Budget Chief: Cut Healthy Patients From Medicare

[NRSKarenRN, BSN, RN]

Friday October 19 5:23 PM ET

Most Medicare Beneficiaries to Face Higher Expenses

WASHINGTON (Reuters Health) - Medicare beneficiaries will soon be required to pay higher deductibles for the government-run health insurance program, if they are not enrolled in Medicare + Choice, the government's subsidized but privately run Medicare managed care program.

The Department of Health and Human Services (news - web sites) (HHS) announced on Friday that the deductible for Medicare Part A coverage will increase about 2.5% to $812 per year in 2002, while the deductible for Part B will rise approximately 8.0% to $54 per month.

Part A covers hospital, skilled nursing, hospice care and some home healthcare services. Part B is an optional supplementary program that was designed to help cover physician services, outpatient care and other services not covered under Part A.

HHS said the increases were mandated by federal law, under which the Part A deductibles are required to be updated on an annual basis and Part B deductibles have always been required to cover at least 25% of the estimated program costs.

Full story @

http://dailynews.yahoo.com/h/nm/20011019/hl/medicare_4.html

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Tuesday October 16 1:48 PM ET

Budget Chief: Cut Healthy Patients From Medicare

By Todd Zwillich

WASHINGTON (Reuters Health) - The federal government should prepare for the expected explosion in retirees by dropping healthy patients who rarely visit the hospital and concentrating Medicare resources on managing chronic, costly diseases, the Congress's chief accountant said Monday.

Speaking to a group of HMO executives, Congressional Budget Office (news - web sites) (CBO) director Daniel L. Crippen said that the government should consider using disease management programs to care for beneficiaries with expensive chronic ailments such as diabetes and congestive heart failure.

At the same time, the government ``should cut loose from the system'' seniors who rarely visit the hospital and thus cost the government little, he said.

Medicare, which now covers some healthcare costs for 39 million elderly and disabled beneficiaries, is expected to more than double its rolls as the baby boom generation retires over the next 20 years. Healthcare policymakers both inside and outside Washington are struggling to find ways to shore up the Medicare system and prepare it for the tidal wave of retirees.

``There may be a way to reform Medicare...in a way that essentially, you don't have to reform it for 80 million,'' Crippen told an audience at a meeting of the American Association of Health Plans.

Crippen said that CBO and experts from Princeton University in New Jersey have begun a project designed to provide detailed data on how Medicare beneficiaries use healthcare services. Officials hope the project will shine more light on a troubling Medicare trend, specifically that some 6% of the plan's sickest seniors use up nearly 60% of the money available for benefits.

Identifying who those seniors are and what diseases they have could encourage disease management programs designed to actively follow chronically ill patients and help them avoid costly hospitalizations.

``We're going to take a careful look here at who those folds are and what their diseases are,'' Crippen said. He added that the government may be able to save substantial funds by agreeing to pay the healthcare costs of inexpensive patients without restriction, with the idea that enforcing the restrictions themselves might be unnecessarily expensive.

Full story @

http://dailynews.yahoo.com/h/nm/20011016/hl/medicare_2.html

[Mijourney]

Hi. So, we'll have a MSA program for less costly beneficiaries and the most costly will be on Medicare and/or Medicaid? I don't know. I'm not against people who want to do their own thing with their money. I'm not sure if it's fair to keep those who use very little of their health care dollars tied to a failing program.

The problem I see is that we already have so many disparities in health care access and delivery and separating these chronically ill people from the rest of the population may result in more increases in morbidity and mortality among them. What I also am fearful of seeing is that the people who are currently healthy fall into the same rut as those who've been unhealthy all along after some major catastrophe befalls them. Somehow, we must find ways to educate the public on the importance of primary prevention so that the boomers won't face the disaster that we've already predicted.