Medicare Watch

Congressional Leaders Announce Appointments to Super Committee

Congressional leaders have announced their appointments for the Congressional Joint Select Committee on Deficit Reduction, the bipartisan committee created by the recently passed debt deal—officially titled the Budget Control Act of 2011. Democrats serving on the committee will be Senators Patty Murray, Max Baucus, and John Kerry and Representatives James Clyburn, Chris Van Hollen, and Xavier Becerra. The Republican contingent includes Senators Jon Kyl, Rob Portman and Pat Toomey and Representatives Jeb Hensarling, David Camp, and Fred Upton. Representative Hensarling and Senator Murray will serve as the committee’s co-chairs. 

The committee is tasked with drafting a bipartisan plan to reduce the deficit by an additional $1.2 to $1.5 trillion dollars. If the committee fails to agree on a plan, or if Congress does not vote to approve the plan, an automatic $1.2 trillion across-the-board cut, known as a sequester, will take effect in 2013. Medicaid, Social Security, certain low-income programs and Medicare benefits are excluded from the sequester. However, Medicare providers could face cuts of up to 2 percent. The committee may consider all parts of the budget to achieve the deficit reduction target, including programs excluded from the sequester, such as Medicare. They may also consider increases in revenue. The committee must deliver legislation to Congress by November 23, 2011, and Congress must vote on the legislation by December 23, 2011.

Given the complexity of the debt deal, Medicare Rights has developed a fact sheet to help people with Medicare understand the implications for the program at different stages of the deal.

Read the Medicare Rights Center’s fact sheet “The Debt Deal and Medicare.”

CMS Reports Physician Group Practice Demonstration a Success

The Centers for Medicare & Medicaid Services (CMS) announced this week that its Physician Group Practice (PGP) demonstration increased quality of care while reducing costs for the 10 participating physician groups. The five-year PGP was designed to determine whether altered provider payment structures could increase care coordination and quality while concurrently decreasing costs to the program by reducing the need for expensive but potentially unnecessary care, such as re-hospitalizations. 

On top of regular Medicare payments, physician groups received incentive payments to practices that met certain benchmark scores on quality measures and achieved savings to Medicare. All 10 of the participating groups reached benchmark performance scores on 30 out of 32 measures, with 7 of 10 meeting the benchmark on all 32 measures. All participants achieved significant improvements on quality measures for conditions such as diabetes and heart failure. Overall, the program saved Medicare around $134 million, about $107 million of which was paid to qualifying physician groups as incentive payments.

All 10 groups will participate in the two year PGP transition demonstration, enacted to build upon the initial PGP program. The PGP demonstration is thought to provide lessons for newer models built on similar principles, including the Accountable Care Organizations (ACOs) envisioned by the Affordable Care Act (ACA). The goals of ACOs, similar to those of the PGP demonstration, are to promote care quality and coordination, and to allow participating providers, both physicians and hospitals, to share in the savings to Medicare achieved as a result of these care improvements.

Read the CMS press release on the PGP demonstration.

Read the CMS PGP fact sheet.

 

Medicare Reminder

If your Medicare prescription drug plan makes changes to its formulary (list of covered drugs) during the year, they must notify you, and you have certain rights depending on why the plan made the change.

If the plan is making maintenance changes, they must give you 60 days’ notice or provide you with a 60-day transition fill. Maintenance changes include covering a generic drug instead of a band-name drug or adding quantity limits for drugs that the FDA adds warnings to.

If your plan is making non-maintenance changes, which is any other change, if you are already taking the drug you must be allowed to continuing taking that drug for the rest of the year, as long as it is medically necessary. Your plan must also send you a notification in the mail.

Learn more about notices that drug plans and Medicare Advantage plans must give at www.medicareinteractive.org.

 

Spotlight

The Centers for Medicare & Medicaid Services (CMS) has launched the Quality Care Finder, a tool designed to help people with Medicare and their caregivers compare information about hospitals, doctors, nursing homes, home health providers, dialysis facilities, and health and drug plans.

Use the Quality Care Finder.