CMS Could Save Billions By Changing Payment, Delivery Methods

Experts examine ways to change care delivery and payment at the Centers for Medicare & Medicaid Services while seniors prepare for the Medicare open enrollment period.

Modern Healthcare: "CMS could save billions of dollars in the Medicare program by making substantive changes to the way care is managed, delivered and paid for at skilled nursing and other long-term-care facilities. A report released last week showed the program could potentially save $2.1 billion if hospitalization rates among long-term-care residents were reduced by 25%." CMS Administrator Donald Berwick "outlined what he called the CMS' 'triple aim' under his guidance: better care, reducing the need for care through prevention, and lower costs, which all relate to the problems and potential solutions in long-term care."

Among the issues that experts say Medicare will need to address are "inadequate staffing, which includes the level of skill and training among skilled-nursing caregivers; low Medicaid costs for skilled-nursing stays that can lead facilities to seek more profitable services from Medicare to make up the difference; and the idea that long-term care has long been viewed as separate from healthcare rather than as an essential and costly component of the nation's healthcare system" (Zigmond, 10/18).

St. Louis Business Journal: "St. Louis hospitals are poised to lose hundreds of millions in federal and state funding over the next several years, thanks to recently-enacted cuts in Medicare and Medicaid reimbursement. Effective Oct. 1, hospitals were hit with a 0.4 percent reduction in inpatient Medicare reimbursement rates, a cut Moody's analysts categorized as an 'extremely rare event.' The cut is on top of reductions in state Medicaid reimbursement that took effect July 1" (Mueller and Solomont, 10/18).  

Meanwhile, regarding Medicare Part D, The Los Angeles Times reports: "The sign-up period for Medicare Part D (Medicare's prescription drug program) for 2011 runs Nov. 15 to Dec. 31. There are a lot of plans to review - an average of 33 per state, according to the Kaiser Family Foundation, a health policy and communications group in Menlo Park, Calif. And the plans change each year, so the plan you had in 2010 may shed some drug options or raise some costs. So don't just stick with the plan you had for 2010: compare, compare, compare" (Kritz, 10/18).

Steamboat (Springs, Colo.) Pilot: "The Colorado Senior Health Insurance Assistance Program (SHIP) offers free confidential counseling to individuals needing help choosing Medicare health and prescription drug plans or navigating Medicare issues. Older adults face a variety of challenges when navigating the complex world of Medicare. Many do not have computer skills or access to the Internet, which is one of the best tools for understanding Medicare and finding answers to questions. Many older adults also are confused by government letters related to Medicare claims, changes and upcoming deadlines" (Manzanares, 10/18).

Wisconsin Rapids Tribune: "Wisconsin Rapids officials' recent decision to eliminate health insurance subsidies for nonunion employees older than 65, starting Jan. 1, likely will affect only 17 people. However, they are part of a growing trend nationwide -- a reason officials of a New York-based Medicare exchange company decided to lend their help. Extend Health offers anyone free side-by-side comparisons of more than 3,500 plans, said Brian Bohlig, chief marketing officer. Although the 66 participating insurance companies pay Extend Health to list their plans in the online database, providing specific plan information, benefits advisers work neither for any provider nor on a commission, said Jill Nohai, vice president of public sector sales for Extend Health's Wisconsin region" (Shuda, 10/18).

Clarksville (Tenn.) Online reprints a statement by the Tennessee Consumer Affairs Division: "There are more than 1 million beneficiaries nationwide who have received non-renewal notices from their Medicare Advantage or Private Fee for Service plans within the past few weeks. The U.S. Centers for Medicare & Medicaid Services (CMS) and the Tennessee Department of Commerce and Insurance are warning of agents who seek to take advantage of this and use aggressive marketing tactics to get beneficiaries enrolled in different plans. Seniors receiving Social Security benefits might not be getting a cost-of-living-adjustment in the coming year, so it is more important than ever to make sure your Medicare prescription plan is the best for your budget and your needs. Also, this year, some plans have chosen not to renew their contract with the Centers for Medicare and Medicaid Services (CMS), meaning some seniors may be forced to choose a new option" (10/18).