Today’s Hot Topics in Medicare News

Ambulance Pay Cuts

Medicare cut to ambulance pay threatens dialysis patients’ access

BY VIRGIL DICKSON: Patient transportation providers are worried that a looming cut to ambulance reimbursement could cause some dialysis patients to lose access to care, as the new rate reimburses companies below their cost to provide rides.

The CMS has started sending notices to Medicare administrative contractors telling them to reduce reimbursement for regular, non-emergency ambulance transportation for dialysis appointments by 13% starting Oct. 1. Congress called for the cut in its February continuing resolution, known as the Bipartisan Budget Act of 2018.

The agency notes that this cut will be on top of a 10% reduction that took place in 2013, so reimbursement for such rides will be 23% less than they were five years ago. (read more)

Congress’ latest spending bill could bring major changes to Medicare Advantage. Here’s what you need to know

BY PHILIP MOELLER: Circle Oct. 15 on your calendar. That’s the first day of Medicare’s annual open enrollment period for 2019 coverage, and there likely will be eye-opening changes next year in private Medicare Advantage (MA) plans.

MA plans were authorized in their present form beginning in 2006. Since then, they have become very popular, and now account for roughly one-third of Medicare coverage. Original Medicare, which consists of Part A and Part B, accounts for the other two-thirds. Each approach to Medicare has its strengths and weaknesses, but the upcoming changes to MA plans have the potential to trigger an even larger shift away from original Medicare. (read more)

CMS: Mix of Racial, Ethnic Disparities in Medicare Advantage

BY THOMAS BEATON: CMS found significant racial and ethnic disparities related to patient experience and chronic disease management in the Medicare Advantage (MA) program, revealing potential health equity concerns within MA.

A report published by CMS and the RAND Corporation found that minority groups experienced poorer overall healthcare experiences than non-minorities during 2016. The team used Medicare CAHPS Surveys and HEDIS data to identify various patterns in healthcare disparities.  

“Compared with white beneficiaries, American Indian or Alaska Native beneficiaries reported worse experiences on six patient experience measures and similar experiences on the other two measures,” the report said. (read more)

GOP Lawmakers Expected to Draft Bill to Expand Telehealth Services Under Medicare

BY JON REID: The House Ways and Means Committee is drafting legislation that would expand the coverage of telehealth services under Medicare, according to a House GOP committee aide, with the goal of addressing a big inefficiency in the U.S. health care system – expensive, unnecessary hospital visits.

A broad coalition of health care stakeholders who are lobbying for the measure says it could save the government a lot of money while improving care for many Medicare beneficiaries.

The bill has yet to be completed. Supporters are optimistic that the legislation could gain leverage on Capitol Hill in spending negotiations this fall because of its potential to save money. (read more)

Maestro Health’s new benefits platform aims to deliver Medicare pricing to non-Medicare employees

BY PHIL ALBINUS: Employee benefit adviser Maestro Health is betting that negotiating health prices with hospitals, doctor and other healthcare providers before an employee needs medical care could help employers see Medicare-like savings.

To help employers cut their health spend and boost employees’ healthcare consumerism skills, officially launched its new benefits platform last week, although it has been available to select Maestro Health clients since last fall. Those early users are seeing healthcare savings in the range of 20% to 30%, according to Maestro Health CEO Rob Butler. None of the early customers were available to comment.

The Maestro Health platform is aimed at employers with 250 to 10,000 employees and offers access to hospitals and doctors across the country. The platform is built around a mobile app that offers information on doctor and hospital networks, along with prescription and medical procedure costs. The app can also be used in conjunction with the platform to help onboard new employees and enroll them into their employer’s benefits plan. Once enrolled, employees can continue to use the app to manage their benefits utilization. (read more)

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