Tuesday, April 6, 2010

Senate Health Insurance Reform Bill Part 3

Pages 728 through 739 are devoted to a new program within Medicare called a Shared Savings Program. It seems to be a program in which a group of providers of services and suppliers that work together to manage and coordinate care for Medicare fee-for-service beneficiaries. These groups will be called Accountable Care Organization (or ACO's) and will be assigned beneficiaries to manage (so, those on Medicare will have even fewer doctors to choose from). I'm just a little confused.....we stopped allowing banks to administer government's student loans to save the money. But we're paying these groups to administer government's health insurance plan in order to save money.

Pages 739 through 752 are devoted to a new pilot program on payment bundling. Basically, the Secretary will choose a mix of conditions that the government will pay one flat rate to the care provider's for, rather than paying for the actual services received. Sounds like a recipe for disaster to me. Granted it's just a pilot program, so it's not that they will necessarily implement the program after the 5 year pilot. We'll see how this one works out.

Pages 752 through 763 are devoted to an Independence at Home Demonstration Program. This program is designed to provide certain Medicare beneficiaries with 24-7 in-home care & medications (not that someone will necessarily be there 24-7, but that they will have someone available to be there at any time 24-7). This is another one of those policies that I'm not against in theory. Those with certain illnesses do need this kind of help, my problem is with the government running it. I know a couple people in two different cities currently receiving in-home care from the government. They receive terrible care and fraud abounds. I think they need to fix their current in-home care system before adding another one.

Pages 763 through 775 are devoted to a Hospital Readmission Reduction Program. Essentially, the Secretary will choose conditions that, if a hospital has a readmission for something relating to that condition, the hospital will not receive full payment for that readmission. Another recipe for disaster that will just raise our health care costs.

Physican assistants will be allowed to order post-hospital extended care services after January 1, 2011 (page 791).

In the years 2010 & 2011, the government will only pay 70% of the charges for a bone density test under medicare (pages 797-799).

$22,290,000,000 is no longer available to the Medicare Improvement Fund (page 800).

Pages 776 through 814 include the formation of, improvements to or extension of programs within the Medicare system. I don't really know how we're going to pay for all these - reduction in dollars to Medicare and expansion of Medicare. Does this make logical sense to anyone?

For the years 2011 & 2012, Medicare will be paying between 25 to 200% more to low-volume hospitals (pages 808-810).

A study will be done on improving payment accuracy which is just a fancy way of saying that they will reform what and how Medicare pays for services. For some services, we just don't know if payments will be going up or down. In other cases, we do know. For example, pages 828 through 832 contain information about Medicare Disproportionate Share Hospitals. Payments to these hospitals will be reduced to 25% and then will be adjusted by some factors that I don't really understand and then by minus 1% of the change in the percentage of individuals who are uninsured.

The Secretary will come up with a process for continually re-evaluating Codes under the Physician Fee Schedule to make sure they're not "misvalued". Part of the process includes repealing Section 4505(d) of the Balanced Budget Act of 1997 which states:

"(d) Requirements for Developing New Resource-Based Practice Expense Relative Value Units.-- (1) Development.--For purposes of section 1848(c)(2)(C)(ii) of the Social Security Act, the Secretary of Health and Human Services shall develop new resource-based relative value units. In developing such units the Secretary shall-- (A) utilize, to the maximum extent practicable, generally accepted cost accounting principles which (i) recognize all staff, equipment, supplies, and expenses, not just those which can be tied to specific procedures, and (ii) use actual data on equipment utilization and other key assumptions; (B) consult with organizations representing physicians regarding methodology and data to be used; and (C) develop a refinement process to be used during each of the 4 years of the transition period"

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