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Medicare News

Hospitals face Medicare penalties for readmissions
St. Bernard Hospital has received a five-star rating for its congestive heart failure program — yet soon may face substantial financial penalties because of its high patient readmission rates. Medicare's new penalty system, which takes effect next fall, is designed to prod hospitals to make sure patients get the care they need after discharge and to reduce the number of potentially avoidable readmissions, which by one estimate cost the government $12 billion a year.

2012 Medicare Debate Is All About the Baby Boomers
Baby boomers take note: Medicare as your parents have known it is headed for big changes no matter who wins the White House in 2012. You may not like it, but you might have to accept it. Dial down the partisan rhetoric and surprising similarities emerge from competing policy prescriptions by President Barack Obama and leading Republicans such as Wisconsin Rep. Paul Ryan.

Dems, allies firmly reject Paul Ryan's new Medicare reform plan
Democrats and their allies quickly united against the Medicare proposal introduced by Rep. Paul Ryan (R-Wis.) and Sen. Ron Wyden (D-Ore.). As he introduced the plan Thursday morning, Wyden insisted that there was plenty for Democrats to support. But lawmakers, the White House and healthcare interest groups took a hard line against the proposal, even linking it to former House Speaker Newt Gingrich. Democrats have held a political advantage on Medicare since early this year, when Ryan proposed ending the existing program and moving seniors into private insurance.

House approves two-year Medicare 'doc fix'
The House voted 234-193 Tuesday evening to approve a payroll tax extenders package that includes a two-year "fix" to the formula for Medicare payments to doctors. President Obama has threatened to veto the legislation, which is expected to die in the Democrat-controlled Senate on Wednesday. Without congressional action on the Sustainable Growth Rate, physicians will see a 27.4 percent cut to their Medicare rates starting Jan. 1.

Medicare changes payment plan to fight drug fraud
Medicare will not pay prescription-drug bills if officials see evidence of fraud, which will let them avoid chasing down money after it has been paid out, Vice President Biden announced Tuesday.The move, Biden said, demonstrates "the administration's continued commitment to cutting waste and protecting taxpayers." The Justice Department recovered $5.6 billion from fraud in 2011, and $2.9 billion was for health care fraud, Biden

House Dems look to exempt Medicare from automatic spending cuts
While some Republicans are taking heat for seeking to mitigate $600 billion in sequestration cuts to the Defense Department, a handful of House Democrats this week put forward their own proposal to spare Medicare from spending cuts triggered by the August debt deal. Rep. Edolphus Towns (D-N.Y.) introduced H.R. 3519, along with six other House Democrats, in a bid to exempt Medicare. Towns said Wednesday that hospitals would not be able to cope with reduced Medicare reimbursements required under the sequestration cuts required under the Budget Control Act.

Donald Berwick Resigns as Head of CMS
Donald Berwick, MD, a long-time advocate of patient safety, is resigning as administrator of the Centers for Medicare and Medicaid Services (CMS), effective December 2, after a short tumultuous term as President Barrack Obama's point person for healthcare reform. Dr. Berwick will have served only 17 months in the post. He was denied Senate confirmation by Republicans, who branded the pediatrician an advocate of healthcare rationing. Dr. Berwick denied that charge, countering that the best way to cut costs is to improve the quality of care. President Obama has nominated Marilyn Tavenner, RN, MHA, Dr. Berwick's principal deputy, to replace him. Ms. Tavenner, a former nurse and hospital executive, was secretary of the Virginia Department of Health and Human Resources under former Virginia Governor Tim Kaine.

Problems persist with Medicare fraud contractors
Contractors paid tens of millions of taxpayer dollars to detect fraudulent Medicare claims are using inaccurate and inconsistent data that makes it extremely difficult to catch bogus bills submitted by crooks, according to an inspector general's report released Monday. Medicare's contractor system has morphed into a complicated labyrinth, with one set of contractors paying claims and another combing through those claims in an effort to stop an estimated $60 billion a year in fraud.

Column: How deficit committee should tackle Medicare
With a divided Congress and a presidential election swiftly approaching, any hope for bipartisan solutions in Washington may seem far-fetched, but I believe the 12-member Joint Select Committee on Deficit Reduction may be the last best chance this Congress has to do something meaningful to put our country back on a path to fiscal sanity and long-term growth. And we can't afford to wait until after the next election to act.

Report links deficit cuts to Medicare, Social Security
Increasing the eligibility age for Medicare to 67 would take a big chunk out of seniors' Social Security, according to a new report that aims to link the two unpopular proposals together. The group Strengthen Social Security calculated that increasing the eligibility age, as some have urged the deficit-cutting supercommittee to do, could consume up to 45 percent of middle-class seniors' Social Security check. The numbers are based on a previous Kaiser Family Foundation analysis that found that 3.3 million people ages 65 and 66 would pay more out of pocket for healthcare if they were no longer eligible for Medicare.

Medicare report: Improve tracking of serious hospital errors
Medicare inspectors must do a better job of tracking reports of serious mistakes in care at the nation's hospitals, as well as of informing rating agencies of the errors, according to a report released Tuesday by the agency's inspector general.Hundreds of serious errors go unrecorded, the report found, because the inspectors who find problems at hospitals don't tell the national agencies that accredit hospitals. That means that those hospitals continue to participate in Medicare and that they don't learn from their mistakes, Inspector General Daniel Levinson writes. Also, Levinson writes, no one tracks the effectiveness of policy changes or how the hospitals actually correct mistakes.

Democrats at odds over Medicare cuts
Democrats on the deficit-cutting supercommittee created a stir Wednesday by calling for hundreds of billions dollars in Medicare cuts. Aides told The Hill that the proposal, backed by a majority of the panel's six Democrats, includes hundreds of billions of dollars in Medicare cuts and more than $1 trillion in new tax hikes. Although details remain vague, Reuters reported on Wednesday that the Democrats' plan includes about $400 billion in Medicare reductions, split roughly between senior benefit cuts and reductions in payments to healthcare providers.

Federal officials target Medicare’s poor-performing drug plans
Nationally, federal officials have given negative assessments to more than a quarter of Medicare’s rated prescription drug plans that will be available to seniors in 2012. And in the Washington metropolitan area, 36 percent score unacceptably low, according to an analysis of Medicare data. The Centers for Medicare and Medicaid Services is notifying the plans that, unless they improve their performance over the next few years, they face expulsion from Medicare.

Senators call for crackdown on drug abuse in Medicare plan
Senators from both parties on Tuesday urged the Medicare program to clamp down on beneficiaries who abuse prescription drugs after an independent audit documented widespread doctor-shopping. The Government Accountability Office scoured more than a billion prescriptions and found that 170,000 beneficiaries visited five or more doctors to get 14 classes of frequently abused pharmaceuticals. That figure represents 1.8 percent of the beneficiaries who received those classes of drugs — and a value of $148 million, much of it paid by the Medicare program.

Budget rep. wants supercommittee to take on permanent Medicare payments fix
Rep. Allyson Schwartz (D-Pa.) is taking the lead in urging the congressional deficit-cutting supercommittee to prevent a nearly 30 percent cut to Medicare physician payments. Schwartz, the second highest ranking Democrat on the Budget Committee and a leader on healthcare issues, issued a "Dear Colleague" letter Wednesday morning asking her colleagues to demand a permanent fix to Medicare's Sustainable Growth Rate formula. Lawmakers for years have delayed statutory cuts to doctors' payments through short-term fixes, but doctors want a permanent fix to the payment formula that was created in 1997.

Medicare pay-for-performance plan criticized over early launch
Members of organized medicine are sharply critical of a plan by the Obama administration to initiate a Medicare value-based purchasing program two years before federal law requires it. Although the 2015 start date of pay-for-performance is mandated by Congress, CMS plans to use a 2013 reporting period to determine how pay will be adjusted for some physicians in 2015.

Medicare testing new way to distribute funds to providers
In an effort to nudge the health care industry toward more cost cutting and efficiency, Medicare is testing a new way of reimbursing doctors, hospitals, therapists and other providers through bundled payments intended to prompt more coordinated care. Unlike the current fee-for-service method, health care providers accepted into the pilot program will receive a lump payment for the various treatments given during an “episode” of care, such as a heart bypass or hip replacement.

Nearly all physicians must revalidate Medicare enrollment by 2013
Roughly 750,000 physicians in the Medicare program soon will be asked to revalidate their individual enrollment records during a massive anti-fraud effort required by the health system reform law. The Centers for Medicare & Medicaid Services hopes to weed out only the people who shouldn't have billing privileges, but physicians are concerned that legitimate health professionals could get caught up in the enrollment sweep by mistake. CMS gradually will send revalidation requests by mail to more than 1.4 million health professionals

Medicare Is Taking A Page From Priceline
The Obama administration is offering a new pricing strategy for doctors and hospitals looking to improve care and lower costs of treating Medicare beneficiaries. It could be called “Name Your Own Price” — except that’s already taken by a certain online travel website that has a certain Star Trek actor as its pitchman. But the principle is the same. On Tuesday, the Department of Health and Human Services unveiled a Medicare pilot program that will pay participating hospitals, doctors and other health providers one, “bundled,” payment to treat a patient for a single episode of care. The program starts in 2012.

Medicare Reform: Obama vs. Ryan
As the fallout over the Standard & Poor's downgrade makes clear, getting the country's future finances under control will require going beyond the spending-growth reductions in the Budget Control Act of 2011 and making fundamental changes to our entitlement programs, especially Medicare. To make the Medicare program fiscally sustainable, reform must: (1) place limits on spending growth and (2) change the program to hold actual spending growth to these limits.

Medicare pays more for drugs than Medicaid, report finds
Medicare pays much more for prescription drugs than Medicaid, according to a report from the inspector general of the Health and Human Services Department. The report says Medicaid rebates help keep prices low in the program. Medicaid and Medicare plans paid roughly the same up-front costs for prescription drugs, the report says, but Medicaid got far more of its money back through rebates from drug manufacturers. The program recaptured about 45 percent of its drug spending, compared with roughly 19 percent for Medicare's drug benefit.

Medicare costs for hospice up 70%
Medicare costs for hospice care have increased more than in any other health care sector as for-profit companies continue to gain a larger share of the end-of-life medical market, government records show. From 2005 through 2009, Medicare spending on hospice care rose 70% to $4.31 billion, according to Medicare records. A recent report by the inspector general for Health and Human Services, which oversees Medicare, found for-profit hospices were paid 29% more per beneficiary than non-profit hospices. Medicare pays for 84% of all hospice patients.

Medicare prescription drug costs to go down
HHS Secretary Kathleen Sebelius and CMS chief Don Berwick announced Thursday that premiums for the Medicare Part D prescription drug program will go down slightly next year. On a conference call with reporters, administration officials pushed new data that said seniors have saved $460 million in prescription drugs since the health care law came into effect — citing drug discounts and doughnut hole rebates. But the bigger news, buried slightly underneath the mountains of data about the ACA, was that premiums for private Part D benefits in 2012 will average about $30 — down from $30.76 in 2011. The approval of generic versions of brand-name drugs and market competition contributed to the decrease, officials said.

Debt deal raises pressure on Medicare providers
Washington policymakers demanded more savings from hospitals, doctors and other medical providers in the debt deal President Obama signed Tuesday, a move designed to protect seniors and others who rely on Medicare. But the budget cutting may end up hurting some of the neediest seniors as the federal cuts take a disproportionate toll on family physicians with many elderly patients and on hospitals that serve them.

Medigap limits could save Medicare money
Federal deficit-reduction proposals that would limit Medicare supplemental insurance plans could save money but raise costs for some elderly beneficiaries, a study said on Wednesday. Requiring higher out-of-pocket costs and deductibles for private "Medigap" plans is contained in most deficit reduction proposals being weighed by Congress. Medicare is a big-ticket item in the federal budget because its costs will balloon as baby boomers, those born between 1946 and 1964, hit retirement age and begin drawing on health benefits.

Does President Obama Really Want To Means-Test Medicare?
President Obama (and many, many others) have been throwing around the phrase “means testing” as they talk about ways to cut spending for Medicare. “You keep using that word. I do not think it means what you think it means,” says Inigo Montoya, Mandy Patinkin’s character in one of the many now-famous lines in the movie The Princess Bride.Of course he wasn’t responding to the President, but he could have been. Here’s what Mr. Obama said at his news conference earlier today when a reporter asked if he “would be willing to means test” Social Security or Medicare:

AMA: Fix SGR in debt-ceiling deal
More than 100 groups representing doctors said Monday that an agreement on the U.S. debt ceiling should include a permanent fix to the formula that Medicare uses to pay doctors. Republican negotiators have poured cold water on the idea of using the debt-ceiling vote to tackle the "sustainable growth rate" formula (SGR). But the American Medical Association and other doctors groups say the two go hand-in-hand.The SGR has become a perennial headache for doctors and Congress alike. The formula calls for a payment cut of nearly 30 percent in January 2012.

HHS to launch campaign touting free services under Medicare
A government effort to motivate Medicare patients to seek preventive medicine, by offering such services for free, has only slightly increased the number of older Americans getting cancer tests, key vaccines and other preventive care. Some 5.5 million Medicare patients have used at least one preventive benefit since Medicare eliminated the charges in January, according to figures released Monday by the Department of Health and Human Services.

US lifts sanctions against Aetna Medicare
Aetna Inc (AET.N) said on Monday that the U.S. Centers for Medicare & Medicaid Services (CMS) had lifted a ban on the No. 3 health insurer's marketing and enrollment of new members to its Medicare plans for the elderly. While Aetna has corrected the problems that led to the sanctions, Aetna's Medicare Prescription Drug Plans will not receive any new low income subsidy assignees from CMS at this time, the company said.

Panel Urges Crackdown On Medicare's Use Of Imaging
An influential advisory group is urging Congress to crack down on doctors who order too many MRIs for seniors, setting off a battle with physicians and patient groups who argue Medicare beneficiaries might suffer significant delays in treatment. The recommendation by the Medicare Payment Advisory Commission would require some physicians who order a lot of MRIs, CT scans, nuclear medicine studies and other imaging tests to get pre-approval from Medicare. In its latest report, sent to Congress Wednesday, MedPAC takes aim at physicians who inappropriately order these tests and concludes that Medicare costs in this area are surging partially because physicians are increasingly buying their own high-tech equipment.

Democrats Thread the Needle on Medicare
Senate Democratic leaders are attempting a balancing act on Medicare — by showing openness to containing the program's ballooning costs but still drawing the line at cutting benefits. The gambit is aimed at convincing voters that Democrats take the need to reduce the deficit seriously but will protect seniors more than Republicans — a message Democratic leaders think will help them retain their Senate majority against tough odds in 2012.In a move that appears designed for media consumption, five Democratic Senators up for re-election in 2012 sent a letter Monday to VP Biden.

Both parties dig in on Medicare demands
Vice President Joe Biden continues to make progress overseeing debt limit negotiations between Democrats and Republicans, the questions remains as to whether the Obama administration will go along with GOP demands to significantly change Medicare. The latest evidence -- a pair of opposing letters to the administration from members of the two major parties -- shows that Democrats and Republicans remain as committed as ever to their positions on a controversial GOP Medicare plan.

Report Finds Inequities in Payments for Medicare
Medicare uses inaccurate, unreliable data to pay doctors and hospitals, the National Academy of Sciences said Wednesday. Although Medicare is a national program, it adjusts payments to health care providers to reflect regional differences in wages, rent and other costs. But in a new report, a panel of experts from the academy’s Institute of Medicine said the payment formulas were deeply flawed. The system of paying doctors has “fundamental conceptual problems,” and the method of paying hospitals is so unrealistic that almost 40 percent of them have been reclassified into higher-paying areas, the report said.

U.S. lawmakers run scared from reforming Medicare
A Democratic victory in a reliably Republican House of Representatives district this week has lawmakers running scared from reforming Medicare, greatly reducing chances of a comprehensive deal to cut the long-term U.S. deficit. Rarely in recent years has a single, off-year special election -- like the one on Tuesday in a House district in upstate New York -- triggered such nationwide political tremors, or had such negative implications for efforts to bring America's federal debt under control.

McConnell Seeks Cuts to Medicare and Medicaid in U.S. Debt-Cutting Talks
Senate Minority Leader Mitch McConnell said he wants “significant” near-term cuts in federal agency budgets paired with longer-term reductions to programs like Medicare and Medicaid in exchange for his support for a boost in the U.S. debt limit. Speaking to reporters yesterday after Senate Republicans met with President Barack Obama in Washington, McConnell said he wants goals set over time to help curb federal budget deficits, including caps for the next two years on spending for programs appropriated by Congress.

Gingrich Criticizes Obama And GOP Health Plans; Medicare Politics Sway N.Y. Race
Newt Gingrich on Sunday rejected a GOP proposal to turn Medicare into a voucher program that helps senior citizens purchase private health insurance. "I don't think right-wing social engineering is any more desirable than left-wing social engineering," Gingrich told "Meet The Press." ... Instead, he pushed for creating a system that allows people to pick other options than government-run coverage

Opinion: Medicare's Math Problem: Taxes - Benefits = Trouble
At age 78, Milton Jones feel like he's earned his Medicare benefits. "I imagine so," he says. "I paid taxes all my life." Today, Jones is retired. He volunteers and calls bingo once a week at his local community center. But for 30 years, he worked in Pittsburgh's steel mills. "I'd mostly run a 983-Caterpillar," he says, "and I'd clean up the molten slag after the the ladle ran over." It was hard, hot work. And Jones — like many seniors his age — says because he's paid in, he's earned the benefits Medicare pays out.

Obama's Medicare chief inadvertently makes case for Ryan plan
As somebody who has spent some time writing about and debating health care policy, my jaw hit the floor when I read the following in the Wall Street Journal from Donald Berwick, Obama's recess-appointed administrator of the Centers for Medicare and Medicaid Services: "Improving quality while reducing costs is a strategy that's had major success in other fields. Computers, cars, TVs and telephones today do more than they ever have, and the cost of these products has consistently dropped. The companies that make computers and microwaves didn't get there by cutting what they offer:

Bill seeks outside review of relative values in Medicare services
A Democratic lawmaker has proposed changing the way the Medicare program identifies physician services for which it pays too little -- or too much -- by requiring independent contractors to review doctor fees annually. Since 1992, a panel convened by the American Medical Association and representing a wide range of specialties has recommended thousands of pay changes to the individual services doctors provide to Medicare patients. The bill would add a layer of review on top of the 29-member AMA/Specialty Society Relative Value Scale Update Committee, known as the RUC

Shutdown would not halt Medicare
With the latest short-term spending bill expiring April 8, administration officials are preparing for a federal government shutdown that now appears imminent. One official said President Barack Obama has made it clear that a shutdown would threaten the country's economic recovery, but added, “From a good-housekeeping perspective, we're cognizant that it's Wednesday and that all agencies are prepared with contingency plans.”

Understanding Rep. Ryan's Plan For Medicare
House Budget Committee Chairman Paul Ryan, R-Wis., left many details to Congress when he unveiled Tuesday his plan to make major changes to Medicare as part of a fiscal 2012 budget resolution. He says his overall objective is to convert Medicare into a premium support program for which the government will spend a specific amount for beneficiaries' care, a fundamental shift from the current fee-for-service program

Agencies slam new Medicare rule on home care
Home health agencies, hospitals and consumer groups are complaining that a new rule intended to curb unnecessary Medicare spending will make it harder for senior citizens to get home care services. Under the requirement, which is to take effect Friday, Medicare beneficiaries will have to see doctors 90 days before or 30 days after starting home health services in order for the home health agencies to be reimbursed. Those face-to-face visits may be a burden for some home-bound frail seniors, as well as those who live in rural areas, the industry says.

Medicare rise could mean no Social Security COLA
Millions of retired and disabled people in the United States had better brace for another year with no increase in Social Security payments. The government is projecting a slight cost-of-living adjustment for Social Security benefits next year, the first increase since 2009. But for most beneficiaries, rising Medicare premiums threaten to wipe out any increase in payments, leaving them without a raise for a third straight year.

CMS keeps current anemia drug rules--for now
When is no decision a good decision? When you're Amgen, and the Centers for Medicare and Medicaid Services decides not to change reimbursements for key anemia drugs. At least not for now; the agency will make its final decision in June. CMS has been mulling limits on the use of Amgen's Aranesp, and Procrit, which is marketed by Johnson & Johnson. CMS has been skeptical that these anemia drugs deliver positive outcomes for patients, such as preventing blood transfusions that kidney patients may require.

Dr. Berwick may have little future at CMS beyond this year
Forty-two Senate Republicans are asking President Obama to withdraw his nomination of Donald M. Berwick, MD, as administrator of the Centers for Medicare & Medicaid Services beyond 2011, citing what they deem the CMS chief's lack of experience and controversial statements. With Democrats needing 60 votes to overcome a GOP block of the nomination, the nearly united front from Republicans, spelled out in a letter to Obama, probably means Dr. Berwick does not have a long-term future at the helm of CMS. Senate Finance Committee members Orrin Hatch (R, Utah) and Mike Enzi (R, Wyo.) have led the effort to remove him.

Lawmakers question Medicare payment contractors
Democratic senators on Tuesday expressed concern that companies hired to help pay and oversee medical claims under the Medicare health insurance program may have costly conflicts of interest. Subsidiaries of WellPoint Inc, Hewlett Packard Co's EDS Corp., now called HP Enterprise Services, and other companies have "numerous relationships" that raise concern, the lawmakers' staff wrote in memo released on Tuesday.Congressional staffers said they looked at those and several other Medicare contractors that the government has hired to monitor the bills that doctors and other healthcare providers send the government after treating Medicare patients.

Medicare fraud strike force arrests 111 for $225 million in fake billings
A total of 111 individuals made up of doctors, nurses and health care company owners and executives were arrested and charged Thursday for Medicare fraud schemes that involved more than $225 million in fake billing. The 111, who are from nine cities, were arrested and charged by the Medicare Fraud Strike Force, U.S. Attorney General Eric Holder announced. Holder said the arrests were the largest federal health care fraud takedown in the country’s history. He said more individuals may be added.

HHS steps up fight against Medicare fraud
Under new rules announced Monday, the federal government will ramp up its fight against Medicare fraud, as mandated by part of the Affordable Care Act, according to a speech made by HHS Secretary Kathleen Sebelius.The announcement was made after a year in which providers were busted for making hundreds of millions of dollars worth of false Medicare claims, and after the feds recovered a record $2.5 billion related to healthcare fraud

Insurance oversight office will move to Medicare agency
The Dept. of Health and Human Services is undergoing a major organizational restructuring that will have an impact on the offices that oversee Medicare and health insurance companies. HHS informed lawmakers on Jan. 5 that it will move the Office of Consumer Information and Insurance Oversight, created by the health system reform law, to the auspices of the Centers for Medicare & Medicaid Services. The insurance office had been established within the HHS secretary's office, and its director was Jay Angoff. Now it will become an office within CMS, renamed the Center for Consumer Information and Insurance Oversight, and will be overseen by Marilyn Tavenner, CMS' principal director.

Patients, groups sue Medicare over service cuts
Five New England residents and five national health care advocacy groups are suing the federal government, saying Medicare benefits are being cut improperly after their conditions are determined to be chronic. A lawsuit filed Tuesday in U.S. District Court in Burlington on behalf of people from Vermont, Maine, Rhode Island and Connecticut targets what it calls an unofficial condition of eligibility.

Medicare ranks will swell for next 18 years
Baby boomers, the generation that once vowed to never trust anyone over 30, begin turning 65 this year. This is a historic moment, ushering a demographic tsunami through the threshold of old age.Though this birthday no longer guarantees full retirement benefits, the big six-five still means one thing: Medicare eligibility. For the next 18 years, boomers will be enrolling in the government's health insurance system, no doubt changing the way companies deal with a growing elderly population.

First Physical With Medicare Now Free
Starting this year, first-time enrollees in Medicare will be offered free physicals, courtesy of the new Affordable Care Act. The "Welcome to Medicare" benefit will be offered only during a person's first year of enrollment in Part B, and the doctor must agree to be paid directly by Medicare for the visit to be free. It's part of an effort to focus on preventive medicine, rather than trying to fix problems after they arise. Preventive services covered by Part B include bone density measurements, mammograms to screen for breast cancer and annual flu shots.

Medicare To Gain 7,000 New Baby Boomers Per Day In 2011
In 2010, there will be 7,000 new Medicare beneficiaries each day; a total of 2.5 million baby boomers who will swamp America's senior's health care insurance program. According to AARP (American Association for Retired Person's), 70 million individuals are estimated to be Medicare beneficiaries over the next 20 years, compared to 45.2 million in 2008. Economists predict that Medicare's current 3.6% of GDP (gross domestic product) cost will jump to 6.4% in twenty years' time, mainly because the costs of medical care and medications are going up considerably faster than inflation, rather than the impact of an aging population

P-GfK Poll: Baby boomers fear outliving Medicare
The first baby boomers will be old enough to qualify for Medicare Jan. 1, and many fear the program's obituary will be written before their own. A new Associated Press-GfK poll finds that baby boomers believe by a ratio of 2-to-1 they won't be able to rely on the giant health insurance plan throughout their retirement. The boomers took a running dive into adolescence and went on to redefine work and family, but getting old is making them nervous.

Some doctors asking Medicare patients to switch plans
Some local doctors, once again faced with a large cut in what the government pays them for treating Medicare patients, are telling senior patients they must switch by year's end to better-paying private Medicare Advantage plans. Paul Williams, 72, was one of about 6,000 patients who recently received a letter from Highline Medical Group, a consortium of 35 doctors in eight clinics in the South Puget Sound area, telling them to switch plans by Jan. 1, when traditional Medicare reimbursements are set to shrink by 25 percent.

US Recovers Record $3 Billion in Civil Fraud Cases
The Justice Department has collected a record $3 billion in the last year in pursuing cases of health care fraud and other false claims against the government.Assistant Attorney General Tony West says health care fraud, an enforcement priority for the Obama administration, accounted for $2.5 billion in civil settlements and judgments in the last fiscal year, which ended in September

Debt experts: Let's make Medicare beneficiaries pay more
Offering the latest tough-love strategy to reduce the nation's debt, a panel of high-profile Republicans and Democrats is scheduled on Wednesday to recommend that Medicare beneficiaries pick up far more of their health care costs and that the government substantially curb the amount both Medicare and Medicaid programs can grow in future years. The panel, led by former Republican Sen. Pete Domenici of New Mexico and Alice Rivlin, a budget director under President Bill Clinton, also calls for a national debt-reduction sales tax of 6.5 percent, as well as changes in Social Security and income tax rates, according to a draft executive summary.

Reforming Medicare payment system creates divide among doctors
While the majority of physicians agree that Medicare payments are inequitable and unfair, there is little consensus about how to reform the system, according to a study published in the Oct. 25 Archives of Internal Medicine. Researchers examined survey responses from 1,222 physicians. Nearly 80% of respondents indicated that Medicare payments are unsatisfactory. Among doctors who accepted Medicare, 40% "strongly agreed" and 38% "somewhat agreed" that under Medicare some procedures are compensated too highly and others are compensated at rates insufficient to cover costs.

Physicians face painful decision on Medicare
While most people are focused on the midterm elections Tuesday, the American Medical Association is gearing up for the lame-duck congressional session scheduled to start Nov. 15. Unless Congress intervenes, payments to doctors for treating Medicare patients will be cut by 23 percent on Dec. 1 and another 6.5 percent on Jan. 1.Cecil B. Wilson, an internist from Winter Park, Fla., who became AMA president in June, is pressing for a 13-month patch that would prevent the Medicare physician cuts. In April, the Congressional Budget Office said that blocking the cuts until January 2012 would cost about $15 billion. A long-term formula fix, through 2020, would cost about $276 billion, it said.

Medicare Standards Are Too Strict, 2 Courts Find
Two federal courts have ruled that the Obama administration is using overly strict standards to determine whether older Americans are entitled to Medicare coverage of skilled nursing home care and home health care. Medicare will pay for those services if they are needed to maintain a person’s ability to perform routine activities of daily living or to prevent deterioration of the person’s condition, the courts said. Medicare beneficiaries do not have to prove that their condition will improve, as the government sometimes contends, the courts said.

New Medicare drug coverage plan is inexpensive and offered nationwide
On Oct. 1, health benefit company Humana announced a Medicare Part D prescription drug plan, co-branded with retail giant Wal-Mart Stores. The two firms said their plan can provide savings on monthly plan premiums and prescription medicine copayments and cost-shares for Medicare beneficiaries, including seniors and people with disabilities. The Humana Walmart-Preferred Rx Plan (PDP) offers a national monthly plan premium of $14.80. Humana and Walmart cited statistics from the Centers for Medicare & Medicaid Services (CMS), which administers the Medicare program, in stating that PDP has the lowest national plan premium in 2011 for a standalone Medicare Part D plan premium offered in all 50 states and Washington, D.C.

New CMS chief to focus on quality, organization and costs
The agency that oversees Medicare and Medicaid needs to focus on three main goals -- better quality of care, a more organized health system and lower per capita costs, said Centers for Medicare & Medicaid Administrator Donald M. Berwick, MD. Dr. Berwick outlined his vision on Sept. 13 during a speech in Washington, D.C., his first major public address since President Obama appointed him in July.Speaking at a conference hosted by America's Health Insurance Plans, Dr. Berwick lauded the Affordable Care Act as "the most significant health care legislation since Medicare and Medicaid were created." He noted how the new health reform law invests heavily in versions of integrated care that the agency is moving toward, such as accountable care organizations and medical homes

Medicare Advantage Premiums to Drop Slightly
Seniors enrolled in Medicare Advantage plans will pay slightly less next year for their health insurance, Obama administration officials announced Tuesday. The average monthly premium in the private Medicare Advantage plans will drop to $35.69 in 2011, which is 45 cents less than this year's average monthly cost. The move comes despite predictions that beneficiaries enrolled in the private plans offered through Medicare would see a sharp increase in out-of-pocket costs after the Affordable Care Act (ACA) cut billions from the plans and added new restrictions on what they can charge and what they must cover

Medicare Confronts Issues With Prescription Drug Program And Medical Equipment Purchases
"Sen. Tom Carper (D-Del.) on Tuesday blasted the Medicare agency for what he considers an inadequate response to his concerns about the prescription-drug program's integrity. … Carper wrote to the Centers for Medicare and Medicaid Services on July 29 and requested the agency establish a process to ensure valid identification numbers on reimbursed prescriptions under the Part D program. The law requires the identification numbers to ensure drugs are being prescribed by legitimate health professionals, but an audit by the Health and Human Services Office of Inspector General found that $1.2 billion in reimbursements in 2007 — representing more than 18 million claims — contained invalid prescriber identification.

New Medicare Chief Pledges to Cut Medical Costs
A contentious Obama administration appointee who runs Medicare and Medicaid on Monday offered his first road map for the programs, pledging to lower medical costs without harming patients. Donald Berwick, administrator of the Centers for Medicare and Medicaid Services, has been quiet about his plans for the agency since President Barack Obama installed him in a recess appointment in July without pursuing Senate confirmation. Republicans said Dr. Berwick was unfit for the job because he had written in praise of Britain's national health system, and Republican senators contended he would impose health-care rationing.

Medicare head pushes health care test sites
Newly installed Medicare chief Donald Berwick, keeping a low public profile after encountering controversy over his appointment, is moving quickly behind the scenes to seed the US health care system with 100 to 300 sites to test new models of caring for patients.Since July 6, when President Obama bypassed the Senate confirmation process and named Berwick with a recess appointment, the Cambridge health guru and former Harvard professor has made launching the sites a high priority, according to officials and industry

Groups Press Congress To End Patients' Wait For Medicare
After Russ Hillard developed Huntington's disease, a devastating neurological disorder, he lost his $35,000-a-year job as a welder and, with it, his health insurance. His wife, who was working part time, had insurance, but it didn't come close to covering the medical bills for the incurable disease, which causes uncontrolled movements, emotional problems and the loss of cognitive abilities. Eventually, Hillard qualified for Medicare, which covers disabled people under 65 after a two-year waiting period.

Medicare to Cover Smoking Cessation
Good news for seniors who want to quit smoking -- Medicare will now cover tobacco cessation counseling -- the Department of Health and Human Services announced. The new coverage was mandated by the Affordable Care Act (ACA), which contains a number of measures that focus on preventing diseases before they occur, such as paying for cancer screenings, and annual no-cost wellness checkups. "For too long, many tobacco users with Medicare coverage were denied access to evidence-based tobacco cessation counseling," HHS Secretary Kathleen Sebelius said in a statement announcing the new benefit.

Modest premium increase for Medicare drug plans
Seniors will see a modest increase in their Medicare prescription premiums next year but benefits will also improve, federal health officials said Wednesday. The average monthly premium charged by Medicare drug plans for standard coverage will rise to an estimated $30 in 2011, an increase of $1 over 2010, or about 3 percent, said Medicare administrator Don Berwick. But since Medicare drug plans vary widely in coverage and costs, consumer advocates cautioned that seniors need to check their particular plan to avoid unpleasant surprises that may not be revealed in a such a broad estimate of average premiums.

CMS approves first medical-necessity reviews
The CMS has approved the first medical-necessity review audits for the Recovery Audit Contractor program, according to agency officials.Medical-necessity reviews are a type of advanced audit that will determine whether medical care given to a patient was appropriate or not. The American Hospital Association has expressed concern that RAC auditors may lack the necessary clinical and Medicare knowledge to determine whether prior hospital care was reasonable or necessary

17K Ind. Medicare beneficiaries get $250 checks
Nearly 17,000 Indiana seniors and persons with disabilities are due to receive $250 Medicare prescription rebate checks. The U.S. Department of Health and Human Services said Tuesday that the one-time, tax-free checks are being mailed to eligible beneficiaries in Indiana whose drug costs are so high they have reached the Medicare Part D drug coverage gap known as the "donut hole." The rebates are part of the federal health care overhaul passed by Congress and signed by President Barack Obama in March

Medicare pay board would be repealed under GOP bill
A group of key Republican senators have introduced a bill that would repeal the Medicare Independent Payment Advisory Board, a new federal panel created by the health system reform law whose mission will be to propose how to extend the program's solvency. The opponents of the new board said passage of their bill, the "Health Care Bureaucrats Elimination Act," ultimately will protect seniors' rights. Sen. John Cornyn (R, Texas) on July 27 introduced the legislation, which is co-sponsored by Sens. Orrin Hatch (R, Utah), Jon Kyl (R, Ariz.), Pat Roberts (R, Kan.) and Tom Coburn, MD (R, Okla.).

Upbeat Medicare Solvency Report Quickly Finds Doubters
The new health law will buttress Medicare for a dozen more years than previously expected, according a report issued Thursday by the program's trustees, The Washington Post reports. But, "[t]he relatively bright picture of Medicare's future triggered immediate debate over whether the forecast by the trustees, all members of President Obama's Cabinet, is realistic. The trustees cautioned that the improved outlook for Medicare hinges on a sustained commitment by the government and the health-care industry to rein in medical costs."

Obama: Healthcare law gave Medicare 'sounder financial footing'.
President Obama used his weekly radio address Saturday to tout the findings of a Medicare Trustees report that concluded the program will remain solvent through 2029, largely as a result of cost-cutting provisions included in the recently enacted healthcare law. The president said the report clearly demonstrated that the passage of healthcare reform has put Medicare on "a sounder financial footing."

From Florida To Oregon, Medicare Advantage's Benefits – And Cuts – Vary
For the 11 million people signed up for Medicare Advantage plans, their future with the popular program may depend on where they live. To help finance health reform, Congress cut $136 billion over 10 years from the program, in which private insurers provide Medicare health plans for seniors. The private plans, which are paid a flat fee from the government for each enrollee were a likely target: They cost the government much more per beneficiary, on average, than does traditional Medicare, according to Medicare’s advisory commission.

Rx for Medicare's birthday: Expand it
Medicare, one of our nation's most cherished social programs, turned 45 last week. I was in active medical practice on July 30, 1965, when Medicare was signed into law by President Lyndon B. Johnson. Its impact on older Americans and their families was swift and spectacular. I saw the results with my own eyes. Almost overnight, millions of Americans age 65 and older had the doors to health care opened to them that had hitherto been closed. They streamed into our doctors' offices seeking long-deferred and sometimes urgently needed medical attention.

Administration sees $8B Medicare savings in 2011
The new health overhaul law is starting to produce savings for Medicare and will eventually add more than a decade of solvency to the program's trust fund, the Obama administration said in an upbeat report released Monday. Medicare will save about $8 billion by the end of next year, and as much as $575 billion over the rest of the decade, the report said. "This reflects the priority we put on acting quickly to secure Medicare's future," Health and Human Services Secretary Kathleen Sebelius told reporters. "We are going to ensure that seniors and Americans with disabilities get more value when they go to the hospital or to see a doctor."

Primary care boosted in proposed Medicare pay rule
The Centers for Medicare & Medicaid Services has issued a proposed Medicare physician fee schedule rule that it says will expand preventive services for Medicare beneficiaries, improve payments for primary care services and promote access to health care. The proposed rule, announced June 25, would implement provisions in the national health reform law that will eliminate out-of-pocket costs for beneficiaries for most preventive services, including a new annual primary care visit benefit, CMS said.

Medicare Crackdown: "Prosecution Is Not the Solution"
The round up continued Friday night across South Florida and the nation as authorities made nearly 100 arrests relating to some $251 million in Medicare fraud. Officials say it is the largest such bust in history.
The crackdown has so far involved 33 South Floridians who produced $140 million in bogus claims. Arrests were announced in Miami by top Obama administration officials US Attorney Eric Holder and Health and Human Services Secretary Kathleen Sebelius, who spoke of tougher penalties and new ways to find the crooks.

Republicans Demand Hearing On CMS Head Berwick, Block Other Nominees
Senate Republicans are still angry over President Obama's recess appointment of Dr. Donald Berwick to head the Center for Medicare and Medicaid Services. Politico: "Republicans on the Finance Committee, which has jurisdiction over the post, say that not holding a hearing with Berwick would 'result in circumventing the open public review that should take place for a nomination of such importance' and 'casts a shadow over his legitimacy and authority to serve as administrator during a critical time for CMS.'

Second Round of $250 Medicare Checks Sent
Seniors who have recently reached the coverage gap in their Medicare prescription drug plan will soon receive $250 checks from the federal government. Over 300,000 one-time payments are in the mail, the Obama administration announced today. The first round of approximately 80,000 checks was mailed to retirees in June. “Seventy percent of our first round of these $250 rebate checks were cashed within a week of eligible Medicarerecipients receiving them,” says U.S. Department of Health and Human Services Secretary Kathleen Sebelius. “So, we know that folks really need some help.”

CMS proposes 2.15% outpatient update
Hospital outpatient departments will see a 2.15% increase in their Medicare payments under a proposed CMS rule that will set payment rates for outpatient services and ambulatory surgical centers in 2011. The update reflects an inflationary increase of 2.4% minus a 0.25 percentage point reduction required under the new reform law. Overall, the agency estimates that more than 4,000 hospitals and other facilities will get paid a total of $40 billion next year under the outpatient prospective payment system, whereas 5,000 ambulatory surgery centers will receive approximately $4 billion.

Insurers’ Group Skips Endorsement of Medicare Nominee
Dr. Donald M. Berwick’s nomination to head Medicare and Medicaid received a lift on Tuesday when a diverse collection of about 90 employer groups, patient advocates, medical societies and others wrote to Senator Max Baucus, the Montana Democrat who helped oversee the creation of the new health care law, in favor of his selection. Among those signing the letter were the National Business Group on Health, the American Academy of Family Physicians, the A.F.L.-C.I.O. and Families USA.

Congress raises Medicare doctor pay by 2.2% through November
The House on June 24 adopted a Senate-passed Medicare physician pay increase of 2.2% through Nov. 30, temporarily reversing a 21% cut that Medicare contractors began applying to claims a week earlier. The measure headed to President Obama, who signed it June 25. The Senate had approved the bill by unanimous consent on June 18. "I believe we need to permanently reform the Medicare formula in a way that attacks our fiscal problems without punishing our hard-working doctors or endangering the benefits on which so many of our seniors rely," Obama said in a statement after the vote.

Congress grants Medicare reprieve
Physicians got a reprieve from a 21 percent cut in their Medicare reimbursement this week when Congress voted to repeal it and even gave them a 2.2 percent pay raise. But it's only a six-month fix. Congress will have to deal with it again in November. And doctors say it's that instability and uncertainty, along with a payment rate that was until now at the 2001 level, that's forcing some of them to stop taking Medicare patients, or limit the number they take, resulting in access problems for seniors.

Senate Passes Plan to Stop Medicare Pay Cuts to Doctors
With lawmakers worried that older Americans relying on Medicare could begin losing access to health care, the Senate on Friday approved a six-month plan to prevent a steep cut in doctors’ fees paid by the federal health program. The $6.4 billion measure would reverse a 21 percent cut in physician payments that was to kick in Friday, raising the possibility that some doctors might begin to turn away those covered by Medicare. The legislation, known on Capitol Hill as the doc fix, was approved without a roll-call vote after leaders of both parties agreed to pull it out of a stalled package of tax changes and safety-net spending.

Drug Rebate Is Mailed Out
Some participants in Medicare Part D prescription-drug plans should be on the lookout for a check in the mail. The U.S. Department of Health and Human Services started sending out $250 rebate checks late last week. The one-time rebate, which is part of the health-care reform bill signed into law by President Obama earlier this year, applies to Part D participants who fall into the drug-coverage gap commonly known as the "doughnut hole." The rebate is meant to help alleviate the costs people incur during the gap. The doughnut hole kicks in after a person's annual prescription-drug cost -- covered at 75% -- reaches a set dollar amount. For 2010, it's typically $2,830.

Beneficiary Information About the $250 Part D Rebate
The Centers for Medicare & Medicaid Services (CMS) posted at www.medicare.gov (under "What's New") "Closing the Prescription Drug Coverage Gap" brochure that describes details about the tax-free, one-time check for $250 for people who enter the Part D donut hole and are not eligible for Medicare Extra Help. The first checks are being mailed June 10 and checks will be mailed monthly after people have entered the coverage gap. To help fight fraud and protect beneficiaries from potential scams, Medicare is reminding seniors there are no forms to fill out to receive this benefit. Medicare will automatically send a check. The envelope will have the US Department of Health and Human Services symbol on it and will say "Medicare Part D." Beneficiaries don’t need to provide any personal information.

Doctors' group turns up heat on Medicare payments
The American Medical Association turned up the heat on the U.S. Congress on Thursday for failing to stop a 21 percent Medicare pay cut for doctors treating elderly patients. The doctors group said it launched a multimillion dollar ad campaign criticizing the U.S. Senate for going on a week-long Memorial Day break before acting on a bill that would have postponed the pay cut that went into effect on June 1.

Medicare: Congressional Tax Committees Release Bill with SGR Fix
Congressional leaders on the House Ways and Means and Senate Finance committees have released the purported “tax extenders” bill (HR 4213), which among other things would raise doctors’ Medicare reimbursements 1% to 2% through 2013.

Congress Fails to Act - Medicare Payments Cut 21%
Despite ACEP's plea for Congress to reject the fundamentally flawed payment formula used to reimburse physicians for Medicare services, the U.S. Congress, once again, failed to take the necessary action to avert the 21% cut in payments beginning June 1. The House did approve a 19-month, short-term increase in physician payments on Friday afternoon by a vote of 245 to 171. This measure would provide physicians treating Medicare beneficiaries with a 2.2% update for the remainder of this year and a 1% update in 2011. However, Congress did not alter the underlying payment formula and reimbursement is projected to be cut by around 30% beginning in 2012.

Battle Looms in Senate Over Obama's Pick to Run Medicare and Medicaid
As all eyes watch Elena Kagan make the rounds of Senate office buildings, greeting senators, answering questions and building support, another of President Obama's nominees is taking the same route -- but with much less fanfare. And he very well could wield as much -- or even more -- influence on America's future as the Supreme Court nominee. Dr. Donald M. Berwick, if confirmed by the Senate, will run Medicare and Medicaid, the world’s second largest insurance provider, as the two health care giants transform to meet the requirements of the recently passed health care reform act.

Changes to Medicare Supplement (Medigap) in 2010
Medicare has several gaps and doesn't pay for all of your health care costs. If you have Medicare you may want to buy Medicare supplemental insurance, also called Medigap insurance. This health insurance helps pay for some of your Medicare costs, such as deductibles, coinsurance, and copayments, and for some care Medicare doesn't cover. Medigap insurance is sold by private insurance companies. By law, companies must offer standardized Medigap insurance plans. Each plan has a different set of benefits.

Medicare Fraud Penalties Tougher Under Proposed Bill
Saying that criminal penalties for Medicare fraud must be updated, two Florida lawmakers introduced a bill April 13 that would double fines, increase background checks and even study how biometric technology could help ensure the appropriate use of program services. U.S. Reps. Ileana Ros-Lehtinen (R, Fla.) and Ron Klein (D, Fla.) said the Medicare Fraud Enforcement and Prevention Act is "a tough new bipartisan bill" that will help crack down on Medicare fraud, protecting seniors and taxpayers alike.

Medicare pay cut stopped again; doctors decry lack of permanent fix
Congress may have stemmed most of the damage from the latest 21% Medicare payment reduction by reversing the cut before any physicians actually could feel it. Still, physician organizations say the harm caused by lawmakers once again bringing doctors to the brink before pulling them back is another major reason why the next solution must be a permanent one. Legislation to reverse the cut and postpone it until June 1 was signed into law by President Obama late on April 15. The cut technically had gone into effect April 1 as lawmakers fought over how to pay for the bill, which also extends various unemployment and health assistance programs.

Seniors fear hit to Medicare
Seniors aren't breaking out the champagne for President Obama's health care law, and for good reason. While Democrats hail the overhaul as their greatest health care achievement since Medicare, seniors fear it's a raid on that same giant health care program - a bedrock of retirement security - in order to pay for covering younger, uninsured workers and their families

CMS sends $41.6 million to Medicare counseling programs
The CMS has announced that nearly $41.6 million has been distributed to state health insurance assistance programs to help beneficiaries get more information about their Medicare health and prescription-drug plan choices.
The grants are the first of two rounds of funding to be distributed to these types of counseling programs in fiscal 2010. Approximately $1.5 million in performance grants will be distributed to the insurance assistance programs in September.

MedPAC urges performance-based GME payments
The Medicare Payment Advisory Commission in a series of recommendations is calling on Congress to overhaul Medicare's graduate medical education, or GME, payments so that institutions are paid based on performance standards. The purpose of these recommendations is to support workforce skills that would reduce cost growth while improving quality, the commission stated. HHS should establish standards for distributing funds to GME institutions that specify “ambitious goals” for practice-based learning and improvement, using overpayments made to the indirect medical education pool to fund the new performance-based program

Obama to name new Medicare/Medicaid chief: official
President Barack Obama has picked a top health policy expert to run Medicare and Medicaid, an administration official said on Saturday, filling a role at the heart of his historic healthcare reform. Obama plans to nominate Dr. Donald Berwick as administrator of the Centers for Medicare and Medicaid Services, a unit of the Department of Health and Human Services, the official said

Medicare audits to be expanded
The use of auditors who pore over physician Medicare claims -- as well as bills from other government contractors -- to identify and recover past overpayments will be expanded under the Obama administration's latest crackdown on fraud, waste and abuse. The president on March 10 announced a new effort to improve federal payment accountability through the use of payment recapture audits. An executive memorandum directs the White House Office of Management and Budget to develop guidance within 90 days on actions agencies across the government should take to expand the use of these reviews.

Obama budget freezes physicians' Medicare pay for 10 years
President Obama promised spending freezes during his first State of the Union address, but his $3.8 trillion fiscal 2011 budget request still would protect physicians from Medicare pay cuts and extend enhanced federal support for state Medicaid programs. Obama's proposal, unveiled Feb. 1, sets aside $371 billion over a decade to pay for the cost of preventing Medicare pay cuts under the sustainable growth rate formula. But the funding would only be enough to turn annual reductions into rate freezes, not to fund pay raises.

Medicare cost plans face uncertain future
Under federal law, the more than 20 Medicare cost plans operating in areas deemed to have sufficient competing Medicare Advantage options for beneficiaries must shut down by 2011 or else convert to Medicare Advantage plans themselves. But a December 2009 report from the Government Accountability Office said some insurers are worried about the effects those conversions would have on the program.

Appeals court rejects effort to sell Medicare physician claims data
A federal appeals court cited an injunctive order from three decades ago when it said a private company does not have a right to sell physicians' Medicare claims data to hospitals. The decision is the latest in a series of court actions protecting doctors' privacy against the release of such information for various purposes.In a ruling on Dec. 18, 2009, the 11th U.S. Circuit Court of Appeals said the government was not required to turn over physician claims information to Real Time Medical Data.

Help for Medicare beneficiaries expands
The Centers for Medicare & Medicaid Services will award new grant money to states in 2010 to support community outreach for Medicare beneficiaries. A total of $45 million in grants will be available to the 54 State Health Insurance Assistance Programs, or SHIPs, CMS announced Dec. 16, 2009. States must apply by Feb. 16, and funds will be awarded in April. The agency said the SHIP grants will help states provide more one-on-one counseling to assist beneficiaries with Medicare prescription drug and plan enrollment information.

Mayo Clinic in Arizona to Stop Treating Some Medicare Patients
The Mayo Clinic, praised by President Barack Obama as a national model for efficient health care, will stop accepting Medicare patients as of tomorrow at one of its primary-care clinics in Arizona, saying the U.S. government pays too little. More than 3,000 patients eligible for Medicare, the government’s largest health-insurance program, will be forced to pay cash if they want to continue seeing their doctors at a Mayo family clinic in Glendale, northwest of Phoenix, said Michael Yardley, a Mayo spokesman.

Retirees Snared by Medicare
Rules for enrolling in Medicare are complex. But when people postpone retirement past age 65, as many people are doing these days, it's easy to get caught up in red tape. Older adults can't get into Medicare any time they want. The easiest time to sign up is when you turn 65, and, if you're already collecting Social Security, enrollment is automatic.

The not-so-sweet side of closing 'doughnut hole'
Six years after Congress added a prescription drug benefit to Medicare, Democrats in the House and Senate are poised to make a central change that they and most older Americans have wanted all along: getting rid of a quirk that forces millions of elderly patients with especially high expenses for medicine to pay for much of it on their own. The closing of an unusual gap in Medicare drug coverage -- a gap that Republicans had, when they controlled Capitol Hill and the White House, insisted was needed for the government to be able to afford the program

Medicare physician pay cut delayed until March
President Obama has signed legislation that would prevent a 21.2% Medicare payment cut from taking place Jan. 1 by freezing physician rates for two months. The temporary patch, which expires after Feb. 28, 2010, is intended to give Congress additional time to craft a more lasting solution to the doctor pay problem. It piggybacked on the fiscal 2010 appropriations bill for the Defense Dept., which helps fund the wars in Afghanistan and Iraq. The White House announced Dec. 21 that the president had signed the legislation.

Medicare use, spending found to vary across country
Regional variations in the use of Medicare services across the U.S. do not directly translate to regional variations in spending, the Medicare Payment Advisory Commission noted in a Dec. 1 study. "The two should not be confused," MedPAC stated in the report compiled for Congress, which has been focused on reining in Medicare spending as it attempts to pass comprehensive health system reform.

Senate debates health reform bill with 1-year Medicare pay patch
Senators opened debate on national health system reform legislation on Nov. 30 in partisan fashion. Democrats talked up the bill's coverage expansions and health insurance reforms, and Republicans highlighted the measure's potential to increase both health insurance premiums and the federal deficit.The bill aims to improve the affordability of health insurance and expand government regulation of health plans. It also would implement Medicare cuts to help pay for it.

Should Doctors’ Pay Be Linked to Hospital Readmissions?
One in five Medicare patients winds up back in the hospital within a month of being discharged. At least some of these readmissions could be prevented with proper follow-up care; as part of the big health-care overhaul, Congress is likely to create financial incentives to push hospitals to lower readmission rates. But, as an M.D. points out in an essay in this morning’s New York Times, practicing docs — not hospital execs — decide whether to admit patients to the hospital.

Medicare, Medicaid spent $54 billion too much in 2009, White House says
Improper payments for health care made up a large portion of the $98 billion the federal government spent inappropriately in fiscal 2009. This total was an increase of $26 billion over the previous year, according to a report issued by the White House Office of Management and Budget. The Nov. 17 report concluded that Medicare fee for service improperly spent $24 billion in fiscal 2009, a rate equivalent to 7.8% of total outlays, and Medicaid improperly spent $18 billion, a rate of 9.6%. Medicare Advantage improperly spent $12 billion in 2009, a rate of 15.4% of total outlays on the private plans.

House passes major Medicare payment reform; what will the Senate do?
Passage of a major Medicare physician pay overhaul in the House on Nov. 19 means attention on the issue turns back to the Senate, which in October rejected a similar measure due to its projected cost. The House bill, the Medicare Physician Payment Reform Act of 2009, passed by a vote of 243-183. The measure would repeal a 21.2% fee reduction scheduled for Jan. 1, 2010, and replace the sustainable growth rate formula

21.2% Medicare pay cut for doctors unless Congress acts
The final 2010 Medicare physician fee schedule confirms that physicians face a 21.2% pay cut starting Jan. 1, 2010, unless Congress adopts legislation to avert it. The official figure is only slightly lower than the 21.5% reduction the Centers for Medicare & Medicaid Services was predicting earlier this year. The Obama administration supports a permanent repeal of the current physician payment formula and has called on Congress to pass legislation to that effect.

House Health Bill Would Lower Medicare Payments, Report Finds
A fresh analysis of the House health care reform plan has sounded a warning about the impact proposed Medicare cuts would have on seniors and could spell trouble for Senate Majority Leader Harry Reid's effort to pull a unified Senate bill to the floor by the end of the week. The House and would-be Senate bills rely on hundreds of billions of dollars in cuts to Medicare to keep reform deficit-neutral.

Some specialists will see extra cuts in Medicare pay
Some specialty groups are loudly protesting new Medicare payment policies that will boost some primary care rates starting next year at the expense of rates for certain specialty services. In the 2010 physician fee schedule, the Centers for Medicare & Medicaid Services adopted several major changes to the practice-expense portion of the relative value unit system that determines pay for individual services

Medicare relaunches DME competitive bidding
The Centers for Medicare & Medicaid Services on Oct. 21 began accepting bids from accredited durable medical equipment, prosthetics, orthotics and supply companies in nine metropolitan areas to decide whether they can participate in the Medicare program. The round one rebid for the DMEPOS competitive bidding program will be open for 60 days.

Failed Senate vote clouds future of SGR reform
Advocates of Medicare physician payment reform turned their attention to the House after the late October procedural defeat of a Senate bill that would have repealed the current system and effectively frozen pay rates for the next 10 years. House Democratic leaders restated a commitment to permanent pay reform soon after Senate Democrats failed on Oct. 21 to secure 60 votes to force floor consideration of the Medicare Physician Fairness Act.

Medicare doctor pay plan hits Senate snag
A proposal to boost Medicare payments to doctors ran into trouble in the U.S. Senate on Tuesday as Republicans and some Democrats balked at adding $250 billion to skyrocketing U.S. deficits over the next decade. Senator Richard Durbin said Democratic leaders lack the votes needed to overcome procedural hurdles in the 100 member Senate.

Medicare Backs Off On Order About Lobbying Seniors
The Obama administration is backing away from a ban on insurance company mailings to seniors warning of dire Medicare cuts if health care overhaul legislation is approved. Medicare said Friday it's OK for insurance companies to lobby seniors, provided the Medicare beneficiaries have given advance approval and no federal funds or data are used. Last month, Medicare had ordered a halt to such mailings after a Democratic lawmaker complained about a misleading flyer.

Senate panel's health reform bill OK'd with 0.5% Medicare pay hike
The Senate Finance Committee's approval of a health system reform bill on Oct. 13 set the final stage for a historic Senate floor debate in which lawmakers are expected to revisit the public health insurance option along with some of the other more controversial items proposed so far.

Accountable care organizations: A new idea for managing Medicare
Many physicians who are tuned into the health system reform debate have already heard of several of the methods being discussed for changing the way the federal government delivers care. But one Medicare delivery reform term that has recently caught the attention of Congress may be a new one to most.

Senators span over Medicare
Slogging through a second day of work on legislation intended to overhaul the nation's health-care system, the Senate Finance Committee wrestled Wednesday with politically volatile proposals to squeeze money out of Medicare.

Obama Defends Medicare Advantage Cuts
In his Joint Session speech President Obama promised that no one on Medicare would be forced to lose the coverage they have now. But others, like Florida Democrat Senator Bill Nelson, worry that Obama's reforms will deny seniors coverage they now rely on. When I asked him about Nelson's fear, Obama disagreed, but he didn't rule out endorsing Nelson's effort to shield current Medicare beneficiaries from the cuts.

Half of large practices net bonuses from Medicare P4P demo
The Obama White House has indicated it will continue the move toward more pay-for-performance in Medicare, despite mixed results for physicians in the P4P demonstrations it inherited from the previous administration. On Aug. 17, the Centers for Medicare & Medicaid Services disclosed findings from three ongoing programs --