Medicare

Chronology of Coverage

Aug. 25, 2015

Commonwealth Fund report finds there is little to no competition in private Medicare Advantage insurance markets in 97 percent of United States counties, with lack of competition even worse in rural markets. MORE

Aug. 9, 2015

Medicare has decided that it will pay for anticancer drug Blincyto, made by Amgen, recognition of high cost and unique value of drug for patients suffering from specific form of leukemia; Obama administration had initially indicated Medicare would not pay for drug, but reversed its decision, according text of final rule to be published; decision comes at time when health providers have raised concerns about high costs of new cancer treatments. MORE

Paula Span The New Old Age column; Medicare has stopped covering vacuum erection devices, otherwise known as 'penis pumps'; move, coming after coverage for erectile dysfunction medication was ended in 2006, leaves millions of elderly men with no Medicare option for impotence except invasive and expensive penile implant surgery. MORE

Impending crisis for Puerto Rico's health system due to prospect of large reduction in funding for Medicare and lack of Medicaid funding has sparked concerns from doctors and patients on island and set off protests and aggressive lobbying efforts in Washington; roots of crisis extend back decades, and situation highlights degree to which the Commonwealth receives far less health care funding than the 50 states, imparity that, in part, accounts for $25 billion of island's $73 billion debt. MORE

Editorial contends strong public support of Medicare and Medicaid and rising support for Affordable Care Act serves as warning to Republicans seeking to radically alter or dismantle programs; notes studies showing public favors keeping Medicare and Medicaid as they are rather than converting them to voucher or block grant system, while approval of Affordable Care Act has reached high of 47 percent; urges voters to support 2016 presidential candidates who will uphold all these programs. MORE

Medicare and Medicaid have transformed in their 50 years of existence from being publicly run programs to ones in which private companies have large and growing role; private health plans account for over half of Medicaid beneficiaries and more than 30 percent of Medicare beneficiaries, something that architects of programs would not have predicted. MORE

Paul Krugman Op-Ed column rejects arguments by Jeb Bush and other conservatives that Medicare must be done away with because it is unaffordable; holds evidence shows Medicare is better at controlling expenses than private insurance that conservatives are pushing; argues Medicare's long-term financial prospects look good overall and Bush's arguments are outdated. MORE

Editorial welcomes Medicare's plans to reimburse physicians for speaking with patients about end of life care, which is long overdue; points to study published in JAMA Oncology that underscores necessity of new policy. MORE

Op-Ed article by Theresa Brown underscores importance of proposed rule from Centers for Medicare and Medicaid Services that will reimburse doctors for end-of-life planning and care for Medicare patients; maintains that doctors need to be incentivized to provide most vulnerable patients with information needed to make best choices possible for themselves. MORE

Obama administration warns that 11 million people could face sudden and deep cuts in disability insurance benefits in late 2016 if Congress fails to replenish Social Security's disability trust fund; warning comes as part of annual report on financial condition of Medicare and Social Security, which combine to make up about 40 percent of federal spending; Republicans have been pushing for changes to Social Security's finance structure, including reductions in disability. MORE

Government Accountability Office investigators say thousands of doctors and health care providers have used 'questionable' addresses to bill Medicare and that Medicare has not verified addresses adequately; warn that invalid addresses could indicate fraud. MORE

The Upshot; Medicare introduces pilot program that will let terminally ill patients receive hospice care and end-of-life-planning while still receiving medical treatments for their illnesses; program is outgrowth of research that has shown blended approach can offer both better quality of life and reduced costs. MORE

Medicare announces that it is rolling out proposal in which doctors will be reimbursed for conversations with patients about end-of-life planning, to take effect in January 2016; plan will be open for comment for 60 days; major medical organizations welcome proposal, which will settle debate that rose up during passage of Affordable Care Act about whether such conversations will lead to rationing of care. MORE

Editorial celebrates 50th anniversary of Medicare and Medicaid enactment, backbones of government health insurance that have successfully allowed eligible Americans to obtain necessary health care; outlines improvements that could be made in both programs to better serve nation and allow them to continue to withstand ideologically-driven, fear-based attacks. MORE

The Upshot; many Republican lawmakers are expressing quiet relief after Supreme Court decision upholding key aspects of Affordable Care Act, noting that different outcome would have been political liability; compares situation to Ronald Reagan's famous critique of Medicare, which he saw as gateway to socialism but later embraced once program became popular among elderly and others. MORE

Story of Renaissance RX laboratory, conducting research in personalized genetic medicine, offers window into burgeoning field of development and sales of genetic tests; Renaissance has come under scrutiny by Justice Dept regarding its billing and payment practices, and as similar labs and start-ups have cropped up, many have raised concerns about way they receive money from Medicare and also about their fiscal relationships with doctors. MORE

Report by Government Accountability Office finds that Medicare fee schedule is based too closely on recommendations from American Medical Association committee, which is made up of physicians who may have interest in overvaluing certain procedures. MORE

Paula Span The New Old Age column examines warnings from experts that while more than 10 million Americans will be eligible for Medicare-covered CT scan to detect lung cancer, screening will not help every eligible patient and may, in fact, cause harm; high proportion of scans will produce false positives, and some positive results that require invasive follow-up, like biopsies, present their own risks. MORE

Mike Huckabee sets himself apart from other contenders in crowded Republican presidential field by declaring his intent to protect Social Security and Medicaid, programs that conservative elite wish to scale back or alter; announcement has potential to expose discrepancies in party, whose blue-collar supporters depend on such programs. MORE

Editorial welcomes Obama administration's request that Congress allow Medicare officials to negotiate drug prices directly with manufacturers, in effort to bring transparency to process; expresses hope that states will do same, with bills in offing to impose new cost reporting procedures; contends manufacturers should be forced to either justify increasingly higher prices or restrain increases so Americans can buy drugs at affordable costs. MORE

Government officials release most detailed report to date on Medicare spending, revealing intricate picture of 36 million patients and $103 billion in total expenditures; heartburn medication Nexium, which accounted for largest spending on single drug, was prescribed to 1.5 million patients at total cost of $2.5 billion; officials express hope that deluge of information will yield useful analysis as experts weigh in. MORE

Pres Obama asks Congress to let Medicare officials negotiate prices with drug manufacturers in effort to lower sky-high prices for genetically-tailored specialty medications. MORE

Pres Obama signs bill ending use of Social Security numbers on more than 50 million benefit cards, move that addresses rise in frequency and sophistication of identity theft;

Medicare officials will have up to four years to begin issuing new benefit cards; effort is part of a broader measure intended to overhaul way doctors are paid for treating Medicare patients. MORE

Many doctors say legislation passed to overhaul how Medicare pays physicians is short on details and are worried about whether system might lead to loss of their autonomy. MORE

Op-Ed article by anesthesiologist Carol W Cassella addresses influx of newly-insured patients who are getting medical care, sometimes with untreated, long-term conditions, due to Affordable Care Act; observes patients often require specialty care at Medicaid and Medicare reimbursement rates, putting significant strain on practices; praises new bill that will modify payments and reward doctors for delivering quality care. MORE

Nursing homes, chasing Medicare money, are switching to amenities intended to attract patients who need short-term rehabilitation after injury or illness, rather than long-term care, which is falling short; competition for patients is strong because Medicare pays 84 percent more for short-term patients than nursing homes receive from Medicaid. MORE

Senate votes 92-to-8 to pass bill that changes way Medicare pays doctors, resolving longtime issue; bipartisan bill seeks payment of doctors based on quality and value of care rather than volume of services; legislation also extends Children's Health Insurance Program through 2017. MORE

Florida Dr Salomon E Melgen is indicted on 76 counts of health care fraud, filing false claims and making false statements in political corruption case involving New Jersey Sen Robert Menendez; prosecutors accuse him of attempting to cheat Medicare of $190 million. MORE

Editorial calls on Congress to approve bipartisan bill that would address flaws in Medicare's formula for paying doctors; argues that while bill is not without problems, and while time will be short after Senate returns from spring break, passage is essential to protect doctors from large reimbursement cuts over next decade and to push them to prioritize quality of care. MORE

Bipartisan bill that recently cleared House of Representatives contains provision giving doctors new protections against medical malpractice suits; bill states that quality-of-care standards and guidelines used by Medicare, Medicaid and the Affordable Care Act cannot be used to show negligence by a doctor or hospital; consumer advocates have expressed concerns over provision. MORE

House votes 392 to 37 to approve sweeping changes to Medicare that would establish new formula for paying doctors, increase some premiums, and extend popular children's health insurance program; vote represents most significant bipartisan policy legislation in House since Republicans regained majority in 2011. MORE

House leaders of both parties are confident of passing bill with sweeping changes in Medicare; Congressional Budget Office says measure could add more than $140 billion to federal budget deficits in next decade. MORE

House Republicans narrowly approve budget that increases military spending, but cuts domestic programs and starts to privatize Medicare; plan is to shrink government spending $5.5 trillion over next ten years. MORE

Gail Collins Op-Ed column calls on Senate Democrats to abandon their opposition to plan created by Reps John Boehner and Nancy Pelosi that would fix formula for reimbursing doctors under Medicaire, issue that has threatened to become crisis; argues while Democratic objections to aspects of bill are legitimate, there comes a time to throw in ideological towel for the greater good. MORE

Negotiations led by House Speaker John A Boehner and Rep Nancy Pelosi are near agreement concerning changes to Medicare formulas for reimbursing doctors and rewarding them for performance; bill will also extend Children's Health Insurance Program, and would be significant accomplishment for Boehner. MORE

House Republicans will propose 2016 budget that partially privatizes Medicare, turns Medicaid into block grants to states, repeals Affordable Care Act and reaches balance in decade; spending proposal is said to resemble one drafted in 2011 by Rep Paul D Ryan. MORE

Government Accountability Office will release report detailing evidence of widespread overuse of psychiatric drugs by older Americans diagnosed with Alzheimer's disease; report urges Medicare officials to immediately take action to reduce unnecessary prescriptions of antipsychotic medications. MORE

The Upshot; Michael Beschloss HistorySource column examines creation of Medicare under Pres Lyndon B Johnson, noting pending Supreme Court case that threatens to gut Pres Obama's signature health care program; focuses on Johnson's abiding respect for his predecessor Harry Truman. MORE

The Upshot; unpopular bill known as the 'doc fix,' passed annually by Congress to ensure that doctors do not absorb big pay cut from Medicare, actually cuts deficit by forcing lawmakers to trim parts of Medicare programs in order to finance doctors' pay; calls to eliminate annual renewal law for a permanent bill might end this efficient practice. MORE

Pres Obama's new budget proposes to save $399 billion over next decade from Medicare, Medicaid and other programs by Health Dept; many Medicare recipients would have to pay more for care and coverage. MORE

Medical data suggests doctors located in places where many retirees live, like Florida, expand volume of services, including unnecessary medical tests, in order to inflate their earnings; Florida in particular has become epicenter of Medicare abuse, and doctors in other states have begun warning their older patients to call them before agreeing to exams or other procedures. MORE

Some cardiologists are making millions of dollars from Medicare for performing controversial, and some say unnecessary, in-office procedures to relieve blocked arteries in the arms and legs; Advisory Board Company reports procedures to put stents in vessels outside heart rose almost 70 percent from 2005 to 2013 to 853,000. MORE

Centers for Medicare and Medicaid Services will no longer pay for services provided by Yorkville Endoscopy, Manhattan clinic where Joan Rivers went into fatal cardiac arrest; agency contends clinic no longer meets standards to supply ambulatory surgical services; and will terminate benefits effective Jan 31; clinic is appealing decision. MORE

Justice Dept accuses Dr Asad Qama of Ocala, Fla, one of nation's top-billing doctors, of performing unnecessary procedures on cardiac patients; he collected more than $18 million in payments from Medicare in 2012. MORE

Older Americans face problem of paying out of pocket for dental care since many people over 65 lack dental insurance; federal Medicare program does not cover routine dental care or dentures, and many Medicare managed care plans offer limited coverage. MORE

Federal regulators are investigating whether a 2012 email by broker-dealer Height Securities predicting that Medicare was about to raise some reimbursement rates, which led to stock price jumps among health insurers, was based on insider information. MORE

Congressional Republicans, now in control, have plans to overhaul Medicare, transform Medicaid, and cut highest tax rates through budget process, measures once out of reach with Democrats controlling Senate; new Senate GOP majority will decide how far to press small-government vision. MORE

Nov. 11, 2014

Medicare will cover annual screenings for lung cancer for four million older Americans with long history of heavy smoking; draft decision by Centers for Medicare and Medicaid Services will extend coverage for CT scans to Medicare beneficiaries who smoked at least a pack a day for 30 years or the equivalent. MORE

Federal officials say they have repeatedly criticized Medicare health plans for serious deficiencies, including improper rejection of claims for medical services and unjustified limits on coverage of prescription drugs; findings come as millions of older Americans prepare to sign up for private health plans and prescription drug plans in Medicare's annual open enrollment period. MORE

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Source: topics.nytimes.com

Category: Insurance

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