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Tag: Medicare

Medicare for the Next 50 Years

More than 85 years ago, Blue Cross and Blue Shield companies pioneered the very idea of health insurance, and they’ve been at the heart of healthcare ever since. Part of this proud history is the unique role that the Blue Cross and Blue Shield System played when President Lyndon B. Johnson signed Medicare into law 50 years ago this week.

At the time, no other entity in the country was equipped with the infrastructure or computing power to process the amount of data needed to turn the vision and hope of Medicare into a reality for the nation’s elderly. So the government turned to Blue Cross Blue Shield and we were there.

More than 19 million people enrolled in Medicare in its first year. Nearly 5 million were admitted to hospitals as Medicare patients, with each hospital admission and visit requiring claims to be processed seamlessly among the patient, the medical provider and the federal government.

Community by community, Blue Cross Blue Shield were there to help give birth to this innovation, and Blue Cross Blue Shield companies have brought security and stability to millions of Medicare patients ever since.

Five decades later, the independent Blue Cross and Blue Shield companies are still partnering with government and the medical community to ensure that Medicare continues to innovate, so it can remain successful for the next 50 years.

Read the full article here.

Contact Steven G. Cosby, MHSA, Group Health Insurance Broker and Agent with Cosby Insurance Group, with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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Medicare Proposes Payment Changes to Hospitals for Hip and Knee Replacements

Federal health officials are proposing a major change in the way Medicare pays for hip and knee replacements, requiring hospitals to partly repay the government if patients get avoidable infections and other complications but rewarding them with extra payments if patients do well.

The proposal announced Thursday by the Centers for Medicare and Medicaid Services is part of the Obama administration’s efforts to overhaul the health-care system, in part by using the payment system to reward quality of care rather than volume of services. Under the current system, doctors and hospitals typically get paid set fees for every procedure they perform, regardless of how patients fare.

The proposal is designed to hold hospitals accountable for an entire episode of care, from surgery through 90 days after discharge. That way, hospitals would have an incentive to work with doctors, home health agencies and nursing facilities to make sure patients get the coordinated care they need, reducing ­avoidable complications and ­re-hospitalizations.

The experiment will “treat these surgeries as one complete service rather than a collection of individual services,” Health and Human Services Secretary Sylvia Mathews Burwell told reporters. She likened the various care providers involved to the parts of a symphony orchestra: “Only by working together [are we] going to get the music to come alive.”

The new payment method would be used in 75 areas across the country, affecting 800 hospitals and an estimated 100,000 patients a year. Officials hope to save $150 million over the five-year demonstration period.

Read the full report here.

Contact Steven G. Cosby, MHSA, Group Health Insurance Broker and Agent with Cosby Insurance Group, with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

Cosby Insurance Group Warrenton Health Insurance Broker and Agent

Medicare Vies To Keep ACOs On Board With More Flexible Rules

More flexibility is coming for Medicare accountable care organizations under a final rule the CMS published Thursday (PDF). The revisions are intended to strike a balance between maintaining the program’s rigor and making sure providers continue to participate.

The Medicare Shared Savings Program will offer a new track to take on more financial risk of patient care, and it will allow Medicare ACOs to avoid penalties beyond the initial three-year term. The CMS will also issue future guidance on benchmarking and rebasing issues that have been sources of contention for many providers.

The Affordable Care Act catalyzed the creation of Medicare ACOs, which are networks of hospitals and physicians that aim to improve the quality and lower the cost of care for Medicare beneficiaries in a defined area. More than 400 ACOs participate in Medicare accountable care contracts, and they care for more than 7 million beneficiaries.

The CMS received 275 comments from concerned stakeholders, and the agency expects 90% of Medicare Shared Savings ACOs will stay with the program because of the rule changes.

Hospitals and physicians have been able to choose between two tracks for shared savings for ACOs, and the CMS is finalizing the third option it proposed in December. The third track is “very much modeled” after the Pioneer ACO, CMS Deputy Administrator Sean Cavanaugh said. And it also shares many similarities with the Next Generation ACO model that the CMS proposed in March.

Providers opting into track three will take on more financial risk, but could also share in potentially higher savings. The CMS said upside and downside risk for this model will be 75%—meaning an ACO’s bonus or penalty would be 75% of its savings or loss— just as it proposed in December. ACOs in track three are also given a fixed population of beneficiaries to care for.

Read the full report here.

Contact Steven G. Cosby, MHSA, Group Health Insurance Broker and Agent with Cosby Insurance Group, with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

Cosby Insurance Group Warrenton Health Insurance Broker and Agent

Health Reform – Medicare Payment Scorecard

Health Reform – Medicare:  Earlier this year, the U.S. Department of Health and Human Services (HHS) set ambitious goals for increasing the proportion of Medicare payments designed to improve the value of care patients receive. HHS goals include tying 50 percent of traditional, or fee-for-service, Medicare payments to quality or value by the end of 2018 through alternative payment models.

Just a few weeks ago, Congress passed legislation adding additional heft to these goals. The Medicare Access and CHIP Reauthorization Act will help significantly increase the proportion of Medicare payments reflecting and supporting the quality of care.

The Catalyst for Payment Reform (CPR) unveiled an independent review of Medicare payments, taking a retrospective yardstick to how Medicare has been paying for health care. CPR released the findings in its Scorecard on Medicare Payment Reform, the first such analysis of the billions of dollars Medicare pays to health care providers. At a time when Congress and the Obama Administration are implementing huge payment reforms in Medicare, the Scorecard serves as a critical benchmark to assess the progress of these efforts and, eventually, how well they are working to improve quality and cost.

Read the full report here.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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House Energy and Commerce Subcommittee on Health Hearing

Chairman Pitts, Ranking Member Pallone and members of the Subcommittee, thank you for the opportunity to testify regarding fiscal priorities in the 114th Congress. As a major driver of federal spending, our health care system must be central to this discussion. I would like to make three main points today regarding the fiscal future of the health care system in the 114th Congress.

First, the expansive spending created by the Affordable Care Act (ACA) will continue to generate fiscal issues for years to come. The ACA was left largely untouched by the Budget Control Act, resulting in unrestrained spending in some of health care’s most expensive programs. Next year Congress should rein in this spending and subject the ACA and Medicaid to cost saving reforms.

Second, making reforms within the exchanges and cutting back on ACA spending will create savings; some of which should be utilized to ensure a sustainable Medicare program for seniors well into the future. In order to preserve Medicare for the next generation, big policy changes must occur, and savings generated through scaling back the excesses of health reform can help pay the way.

Finally, decreasing ACA spending and applying some of these savings to Medicare reform is just part of the fiscal priorities conversation. Any change undertaken should lay a foundation for a more efficient health care system, and the 114th Congress should work to towards that ultimate objective by focusing on achievable goals in the present.

Read the full article here.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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