Morning Briefing
Summaries of health policy coverage from major news organizations
Judge Orders Medicare To Tell Therapists That Patients Don't Have To Improve To Get Services
The New York Times: Failure To Improve Is Still Being Used, Wrongly, To Deny Medicare Coverage
For months, physical therapists worked with [Edwina] Kirby, a retired civil servant who is now 75, trying to help her regain enough mobility to go home. Then her daughter received an email from one of the therapists saying, “Edwina has reached her highest practical level of independence.” Translation: Mrs. Kirby wouldn’t receive Medicare coverage for further physical therapy or for the nursing home. If she wanted to stay and continue therapy, she’d have to pay the tab herself. ... A federal judge last month ordered the federal Centers for Medicare and Medicaid Services to do a better job of informing health care providers and Medicare adjudicators that the so-called improvement standard was no longer in effect. (Span, 9/12)
Morning Consult: GOP Chairmen Question CMS Handling Of Medicare Fraud
The leaders of three congressional committees are raising concerns about how the Centers for Medicare and Medicaid Services investigates Medicare fraud. In a letter to CMS Acting Administrator Andy Slavitt, the chairmen say they’re concerned that the agency investigates claims after payments have already been made, rather than seeking to prevent fraudulent payments from being made. The agency may rely too much on a “pay and chase” concept, despite efforts to move toward a more preventative model. (McIntire, 9/12)
VT Digger: Vermont ACOs Exceed Medicare Spending Targets Again
For the third year in a row, health care reform companies in Vermont did not earn incentive payments that the federal government offers them to save money when they treat Medicare patients. The companies are called accountable care organizations, or ACOs. They represent groups of doctors and health care systems that, while they may work for separate companies, are legally allowed to come together under the ACO to coordinate patient care without violating antitrust laws. (Mansfield, 9/12)
Morning Consult: Burr: ‘I Stand By’ Medicare Proposal
The fight over Medicare in North Carolina’s Senate race is getting messy and complicated. Sen. Richard Burr (R-N.C.), in an interview with Morning Consult, said he stands behind his proposal to overhaul Medicare to implement a premium support system and competitive bidding. He said this shortly after his office told McClatchy that he would not be looking for a vote on the plan. “I’ve never said that I divorce myself from the proposal I’ve put out there. I stand by everything legislative I’ve done or proposed,” Burr said. It’s not uncommon for lawmakers to propose legislation and then leave it to leaders to decide about whether, and when, it should receive action. But Burr’s challenger, Democrat Deborah Ross, has pounced on the two statements — one to McClatchy and one to Morning Consult — as contradictory. (Owens, 9/9)
