Medicare

Is it time to consider social determinants of health in Medicare payments?

Cameron Gettel, MD

Policy

March 22, 2021

Eta was a 76-year-old woman with a recent heart attack in and out of the hospital over the last several months. Her course had been complicated by social determinants of health, in that she lacked reliable transportation for necessary follow-up, had unstable housing, and her insurance did not cover valuable care from home health agencies. These obstacles made it difficult for her and her doctors to ensure that she recovered. …

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Patients over paperwork: Medicare has delivered lower costs and regulatory relief for health care providers

Seema Verma, MPH

Policy

October 28, 2020

The COVID-19 public health emergency has highlighted that government rules and regulations should not hinder providers from delivering high-quality care to patients. The Trump Administration exhibited an understanding of this principle long before the pandemic when it announced the Cut the Red Tape initiative in 2017. With a healthcare system marked by $200 billion in annual administrative costs that contributes to higher costs for patients and …

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Clinicians shouldn’t be punished for taking care of needy populations

Peter Ubel, MD

Policy

September 28, 2020

It has always been financially rewarding for doctors to take care of rich patients. People with more money … well, they have more money to spend on health care. But shouldn’t this more money/higher payment relationship go away in Medicare?

It doesn’t, and some recent payment reforms may be making matters worse.

Medicare is a federal program to reimburse medical costs in people who are disabled, have kidney failure, or are …

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Why telemedicine needs to be a permanent part of Medicare [PODCAST]

The Podcast by KevinMD

Podcast

August 19, 2020

“While preparing to assist our patients in the emergency rooms and dedicated COVID-19 wards, our clinic continues to triage patient concerns, creates new care plans, and provides a necessary layer of support, reassurance, and education in a chaotic and stressful time. Like all of you, my colleagues and I look forward to resuming our normal lives as once this pandemic is …

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A response to unemployment during the COVID pandemic: Medicare for all

Mallika Sabharwal, MD

Policy

May 15, 2020

One afternoon in clinic, I opened a patient’s chart for a telehealth visit. Within days of the COVID pandemic, all clinic visits had transitioned to telehealth. The young woman had sent a picture through the electronic medical record of a rash on her leg. Upon calling her, the woman explained that the rash started a month ago, wasn’t painful, and she couldn’t recall anything that caused it. On further investigation …

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CMS needs to permanently eliminate barriers preventing routine use of telemedicine

Magdalena Bednarczyk, MD

Conditions

April 11, 2020

On March 6, 2020, the Centers for Medicare and Medicaid Services (CMS) provided a temporary waiver to expand telemedicine services, whose use was previously limited to specific circumstances. However, as the United States grapples with the unprecedented impact of the COVID-19 pandemic on our nation’s health care system, CMS should permanently eliminate barriers limiting the routine use of telemedicine.

As clinicians, we can …

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Would Medicare for all help us combat COVID-19?

Rani Marx

Conditions

March 21, 2020

In 2009, when more than $35 billion was invested in expanding national electronic health record (EHR) uptake, one of many advantages touted was its value as a tool for managing population health. This promise has failed to materialize due to a chaotic rollout of non-communicating systems. Today, as we confront COVID-19, the coronavirus wreaking international havoc, the need for such a tool is exquisitely evident.

How could …

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Medicare for all is dead because Democratic voters aren’t buying it

Robert Laszewski

Policy

December 16, 2019

Fixing Obamacare and adding a public option is the health care policy territory first staked out by Democratic Presidential candidate Joe Biden.

Writing about Biden’s plan recently on my blog, I said:

If the Democrats capture the White House, keep the House, and take over the Senate, no matter who they elect as President, this Biden health care outline, not Medicare for all, will likely be the plan Democrats …

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Medicare for all advocates are in for a rude awakening

Talal Khan, MD

Policy

December 11, 2019

Migrating to the U.S. as an international medical graduate, I was shocked by the health care culture of excess. Initially, it felt good to order a CT scan on everyone who had a fall or cardiac enzymes on anybody who had atypical chest pain. I felt powerful and light years ahead of the system I left behind, where you would have to very cautious about ordering diagnostic tests as, mostly, …

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Is there a link between readmission and a hospital’s non-profit status?

David Lozar, MD

Policy

December 10, 2019

It was the middle of winter in downtown Chicago in 1995, and I was sitting across from an apologetic alcoholic holding a slimy NG tube. Mr. Smith, an emaciated man in his sixties, had been on my service for three days with acute pancreatitis, and this was the fifth nasogastric tube that had “slipped” out of his nose.

Subsequently, his morning labs were just as bad as they had been on …

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Expensive Medicare patients aren’t who you think

Peter Ubel, MD

Policy

October 22, 2019

Over half of Medicare spending is concentrated in 10 percent of patients. With Medicare expenditures rising at an unsustainable clip, reigning in the costs of those patients is key to controlling health care spending.

So who are those patients and what expenses are they racking up?

It’s not who or what I expected. When I think of high-cost patients, I envision people with drawn-out hospital stays, or imagine people …

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How the latest Medicare fraud schemes involve telemedicine

Victoria Knight

Policy

October 15, 2019

Dean Ernest had been living in a nursing home about a year when his son, John, got a call last winter asking if his father was experiencing back pain and would like a free orthotic brace.

The caller said he was with Medicare. John Ernest didn’t believe him, said “no” to the brace and hung up. He didn’t give out his father’s Medicare number.

And yet, not just one, but 13 braces …

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Why Medicare for all is not going to happen in America

Margalit Gur-Arie

Policy

October 14, 2019

I am going to make a prediction here. No matter who we elect in 2020, Bernie or Trump or anything in between, Medicare for all is not going to happen in America. One can run an electrifying campaign on the promise of Medicare for all, or indignantly against it, but this is pure theater on both sides. I don’t know if God can make a rock so big and heavy …

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Clearing up the confusion surrounding Medicare for all

Caroline Poplin, MD, JD

Policy

September 18, 2019

The Democratic debates this summer demonstrated massive confusion around Medicare for all. Does it mean Medicare for all who want it? Medicare Advantage? A “public option” on an Affordable Care Act (ACA) exchange?

Democrats need to get their story straight.

The confusion is understandable. Medicare for all has been an aspiration since at least the New Deal, but since 1965, when Congress …

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Primary Care First: CMS develops a value-based primary care program for independent practices

Robert Colton, MD

Policy

July 29, 2019

The monumental shift in health care from fee-for-service or a volume-based approach to value-based care will change health care delivery for the better in the United States. When physicians do what is necessary and avoid over-testing and procedures of limited or no value, the outcomes are best for the patient, and for the entire health care system.

The Centers for Medicare and Medicaid Services have tested and continue to test models …

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Why MIPS is a useless mental exercise

Linda Girgis, MD

Physician

June 23, 2019

Every day I receive all kinds of emails and other ads telling me about services offering me help to meet MIPS quality metrics. While they may be helpful, most doctors don’t see the need for such a program. It drives up costs in administering and time in needless metrics reporting. Yet, give us a new regulation and a whole industry is going to pop up to profit off of our …

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Medicare for all will kill jobs. But it may be necessary.

Elisabeth Rosenthal, MD

Policy

May 31, 2019

As calls for radical health reform grow louder, many on the right, in the center and in the health care industry are arguing that proposals like “Medicare for all” would cause economic ruin, decimating a sector that represents nearly 20% of our economy.

While exploring a presidential run, former Starbucks chief Howard Schultz called Medicare for all “not American,” adding, “What industry are we going to abolish next — …

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A physician suggests how to improve Medicare

Niran S. Al-Agba, MD

Policy

May 23, 2019

This is a brief explanation of Medicare from a physician’s perspective, as well as my thoughts on how Congress could make adjustments that would bring us closer to universal care and provide the private market the freedom to improve health care outcomes.

Medicare is a national health insurance program that provides health insurance for Americans ages 65 and older, and those who are disabled or have specific chronic conditions. Medicare covers …

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Medicare for all doesn’t look like single payer in the rest of the world

Niran S. Al-Agba, MD

Policy

May 9, 2019

Recent polls show a majority of Americans support Medicare for all, but few seem to realize that no other system in the world operates like the current single payer proposals in Congress. Recently, I addressed the concept of single-payer health care, with Cuba’s system as an example. Today I’m writing more about the ideas being discussed now in our country and how those compare to other nations …

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When is a check-up not a check-up?

Edward Hoffer, MD

Conditions

April 26, 2019

Kaiser Health News told the story of a 69-year-old woman who went to a new doctor for her annual check-up, assuming it was covered by Medicare and was happy with the visit until she got a $400 bill.

Most Americans believe in “annual check-ups,” at which your doctor reviews your medical history, gives you a thorough physical and orders lab tests. The actual value of such visits has been questioned, but …

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