Today’s Hot Topics in Medicare News

New Medicare Card

New Medicare cards: What to do if you haven’t received your new card

BY LEADA GORE: More than one million people in Alabama and four other states will be receiving new Medicare cards in the coming weeks.

The new cards no longer contain a person’s Social Security number, replacing it with a unique, randomly-assigned Medicare number designed to protect people’s identities.

“This change not only protects Medicare patients from fraud, but also safeguards taxpayer dollars by making it harder for criminals to use Social Security numbers to falsely bill Medicare for care services and benefits that were never performed,” said Angela Brice-Smith, Regional Administrator for the Centers for Medicare & Medicaid Services. (read more)

Replacing Long-Term Care Hospitals with Skilled Nursing Could Save Medicare $4.6B

BY ALEX SPANKO: New research takes aim at the long-term care hospital (LTCH), suggesting that the federal government could save billions if it paid those providers the same way as skilled nursing facilities — or just replaced them with SNFs altogether.

“We find that most LTCH patients would have counterfactually received care at skilled nursing facilities … and that substitution to LTCHs leaves patients unaffected or worse off on all measurable dimensions,” the researchers wrote in their analysis, published as a National Bureau of Economic Research working paper last month.

The team consisted of Liran Einav of Stanford University, Amy Finkelstein of the Massachusetts Institute of Technology, and Neale Mahoney of the University of Chicago, who set out to determine whether or not LTCHs justified the generally higher reimbursements they receive from Medicare: In 2014, for instance, long-term acute care hospitals received $1,400 per day for their services, as compared to $450 for SNFs. (read more)

Medicare ACOs saved $1.1B in 2017, CMS data show

BY LES MASTERSON: The results are great news for ACO advocates. Clif Gaus, president and CEO of the National Association of ACOs, said the results show “ACOs have turned the corner and this evidence dispels confusion about ACO performance.”

Farzad Mostashari, founder at Aledade, took to Twitter to suggest MSSP savings were actually much bigger than announced if other downstream factors are taken into account.

Mostashari said ACOs are cheaper than fee-for-service and Medicare Advantage models. Plus, program savings don’t come via provider payment cuts or narrow networks. (read more)

Watch Out, This Medicare Scam Begins With A Phone Call

BY KATHLEEN KOZAK: Watch your back! And in particular, companies looking to profit off your backaches.

Recently I received a fax from a company with the motto, “nothing to lose but the pain.” On the front was a picture of Joe Namath, a former pro football quarterback who is all-too-familiar with pain.

The fax said a patient of mine had contacted the company and was requesting “an insurance approved product in order to reduce pain and/or assist with their medical condition.” (read more)

More Choice for Medicare Advantage Subscribers, or More Problems?

BY THOMAS GOLDSMITH: The government agency in charge of Medicare recently announced that it’s giving some patients more choice about whether to take an expensive drug infused in a medical office, or a cheaper substitute.

However, the “preferred drug” referred to by the Centers for Medicare and Medicaid Servicesturns out to be one preferred by CMS, not necessarily by a patient or doctor and might not be what the doctor originally ordered.

Commercial insurers have practiced this type of “step therapy” for years as a cost-saver. The idea is to try lower cost older or generic drugs first to see how well they do for a patient. Patients get access to the newer, more expensive, drugs only if the first treatments don’t work for them. (read more)

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