In its efforts to prevent alleged widespread fraud in Medicare, federal regulators have blocked for at least six months any new home health and hospice providers from participating in these federal programs. This strategy may succeed in grabbing headlines but it won’t stem corruption and may limit access to care for many who need it. In the name of fraud [...]
In a new experimental program, Medicare soon will pay participating doctors to provide better preventive care for frail older adults and younger people with disabilities. Among the initiatives, it will encourage greater support aimed at avoiding falls. The program, called Long-term Enhanced ACO Design, or LEAD, is an important step toward encouraging medical providers to help prevent falls before they [...]
To the shock of the big insurance companies that run most Medicare Advantage managed care plans, the government has proposed boosting payments to plans by just 0.09% in 2027. That would be a fraction of the annual increase plans received in the past and far below what they, and their investors, expected. Share prices plummeted and plan executives darkly warned [...]
Medicare’s new hospital payment experiment, which it calls TEAM (Transforming Episode Accountability Mode), may have profound effects on patients, their families, and providers such as nursing homes and home health agencies. While the acronym signals the virtues of collaboration and shared goals, its outcomes are far less certain. At its best, TEAM will encourage hospitals to improve the quality of the [...]
Since Congress passed the big tax and spending bill on July 3, most observers have focused their attention on its cuts to Medicaid, the program that helps support low-income older adults and people with disabilities. But the Trump Administration is quietly making big changes to Medicare, the program that insures nearly 70 million seniors and younger people with disabilities. Just [...]
Will the Trump Administration push more beneficiaries into Medicare Advantage managed care plans? Will the Administration limit payments to the insurance companies that run those plans? Will it do both? Whatever Trump does, the consequences will be significant for older adults and younger people with disabilities who rely on Medicare for their health care. Done well, an overhaul of MA [...]
Medicare Advantage prior authorizations have few friends. Doctors hate them. Patients hate them. Politicians say they hate them and introduce bills to curb them. But how onerous are they really? Less than many people think. But they still create opportunities for insurance companies to maximize profits at the expense of needed care. And they can be improved. Prior authorizations are [...]
President-elect Donald Trump prides himself on making deals. Here is one for him: Keep Joe Biden’s commitment to have Medicare pay for GLP-1 drugs such as Ozempic and Wegovy for weight loss. But only if the drugmakers agree to substantially reduce their prices right away. Such a move would be fraught for Trump and his Republican allies on multiple levels. [...]
The incoming Trump Administration has been sending mixed signals about the fate of Medicare. But if Trump advisers and GOP lawmakers are serious about slashing government spending it is hard to see how they will ignore the program, which last year cost $850 billion and accounted for about one out of every six dollars the federal government spent. Trump’s problem: [...]
Democratic presidential candidate Kamala Harris says she wants to create a home-based long-term care benefit under Medicare. She’s suggesting an historic change in the health care system for older adults and some younger people with disabilities. But her idea raises important political and policy questions. Harris describes the broad outlines of her plan in a hard-to-find fact sheet here. Oddly, [...]