Medicare

April 16th is National Healthcare Decisions Day: Plan for your end-of-life care now

Physician
April 16, 2023

When COVID killed thousands of seniors three years ago, few of them showed up in emergency rooms with advance directives. Even fewer thought about the end of life or how to die. Sadly, many lives were discarded in makeshift morgues/cooling trucks behind hospitals. It’s never too early to plan for the next pandemic, retirement, and the end of life.

On April 16, 2023, National Healthcare Decisions Day, take a moment and …

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Don’t fall for the Medicare Advantage hype: the realities of coverage for low-income enrollees [PODCAST]

Podcast
February 16, 2023
YouTube video

Subscribe to The Podcast by KevinMD. Catch up on old episodes!

We’re joined by Aniyizhai Annamalai, an internal medicine-psychiatry physician. Dr. Annamalai’s patients are mostly indigent, not employed due to disability, and have serious mental illnesses. Most of them qualify for Medicaid. In this episode, Dr. Annamalai shares …

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End-of-life choices: Why Medicare needs to change [PODCAST]

Podcast
January 21, 2023
YouTube video

Subscribe to The Podcast by KevinMD. Catch up on old episodes!

End-of-life care is a crucial and often overlooked aspect of health care. In this episode, we speak with Kevin Haselhorst, an emergency physician and author who shares his insights on the challenges and opportunities in this area. …

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Medicare “Advantage” for my indigent patients

Policy
December 4, 2022

Despite the aggressive marketing, Medicare Advantage plans offer little benefit for poor and vulnerable patients.

Consider my patient C, who was in pain from her knee arthritis. She was often in pain, but now her new pain medication helped her less than her previous one. She also wanted her old asthma inhaler back as the new one was harder to use. We had changed all her medications since her new Medicare …

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CMS Medicare fee cuts: The altruism of physicians is used against them

Policy
August 7, 2022

It’s hard to concisely put into words how frustrated physicians are right now. How many other professional groups out there have to fight to not have their compensation cut multiple times a year? Recently, CMS released its proposed physician fee schedule for Medicare for 2023, which reduces the conversion factor by 4.42%. This compounds upon additional cuts such as the resumption …

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

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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Clearing up the confusion surrounding Medicare for all

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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Medicare for all and the problem of health care on demand

Policy
March 10, 2019

The evolving politics of single-payer health care conflate the concepts of universal coverage, health care on demand and free health care. To the indiscriminate progressive mind, all three are part of the holy grail. The fly in the ointment is that highly attractive and altruistic politics runs into the brick wall of reality. As Thomas Sowell — a noted Stanford economist — wrote: “The first lesson of economics is scarcity: …

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Fix the pay imbalance between specialists and primary care physicians

Policy
August 27, 2017

Reformers have expended considerable effort to change the way Medicare buys health care for millions of Americans, finding a wide range of support across the political spectrum. But Medicare’s current structure may doom these reforms. Some primary care doctors fear that the skewed incentives in Medicare’s pricing system will get built into any new system, whether it is “accountable,” “affordable,” or “value-based.” This fear is well-founded. If special interests buy …

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How to perform services that increase primary care revenue

Policy
April 24, 2016

CMS states it wants to increase pay to primary care physicians.  And while we might quarrel with their strategies or with the speed of achieving the goal, few would quarrel with the goal itself.  In recent years, CMS has developed HCPCS codes and adopted CPT codes, some limited to primary care and some not specialty restricted but all likely to be reported by primary care practices. Meanwhile, although payment systems …

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A physician’s open letter to Medicare patients

Physician
November 1, 2015

Dear patients,

This is a hard letter to write, but it is important that you know about a major change that is coming for both of us in 2017, just a short year away.

As you recall, last year I left a large hospital group practice and opened my own office, and I want to thank you for your faithfulness in following me to my new location.  With the newfound freedom of …

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Bundled payments means the death of quality medical care

Policy
September 30, 2015

A recent CMS proposal to bundle payments for doctors and hospitals for hip and knee replacements in 800 model centers has hit a roadblock. The five-year program would have begun January 1, 2016, and nearly 300 comments were received by CMS earlier this month. Apparently most of the comments were not, shall we say, favorable. Even the Federation of American Hospitals protested

For those who are unaware, “bundled payments” means that …

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Medicare’s perverse incentive to keep patients on dialysis

Policy
December 2, 2014

One of the most subtle deceptions hidden inside the cracks of our sick care system is the lie told to doctors: that health is our primary goal for our patients.

I began to understand this paradox clearly when I listened to my friend’s anguish.

She’s been working as a full-time medical assistant in a busy nephrology practice, supporting two sometimes three full-time sub-specialty doctors. The practice is located in a small town …

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Medicare will pay for care coordination. Should doctors take the money?

Policy
December 1, 2014

CMS recently announced it would begin next January to pay physicians for care coordination activities. It’s about time. As physicians have been saying for some time, any payment system that hopes to encourage value (better patient outcomes) has to start by paying physicians to coordinate the care of their patients.  When physicians follow up on referrals or communicate with patients outside of the office, healthoutcomes improve, costs shrink and the patient …

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Why does Medicare pay resident salaries?

Education
November 16, 2014

Training doctors is no easy task. After medical school, newly minted doctors enroll in residency programs at various hospitals throughout the country for a length of 3 to 8 years, depending on their specialty. Some specialties, like family medicine, are even considering adding another year to the process. Resident physicians spend this time working long, arduous hours under their attending physicians, learning the clinical intricacies of their specialties that could not …

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Value-based care: Bad for doctors, bad for patients?

Policy
September 11, 2014

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Value-based health care is antithetic to patient-centered care. Value-based health care is also diametrically opposed to excellence, transparency and competitive markets. And value-based health care is a shrewdly selected and disingenuously applied misnomer. Value-based pricing is not a health-care innovation. Value-based pricing is why a plastic cup filled with tepid beer costs $8 at the ballpark, why a pack of gum …

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The Medicare spending we should be concerned about

Policy
April 24, 2014

“Do patients care about how much money their doctors make?”

This is the headline of a recently published post by Trudy Lieberman, and was written in response to the recent New Your Times’ coverage of Medicare disclosing payments to individual providers.

Now, I found the Times story fascinating on many levels, but I’ll admit it hadn’t occurred to me that the main value of this data release is that patients can …

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Why Medicaid patients use the emergency department for primary care

KevinMD
January 3, 2014

A study from Science found that those on Medicaid in Oregon made 40% more visits to the emergency department.

The Oregon Health Insurance Experiment included about 90,000 low-income people and assigned 30,000 of them to Medicaid by lottery. It’s essentially a naturally-occurring randomized controlled trial.

The result seems to have caught the public policy experts by off guard:

“I suspect that the finding will be surprising to many in the policy …

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Why physicians are hesitant to take Medicaid patients

Policy
November 18, 2013

In an earlier post, I presented some data on which kind of physicians in the United States are most and least likely to see new patients who receive Medicaid, the state/federal program to pay healthcare costs for low income people. Now a recent study lays out some reasons why many physicians are so reluctant to see such patients.

Not surprisingly, it starts with low reimbursement rates. Medicaid pays about 61% …

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How to respond to a Medicare audit: 17 tips from a lawyer

Policy
November 9, 2013

Although you may speak of a “routine” Medicare audit, there is really no such creature. This is like saying you have a “routine IRS audit.” The fact is that there is some item you have claimed as a Medicare provider or the amount of claims Medicare has paid in a certain category that has caused you or your practice to be audited.

Having too many claims for level five CPT codes …

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