Kaiser Health News

Medicare Advantage Plans Shift Their Financial Risk To Doctors

Oct 9, 2018
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STUART, Fla. — Dr. Christopher Rao jumped out of his office chair. He’d just learned an elderly patient at high risk of falling was resisting his advice to go to an inpatient rehabilitation facility following a hip fracture.

He strode into the exam room where Priscilla Finamore was crying about having to leave her home and husband, Freddy.

“Look, I would feel the same way if I was you and did not want to go to a nursing home, to a strange place,” Rao told her in September, holding her hand. “But the reality is, if you slip at home even a little, it could end up in a bad, bad way.”

After a few minutes of coaxing, Finamore, 89, relented and agreed to go into rehab.

Keeping patients healthy and out of the hospital is a goal for any physician. For Rao, a family doctor in this retiree-rich city 100 miles north of Miami, it’s also a wise financial strategy.

Months in prison didn't rid Daryl of his addiction to opioids. "Before I left the parking lot of the prison, I was shooting up, getting high," he says.

Daryl has used heroin and prescription painkillers for more than a decade. Almost four years ago he became one of more than 200 people who tested positive for HIV in a historic outbreak in Scott County, Ind. After that diagnosis, he says, he went on a bender.

Millions of Medicare Advantage customers are fast approaching a deadline for a task they’d rather avoid: Researching and then settling on coverage plans for 2015.

The annual enrollment window for the privately run versions of the government’s Medicare program for the elderly and disabled people closes on Sunday. This is the main opportunity most customers have each year to adjust their health coverage, and it may be worth paying extra attention to the details.

Hospitals to Pay for Patient Harm

Jun 24, 2014

Beginning in October, hospitals that have higher-than-acceptable rates of patient complications will see their Medicare payments cut by 1 percent.  In Florida, 31 are in the danger zone, according to a preliminary analysis. 

Of those, two from the lower Gulf Coast were considered at extreme risk of penalty because their scores were so bad, according to the study by the Centers for Medicare and Medicaid Services.

(UPDATE) Florida Blue, the newly adopted brand for the former Blue Cross and Blue Shield of Florida, is canceling 80 percent of its current individual policies because they don't jibe with the requirements under the Affordable Care Act that go into effect Jan. 1. The number affected is estimated to be 300,000.