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Medicare is the federal health care system that covers about 36 million people age 65 and older, plus 7 million disabled. It has four parts:
Financed by a 2.9 percent payroll tax divided equally between employees and employers.
Financed by beneficiary premiums and federal general revenue. Current monthly premiums are $93.50. Starting this year, individuals whose taxable income is more than $80,000 will pay a higher premium.
Financed by Medicare and beneficiary premiums, which vary among plans.
The plans are private and financed by Medicare and beneficiary premiums, which vary among plans.
-- Larry Lipman
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All the entries posted on February 20, 2008.
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Home > Medicare Monitor > Archives > 2008 > February > 20
Wednesday, February 20, 2008
Medicare says it could ‘bundle’ dialysis payments
Medicare may change the way it pays kidney dialysis centers for end stage renal disease treatments.
According to a report sent to Congress on Wednesday, Medicare could use a “prospective payment system” that sets a specific bundled price for dialysis care. Currently, Medicare pays about 60 percent of such care through a prospective payment system. But it pays individually for items such as drugs, laboratory services, supplies and blood products.
Rep. Pete Stark, D-Calif., chairman of the Ways and Means health subcommittee, has been pressing for bundled dialysis payments and said the report shows Medicare is ready to make it happen.
“It is critically important that a fully bundled payment system accommodates the individual clinical needs of the patient, and the variance in treatment that may be needed to ensure proper care. It cannot be a ‘one-size-fits-all’ system. It must also include rigorous quality reporting and monitoring. The CMS report makes it clear that this type of flexibility and quality control is attainable within a bundled system.
“None of this will happen tomorrow,” Stark said. “It will take a couple of years to design and implement these changes, but I bet the system could be up and running by 2011. I wouldn’t be surprised to hear calls for delay and other scare tactics generated by those in the industry who make money off of the status quo. Regardless, I will work to enact legislation this year that gets this much-needed payment reform underway.”
“It is critically important that a fully bundled payment system accommodates the individual clinical needs of the patient, and the variance in treatment that may be needed to ensure proper care. It cannot be a ‘one-size-fits-all’ system. It must also include rigorous quality reporting and monitoring. The CMS report makes it clear that this type of flexibility and quality control is attainable within a bundled system.
“None of this will happen tomorrow,” Stark said. “It will take a couple of years to design and implement these changes, but I bet the system could be up and running by 2011. I wouldn’t be surprised to hear calls for delay and other scare tactics generated by those in the industry who make money off of the status quo. Regardless, I will work to enact legislation this year that gets this much-needed payment reform underway.”
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Leavitt: Wanna do a demo?
The expectation is that electronic records will reduce the number of medical errors and improve the quality of care. The project will be open to small- and medium-sized primary care practices.
“Communities have a tremendous opportunity to help transform health care delivery from the local level on up,” Leavitt said. “Broad adoption of interoperable electronic health records has the potential not only to improve the quality of care provided, but also to change the way medicine is practiced and delivered.”
So far, HHS and Medicare officials have met with community leaders in Atlanta, Ga.; Kansas City, Kan.; Cleveland, Ohio; Portland, Maine; and Providence, R.I.
Under the demo program, 1,200 doctors could earn up to $58,000 each over five years or $290,000 per practice. The money would come as incentive and bonus payments depending on how many standardized electronic record functions a practice used.
The Centers for Medicare and Medicaid Services expects to select four communities this year and the remaining eight next year. Once the communities are selected, the agency will then begin working with the doctor groups to recruit them into the project.
“We are looking for communities which have strong ties to primary care physicians and are willing to assist CMS in education activities and the recruitment of physician practices for the demonstration,” said acting CMS Administrator Kerry Weems.
According to the department, eligible communities will include those that:
- Demonstrate active community collaboration with a broad group of stakeholders, including providers and medical professional groups, consumers, health plans, and employers;
- Show private-sector support, with likely probability that similar programs will be implemented among employers or health plans in the region;
- Are geographically large enough to recruit a sufficient number of small- to medium-sized primary-care physician practices, of which 100 will be eligible for incentives and 100 will be control sites; and
- Are not already part of an existing CMS demonstration similar to the electronic records project.
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Lawmakers: Hold off on doctor pay cut
Two Georgia congressman have introduced bipartisan legislation to further delay the impending Medicare pay cut for doctors by 18 months, from July 1 until Jan. 1, 2010.
Reps. Tom Price, a Republican, and David Scott, a Democrat, said the delay would give Congress more time to address the thorny reimbursement issue. The American Medical Association has repeatedly warned that the scheduled pay cuts, which Congress has repeatedly delayed, could jeopardize patients’ access to physicians.
“The current Medicare reimbursement process is fatally flawed,” Price said. “The dangerous pending reimbursement cuts will discourage doctors from participating in Medicare and threaten quality health care for our seniors. We must find a sustainable, long-term solution that ensures Medicare beneficiaries will not continue to be put at risk each year. In the meantime, it is necessary to stop unrealistic payment levels in order to ensure the availability of accessible, quality health care to our nation’s seniors.”
Scott said Congress “needs to address long-term action,” because the formula used in setting doctor pay rates “will only further mandate more fee cuts in the foreseeable future.
“Medicare payments only cover about 65 percent of the actual cost of providing patient services. While I expect doctors to participate in quality improvement measures and invest in health information technology, it doesn’t make sense to further burden physicians with these provisions as they certainly can not bear these additional costs without positive payment updates.”