The number rose 88 percent over the past six years, to 1.8 million nationally in 2012, according to the Medicare Payment Advisory Commission, which helps guide Congress on Medicare issues. At the same time, Medicare hospital admissions stayed about the same.

Here are some common questions and answers about observation care and the coverage gap that can result. (Seniors enrolled in Medicare Advantage should ask their plans about their observation care rules since they can vary.)

Q. What is observation care? Continue reading

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Insurers push back against growing cost of cancer treatments

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 This KHN story also ran in .

Some cancer patients and their insurers are seeing their bills for chemotherapy jump sharply, reflecting increased drug prices and hospitals’ push to buy oncologists’ practices and then bill at higher rates.

Patients say, “‘I’ve been treated with Herceptin for breast cancer for several years and it was always $5,000 for the drug and suddenly it’s $16,000 — and I was in the same room with the same doctor same nurse and the same length of time’,” said Dr. Donald Fischer, chief medical officer for Highmark, the largest health plan in Pennsylvania. Continue reading

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Hospital prices vary wildly for common treatments

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Some heart surgeries have become so common — the angioplasty, for example, to open clogged arteries — you might think the charge for it wouldn’t vary much from hospital to hospital.

You might assume the same about hip or knee replacements, which now hold the top spot in this country as the reason for overnight hospital stays by Medicare patients.

You would be so wrong. Continue reading

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Medicare could save billions by changing drug plan assignment

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Blue and white capsules spilling out of a pill bottle

Photo courtesy of Pawel Kryj

By Julie Rovner
KHN/June 2, 2014

A new study finds that Medicare is spending billions of dollars more than it needs to on prescription drugs for low-income seniors and disabled beneficiaries.

In 2013, an estimated 10 million people who participate in the Medicare prescription drug program, known as Part D, received government subsidies to help pay for that coverage. They account for an estimated three-quarters of the program’s cost.

Most of those low-income enrollees are randomly placed in a plan that costs less than the average for the region where the person lives.

But even though these are lower-cost plans, they often end up costing the government and the beneficiary more. Continue reading

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Medicare to consider paying doctors for end-of-life planning

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End of life factBy Michael Ollove
Stateline staff Writer

The federal government may reimburse doctors for talking to Medicare patients and their families about “advance care planning,” including living wills and end-of-life treatment options — potentially rekindling one of the fiercest storms in the Affordable Care Act debate.

A similar provision was in an early draft of the federal health care law, but in 2009, former Republican vice-presidential candidate Sarah Palin took to Facebook to accuse President Barack Obama of proposing “death panels” to determine who deserved life-sustaining medical care. Amid an outcry on the right, the provision was stripped from the legislation.

Now, quietly, the proposal is headed toward reconsideration — this time through a regulatory procedure rather than legislation. Continue reading

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