BY HOWARD GLECKMAN: Mom falls and breaks her hip. Her injury is repaired at the local acute care hospital but she needs intensive rehab and post-surgical care. She could be sent home or to a skilled nursing facility (SNF) but instead she is discharged to a long-term care hospital (LTCH)—a facility that specializes in intensive post-acute services.
But a new study, published by the National Bureau of Economic Research, finds that in 2014, Medicare paid LTCHs three-times what it paid SNFs, or about $33,000 more, for each discharge. And there is no evidence, according to the research, that mortality is any lower than for nursing facility patients. Overall, according to the authors, Medicare could save $4.6 billion annually by reimbursing LTCHs like SNFs—with no harm to patients. (read more)
BY KIMBERLY LANKFORD: If you have a Medicare Part D prescription-drug plan or a Medicare Advantage plan (which combines medical and drug coverage), you have an opportunity to switch plans every year during open enrollment, which runs from October 15 to December 7.
Many people put their Medicare Advantage and Part D plans on autopilot, although the choice of plans, costs and coverage, as well as your health care needs, can change from year to year. Sticking with the status quo could be a costly mistake in the coming year, because there have been major changes in benefits and coverage. (read more)
BY LORI ROBERTSON: Beginning Jan. 1, Medicare Advantage enrollees may be required to use lower-cost alternatives to more expensive drugs for new prescriptions for medications administered by a physician or in a clinical setting.
Health and Human Services Secretary Alex Azar has described the new policy as “unleashing our Medicare Advantage plans to negotiate discounting on $12 billion of drugs.” Some patient advocacy groups, meanwhile, have described the policy as one that “could erect barriers to care for cancer” and put “insurers in control of treatment decisions.” Those are two sides of an issue called “step therapy.”
We’ll explain what the new policy entails. (read more)
BY PETER SULLIVAN: A recent study concluding that Sen. Bernie Sanders‘s (I-Vt.) “Medicare for all” bill would cost $32 trillion has set off a furious debate over the cost of the plan.
But there’s one estimate that would make an even bigger splash: the score from the nonpartisan Congressional Budget Office (CBO).
However, it does not appear that CBO is working on a spending estimate, despite a request from Sen. John Barrasso (R-Wyo.), who asked for a cost analysis in September in order to highlight the steep costs for Medicare for all, also known as single-payer.
Barrasso told The Hill last week that he doesn’t recall receiving a response from the CBO, suggesting that his request was not accepted. (read more)
BY ED TEIXEIRA: The home care franchise category continues to grow and prosper as the home health care industry has grown to over 15, 000 national providers including home health care agencies, which provide skilled nursing services, and home care agencies, which provide companion care or non-skilled nursing services. Reimbursement for home care services is primarily private pay while most home health care agencies are Medicare-certified. (read more)