Rule Aims To Curb Huge Out-Of-Pocket Costs For Patients Kept In ‘Observation Status’
Because the patients are never fully admitted to the hospital, Medicare will refuse to pay the sometimes astronomical costs of their nursing home stays. Now patients will have to be made aware of the loophole. The notices are expected to begin in January. Also in the news, Health and Human Services Secretary Sylvia Mathews Burwell's thoughts on value-based payments, stories about the program's new drug plan, an update on the Massachusetts "boondoogle" and a breakdown of the star ratings for New Hampshire hospitals.
The New York Times:
New Medicare Law To Notify Patients Of Loophole In Nursing Home Coverage
In November, after a bad fall, 85-year-old Elizabeth Cannon was taken to a hospital outside Philadelphia for six and a half days of “observation,” followed by nearly five months at a nearby nursing home for rehabilitation and skilled nursing care. The cost: more than $40,000. The hospital insisted that Ms. Cannon had never been formally admitted there as an inpatient, so under federal rules, Medicare would not pay for her nursing home stay. The money would have to come from her pocket.The experience of Ms. Cannon and thousands like her inspired a new Medicare law — in force as of Saturday — that requires hospitals to notify patients that they may incur huge out-of-pocket costs if they stay more than 24 hours without being formally admitted. (Pear, 8/6)
Los Angeles Times:
Obama's Health Secretary Wants To Make Patients Healthier By Transforming How Doctors And Hospitals Get Paid
Largely out of the spotlight, Obama administration officials have labored on an equally sweeping project to transform the way America’s doctors, hospitals and other medical providers deliver care. The foundation of this effort involves scrapping the way medicine has traditionally been paid for – a system akin to auto repair in which each service a doctor or hospital provides is billed separately, no matter how well it is performed and what the long-term outcome is.In place of that, the Obama administration is trying to build a system that pays doctors, hospitals and others based on how their patients recover and how much their care costs. (Levey, 8/5)
Politico Pro:
Conservative Group Launches $4.8M Campaign Against Medicare Changes
The American Action Network on Monday is announcing a three-pronged, $4.8 million advocacy campaign that targets Medicare's plan to pilot a new way to pay for drugs, as well as the agency's long-gestating Independent Payment Advisory Board. It's the single largest issue-advocacy campaign in the conservative group's history — with $1.9 million in print ads, $1.7 million in direct mail, and $1.2 million in digital ads, all targeted at seniors — and it comes with Congress on recess. (Diamond, 8/8)
The Wall Street Journal:
A New Medicare Charge Is Coming: Here’s How To Lessen The Blow
For high-income Americans covered by Medicare, now is the time to make tax moves to minimize an increase in premium surcharges. These surcharges apply because Congress has decided the top 5% or so of Medicare recipients should contribute more for their coverage than lower earners. Last year, about 3 million Americans owed extra premiums for Part B coverage for medical services, such as doctors, and about 2 million owed them for Part D coverage for drugs. (Saunders, 8/5)
Politico Pro:
CMS Halts Payment Boost For Massachusetts Hospitals
Massachusetts won’t get its “boondoggle” next year. CMS this week said it won’t let a Nantucket hospital resubmit certain paperwork that, if it had been filed correctly, would have led to higher reimbursements for Massachusetts hospitals — and slightly lower payments for the rest of the country. The policy, which was part of Obamacare, has been derided by Republicans and hospitals in other parts of the country as a special benefit for Massachusetts that helped get the health law passed. But for one year at least, the “Bay State Boondoggle” is no more. (Haberkorn, 8/5)
Concord Monitor:
Local Hospitals Get Three Of Five Stars From Medicare Rating System (For What It’S Worth)
Patients who were treated in Concord Hospital reported being much happier with their care than patients at many other New Hampshire hospitals, but that didn’t stop the facility from getting a middle-of-the-road three stars out of five in the latest Medicare ranking of thousands of hospitals.Franklin Regional Hospital also received three stars, as did the majority of hospitals around the country and about half of the 19 New Hampshire hospitals that received rankings. (Brooks, 8/6)
