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01/04/2011 10:47 PM

new HHS office dealing w/BOTH MEDICARE & MEDICAID

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New HHS Office to Deal With Problems of 'Dual Eligibles'

By Emily P. Walker, Washington Correspondent, MedPage Today

Published: January 03, 2011


The Centers for Medicare and Medicaid Services (CMS) announced it will create a new office to help coordinate care for "dual-eligibles" -- people enrolled in both the Medicare and Medicaid programs.

The new office was mandated under the new healthcare reform law. It's designed to assist the nine million people in the dual-eligible category -- a population that is often very poor and sick, and considered one of the most expensive to care for.

Most dual-eligibles are very low-income elderly, but some are younger and disabled.

Most of the time, they are enrolled in Medicare, but also rely on their state's Medicaid program to provide additional coverage not included in Medicare, such as long-term care, vision, hearing, and dental care.

More than 70% of dual-eligibles have incomes of below $10,000 according to the Kaiser Family Foundation, and one-third of dual-eligibles have significant limitations in activities of daily living (compared with just 14% of other Medicare beneficiaries).

Because of their significant medical needs, dual-eligibles account for 25% of Medicare spending and nearly 40% of all Medicaid spending, even though they make up fewer than 20% of enrollees in either program.

Dual-eligibles use a wide range of services paid for by either Medicare or Medicaid, including long-term care, prescription drugs, and acute care service.

According to the CMS announcement, the new Federal Coordinated Health Care Office (CHCO) will:

•Ensure more effective integration of benefits under Medicare and Medicaid for dual-eligibles and improve coordination between the federal government and states in delivering benefits

•Monitor and report on total spending and health outcomes for dual-eligibles

•Provide technical assistance to states, health plans, and physicians to help them develop integrated programs for dual-eligibles

•Work with CMS to test models to improve care coordination, reduce costs, and improve the dual-eligible experience

•Work to improve dual-eligibles' understanding of and satisfaction with their coverage

•Recommend ways to eliminate cost shifting between the Medicare and Medicaid programs Watch/tb/24150

© 2011 Everyday Health, Inc. All rights reserved.


03/16/2011 04:45 PM
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MedPAC Calls for Small Pay Increase for Docs in 2012

By Emily P. Walker, Washington Correspondent, MedPage Today

Published: March 15, 2011


Codifying recommendations made at a meeting last month, the [u]Medicare Payment Advisory Commission (MedPAC)[/u] has officially recommended that physician reimbursement under the Medicare program be increased by 1% in 2012.

MedPAC -- an independent agency of 17 trustees that provides Congress with advice on Medicare -- sends a report to Congress each March on Medicare's fee-for-service payment system and recommends payment updates for the following year.

In its report to Congress last year, MedPAC also recommended a 1% pay increase, justifying the size by explaining that most Medicare patients have access to physicians and there doesn't appear to be any doctor shortage.

This year, they said it's just as easy for a Medicare beneficiary to access a doctor as it is for someone with private insurance, adding a caveat that a "small share" of people with Medicare do report difficulty in finding a primary care doctor.

In addition, they noted, contrary to threats that doctors will stop accepting new Medicare patients, the vast majority of physicians are not shutting their doors.

"In light of these positive indicators and the modest expected growth in physicians' and other health professionals' costs, the Commission recommends an update of 1% for physician fee-schedule services in 2012," the trustees wrote.

MedPAC's recommendations are in sharp contrast to the numbers produced by the sustainable growth rate (SGR) formula that is supposed to govern Medicare payments.

The SGR math results in large cuts in Medicare reimbursement year after year.

In December, similar to previous years, Congress passed a $15 billion, one-year "doc fix" bill to prevent a looming 25% cut in physician reimbursement under the SGR formula that was scheduled to take effect Jan. 1.

Unless the SGR formula is changed, physicians will be facing that 25% cut -- or perhaps an even larger one -- again in 2012.

The commission has previously recommended moving away from fee-for-service and to a different pay system that would give incentives to physicians to provide higher quality care, and reiterated that message in its most recent report.

In 2009, Medicare spent $64 billion on physician and other health professional services.

Small Increase for Hospitals

The MedPAC trustees also recommended a 1% payment update to hospitals that treat Medicare patients.

In 2009, Medicare paid $148 billion for 10 million inpatient admissions and 147 million outpatient services delivered at 3,500 hospitals. Medicare payments per fee-for-service beneficiary grew by 6% from 2008 to 2009, the report said.

The 1% payment update recommendation is better news for hospitals than last year's report, in which MedPAC recommended a 2% reduction each year for the next three years to make up for overpayments made in 2008 and 2009.

The overpayments were the result of changes in the use of new diagnosis-related groups in 2008.

Congress should pass legislation that allows the government to recoup those overpayments, the trustees wrote.

The report found that the supply of hospitals, the range of services offered, and the volume of outpatient services provided at hospitals have grown over the past several years.

The quality of hospital care appears to be improving as well:

Hospitals reduced mortality rates across five common medical conditions; however, readmission rates haven't improved significantly, the trustees said.

The cost per patient discharged grew by 3% in 2009, compared with 2008, which saw the lowest growth since 2000, the report found.

That "reflects the hospital industry's response to the financial crisis that occurred in fall 2008, which increased pressure on hospitals to constrain their cost growth in 2009," the trustees wrote.

Home Health Targeted for Cuts

In this year's report, MedPAC criticized many aspects of the home healthcare system, pointing to the large amounts of fraud and the "flawed" way that Medicare pays for home health services.

MedPAC recommended that HHS totally revamp how it pays for home healthcare, including tacking on a copayment in order to make beneficiaries "more apt to consider the value of the benefit and share in decision making about when to use home health services."

The trustees recommended no payment update for home healthcare services, because the number of home health agencies has increased to "an all-time high" and Medicare's payments have exceeded their costs by nearly 18% for the 10th consecutive year, according to a press release from MedPAC.

The commission also said that fraud in home healthcare has become "a significant concern" and recommended that the Secretary of Health and Human Services and the Office of the Inspector General review counties with "aberrant home health utilization" and suspend provider enrollment and payment in counties where widespread fraud is discovered.

While AARP lauded MedPAC's recommendation to give physicians a pay increase for 2012, the senior's group expressed concern over the suggestions for home healthcare.

"While some of MedPAC's other proposals for home healthcare address the root cause of rising costs, adding a copayment would simply shift costs to vulnerable seniors who often don't have the resources to compare alternative treatments," said AARP Legislative Policy Director David Certner in a prepared statement.

The MedPAC report also recommended:

•An increase of 0.5% for ambulatory surgical centers in 2012

•A 1% increase for outpatient dialysis services

•A 1% increase for hospice facilities

No payment increase for skilled nursing facilities, inpatient rehabilitation facilities, long-term care hospitals

MedPAC said managing payment updates "will not solve the fundamental problem with current Medicare [fee-for-service] payment systems -- that providers are paid more when they deliver more services without regard to the quality or value of those additional services." 25354?utm_content=&utm_medium=email& utm_campaign=DailyHeadlines&utm_source=WC&em=

© 2011 Everyday Health, Inc. All rights reserved.


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