Medicare

Seniors who received $250 checks for prescription drug costs under the Democrats' law would not have to repay the money.

A Medicare rights group filed a class action lawsuit against the federal government on Tuesday that could affect many thousands of Americans seniors.

The suit seeks to require Medicare to cover certain types of rehabilitative care even when it likely won't lead to an "improvement" in patients' condition.

"This has been the main barrier keeping people from getting the care and services they need," said Judith Stein of the Center for Medicare Advocacy, which filed the lawsuit in United States District Court in Burlington, Vt.

The lawsuit was brought on behalf of four individuals from Vermont, Connecticut, Rhode Island, and Maine and five organizations. These include the National Committee to Preserve Social Security and Medicare; the National Multiple Sclerosis Society; Parkinson's Action Network; Paralyzed Veterans of America; and the American Academy of Physical Medicine and Rehabilitation.

Plaintiffs say almost 78 percent of the 46 million or so Medicare beneficiaries have at least one chronic condition, such as multiple sclerosis or Alzheimer's. Denying them care if they don't meet the so-called "Improvement Standard," the advocates argue, can prevent them from performing routine daily activities or even cause their condition to deteriorate - leading to higher costs down the road.

Associations representing high-needs patients are hitting back at a congressional advisory panel’s recommendations for Medicare payments in fiscal 2012.

The Medicare Payment Advisory Commission (MedPAC) said on Thursday that new copayments are needed for home health visits to discourage seniors from overusing the service. 

Val Halamandaris, president of the National Association for Home Care and Hospice, said MedPAC should instead encourage home health visits.

"Not only is home care the right way to save billions in Medicare expenditures, it is what our seniors need to meet their increasing and complicated healthcare requirements," Halamandaris said in a statement Friday afternoon. "Steering seniors away from home care through high copayment requirements is simply bad policy."

Meanwhile, a nursing home association criticized the advisory panel for voting against a cost-of-living increase for skilled nursing facilities (SNFs) in fiscal 2012.

"MedPAC's recommendation fails to consider the significant and historic underfunding of SNF patient care by state Medicaid programs,” said Alan Rosenbloom, president of the Alliance for Quality Nursing Home Care in a statement. “This underfunding negatively affects all government-funded patients in SNFs.”

About four-fifths of the nation’s hospitals and 41 percent of physicians are aiming for federal stimulus dollars for using electronic health records (EHRs), according to new survey results released by President Obama’s health information technology czar.

Starting this year, hospitals and office-based physicians can receive Medicare and Medicaid incentives for the “meaningful use” of EHR technology in accordance with standards established by the Medicare agency. The stimulus package enacted in the first month of the Obama administration makes available up to $45,000 in Medicare and $63,000 in Medicaid incentives to office-based physicians, while hospitals stand to receive millions for the adoption and use of EHR technology. Registration for the Medicare and some Medicaid programs began earlier this month.

About two-thirds (65 percent) of hospitals and 32 percent of office-based physicians plan to enroll in meaningful use programs by the end of 2012 in order to receive the maximum incentives, according to survey results announced Thursday morning. Fewer federal dollars will be available to hospitals and doctors that wait to adopt EHR technology, and failure to meaningfully use EHRs starting in 2015 will result in Medicare penalties.

EHR technology is meant to improve healthcare quality by making it easier for care providers to share information, but the technology’s high cost has often been cited as a main reason for the healthcare community’s reluctance to adopt it. Dr. David Blumenthal, the national coordinator for Health Information Technology (ONC), said Wednesday morning that the stimulus incentives are encouraging providers purchase EHR systems.  

“For years we have known that electronic health records would improve care for patients and bring about greater cost effectiveness in our health sector, yet adoption rates by health care providers remained low,” he said in a statement. “In 2009, Congress and the President authorized major new federal support for EHR adoption and use, and in combination with medical professional and hospital leadership. I believe we are seeing the tide turn toward widespread and accelerating adoption and use of health IT."

The American Hospital Association conducted the survey on hospitals' EHR plans, while the National Center on Health Statistics reported the office-based physician data.

The long-term-care pharmacy lobby says a proposed regulation that aims to reduce waste in Medicare would end up raising prices for the Part D prescription program.

The proposed rule would require pharmacies that dispense brand-name drugs to long-term-care facilities, such as nursing homes, to deliver them once a week instead of once a month. The Congressional Budget Office has estimated that more frequent deliveries would save $712.5 million a year as Medicare reduces its bill for drugs that never end up being used.

Waste, federal regulators explain in their proposed regulation, may occur "when treatment with the Part D drug has been discontinued, the Part D enrollee has been discharged to the community, the Part D enrollee has been hospitalized, or the Part D enrollee has died, leaving unused dispensed drugs."

The Long Term Care Pharmacy Alliance (LTCPA) questions those savings in its comments on the proposed rule, which were due Tuesday. 

The Medicare agency on Friday issued a proposed rule spelling out how hospitals will be rewarded for providing high-quality care for patients, as required by Democrats' healthcare reform law. Under the program, known as value-based purchasing, hospitals that perform well on measures relating to quality of care and patient experience would get higher Medicare payments.

"Today's proposal is a huge leap forward in improving the quality and safety of America’s hospitals for both Medicare beneficiaries and all Americans," Centers for Medicare and Medicaid Services (CMS) Administrator Donald Berwick said in a statement. "The hospital value-based purchasing program will reward hospitals for improving patients' experiences of care, while making care safer by reducing medical mistakes."

Blair Childs, senior vice president for the Premier healthcare alliance, immediately praised the development in a statement Friday afternoon.

"The Premier healthcare alliance learned firsthand through [its] Hospital Quality Incentive Demonstration (HQID) pilot project that a well-designed value-based purchasing program can achieve better outcomes for patients," he said.

"We are eager to see these results spread nationwide as all hospitals receive added incentives to improve the quality and reliability of care."

The new program is set to start in 2013. CMS is accepting comments until March 8 and will issue a final rule next year.

The administration will remove a Medicare policy that had reignited the "death panel" debate from last year's healthcare fight.

The Medicare agency on Thursday launched an online tool that contains information about doctors and other medical professionals who participate in Medicare, the first step toward rating physicians.

The "Physician Compare" feature was required by Democrats' healthcare reform law. It contains information about physicians' practices and lets patients know whether the doctors have opted to share quality-of-care data with the federal government.

The healthcare reform law also requires the Centers for Medicare and Medicaid Services to expand the feature by 2013 with more information about the quality of care Medicare beneficiaries receive from physicians and the other healthcare professionals profiled on the site. The expansion will include information on quality of care and patient experience that can help consumers learn more about the care provided by physicians who participate in the Medicare program.

The Medicare agency has issued new regulations rewarding high-quality care for end-stage renal disease (ESRD), a condition whose treatment has come under heavy criticism because the federal government pays more but gets worse outcomes than many other countries.

The new regulations establish performance standards and payment incentives required under a 2008 Medicare law. Payments under the newly created Quality Incentive Program are set to begin Jan. 1, 2012.

The new regulations aim to replace the current payment system, which rewards providers based on the volume of services provided. That has led to wide variations in the quality of care at dialysis centers across the country, with very little public information available for patients to make informed choices about the best place to get the care they need.

The conviction rate for Medicare fraud is largely flat despite the millions recently spent to beef it up.