Medicare payments

Senate Leaders Press For Change In Hospital Funding

Feb 8, 2018
WGCU

A proposal to redistribute hundreds of millions of dollars away from safety-net hospitals and toward increasing base Medicaid payments at all hospitals drew opposition Wednesday in the Florida Senate.

The Obama administration is recruiting as many as 20,000 primary care doctors for an initiative it hopes will change the way physicians get paid and provide care.

The program, which was announced Monday, will be run by the Centers for Medicare and Medicaid Services. The aim is to stop paying doctors based on the number of billable services and visits provided to Medicare beneficiaries and instead to tie payments to overall patient health and outcomes.

Associated Press

For most hospitals in Florida, Medicare is changing the way it pays for hip- and knee-replacement operations to ensure that patients get the right care at the right time at the right price for taxpayers. 

Bipartisan House leaders are working on a $213 billion plan to permanently change how doctors are paid for treating Medicare patients, a costly problem that's vexed Congress for years, a document circulating among lawmakers showed Tuesday.

Many of the plan's details had already been disclosed by lobbyists, legislators and congressional aides. But some particulars were new, such as setting a 2020 starting point for higher out-of-pocket expenses for people buying new Medigap policies, which cover costs not insured by Medicare.

A law that allows rural hospitals to bill Medicare for rehabilitation services for seniors at higher rates than nursing homes and other facilities has led to billions of dollars in extra government spending, federal investigators say.

Most patients could have been moved to a skilled-nursing facility within 35 miles of the hospital at about one-fourth the cost, the U.S. Department of Health and Human Services' inspector general said in a report released Monday.

HHS Quickens Pace to Quality-Based Medicare Pay

Jan 27, 2015
Kaiser Health News

The Obama administration Monday announced a goal of accelerating changes to Medicare so that within four years, half of the program’s traditional spending will go to doctors, hospitals and other providers that coordinate their patient care, stressing quality and frugality.

31 FL Hospitals to See Medicare Pay Cut

Dec 19, 2014

In its toughest crackdown yet on medical errors, the federal government is cutting payments to 721 hospitals – including 31 in Florida -- for having high rates of infections and other patient injuries, records released Thursday show.

Medicare assessed these new penalties against some of the most renowned hospitals in the nation, including the Cleveland Clinic, Brigham and Women’s Hospital in Boston, the Hospital of the University of Pennsylvania in Philadelphia and Geisinger Medical Center in Danville, Pa.

New ACO Rules Would Delay Penalties 3 Years

Dec 2, 2014

Health care systems experimenting with a new way of being paid by Medicare would have three extra years before they could be punished for poor performance, the federal government proposed Monday.

Associated Press

Dr. Salomon Melgen, the Palm Beach County ophthalmologist who received more than any other doctor in the country from Medicare in 2012, tried to use political pull in the Democratic Party to get the FBI off his case.

Three of the top five Medicare payments in 2012 went to doctors who practice in Florida, according to data from the Centers for Medicare and Medicaid Services. The Florida doctors topping the list are Salomon E. Melgen of West Palm Beach (#1), Asad U. Qamar of Ocala (#2) and Alexander M. Eaton of Fort Myers (#5).

Per-person Medicare spending, much higher in Florida than all but one other state, has seen a dramatic increase in "post-acute" services -- nursing homes, home-health services, rehabilitation, and so on. And there is no rhyme or reason to the spending; patients who are much alike may be sent to nursing homes in one region, sent home in another. 

Kaiser Health News

After three years and $8.5 million, a team of economists has come to the conclusion that geographic differences in health-care spending are real, both for Medicare and commercial insurers. 

In other words, the gap can't be explained by variations in income, the level of illness, or some other rational factor, the report says. For example, Medicare patients aren't sicker in super-expensive South Florida than anywhere else.  There are just more bills being sent to Medicare from South Florida than most places.

Accountable Care Organizations, new Medicare payment arrangements aimed at improving coordination of care for the chronically ill, are really taking off in Florida, according to MedPage Today. Florida has more ACOs than any other state, even the much more populous California.

Should Medicare Pay Be Tied to Geography?

Mar 25, 2013

Doctors and hospital administrators in parts of the country that are heavy Medicare spenders can relax their grips on their prescription pads and billing computers.

An influential panel on Friday panned the idea raised in Congress to pay them less for Medicare services if their regions are heavy users of medical services.

The idea is an outgrowth of decades of research into why Medicare spends more per beneficiary in some places such as New York City, Florida and McAllen, Texas, and significantly less in parts of Minnesota and Wisconsin.