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Will Medicare Changes Result in Better Quality?

September 3, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medical Debt, Medicare

As the price of health care in America keeps rising, you may be among those that are frustrated by the kind of generic approach taken by  health insurance companies and government entitlement programs. The traditional fee-for-service format of health care reimbursement means that the best hospitals and doctor’s offices don’t get rewarded and the lower performing offices don’t have consequences. But, this is all likely to change with new Medicare rules that are slated to pursue more of a ‘meritocracy’ in the way that health care dollars get paid out.

New Medicare Rules

Reports from the Centers for Medicare and Medicaid Services show that Medicare is going to begin making some changes in the way that it reimburses health care providers starting late this year. In what Medicare officials call a ‘value-based purchasing’ program, Medicare will consider various aspects of a provider’s operations in setting the reimbursement rates for that particular office. Key factors will include observation of outcomes, or in other words, whether the procedures and services performed at an office actually help patients to recover from illnesses and improve quality of life.

Responses to the Changes

For you, this represents a major change and a big potential edge in making sure you get what you deserve for the money, especially when you have out of pocket expenses. On the downside, though, some providers are arguing that hospitals and offices in rural areas, or those with other significant disadvantages, may be punished unfairly. Read the rest of this entry →

More on Medicare’s Simplicity…. “Not” Says Harvard!!

August 18, 2011 in Health Insurance, Medicare, News

J. Michael McWilliams, assistant professor of health care policy and medicine at Harvard Medical School and a practicing general internist in the Division of General Medicine at Brigham and Women’s Hospital is out this morning with an academic view of the subject I blogged about here last week: getting on Medicare is not simple.

The Harvard research compared choosing a Part C Medicare plan (also known now as Medicare Advantage after originally being called Medicare Choice) vs. Original Medicare (Parts A and B). McWilliam’s view:

“Most other Americans choose from just a few health plans, but elderly Medicare beneficiaries often have to sift through dozens of options… The Medicare Modernization Act of 2003… dramatically increased the number of private plans participating in the (Part C) program and encouraged (Part C) plans to compete for enrollees by offering lower premiums and more generous benefits, such as prescription drug coverage.”

I couldn’t agree more, as I said last week. I’m trying to get the actual research document so I can opine more.  Although I agree with his finding as expressed in the press release, I actually think Part C is easier than choosing A & B and then having to pick a Gap plan and a D plan. 

Remember last week’s flow chart (the official flow chart from the Centers for Medicare and Medicaid Services). Medicare Advantage is actually the shorter branch of the decision tree, the one on the right hand side of the diagram.

But not every county has a good Part C option and/or your provider may not participate in it and/or it may change next year and/or… and so forth, and so forth…

Like I said I said, Medicare is not simple . Go to your senior center and ask for SHINE (SHIP outside Massachusetts).