Medicare Watch

IOM Makes Recommendations on How to Tackle Rising Health Care Costs

In a recently released report, the Institute of Medicine (IOM) finds that the U.S. health care system wastes $750 billion dollars per year—about 30 cents of every health care dollar spent. Inefficiencies in the health care system result in tens of thousands of unnecessary deaths each year: according to the report, 75,000 avoidable deaths occurred in 2005.

The report also details several recommendations for improving health care delivery and containing increasing rising costs. The recommendations include:

• Collecting and sharing health information digitally, while ensuring that data is protected
• Involving patients and families in health care decisions
• Fostering partnerships among health care systems and community-based organizations
• Improving care coordination within and across health care systems
• Creating payment systems that incentivize learning and adaptability by providers
• Increasing transparency about health care system goals and performance

The IOM report looks to other industries to provide examples for how to achieve some of these recommendations. For instance, the report highlights online banking as a model for electronic health records and the aviation industry as an example of how to monitor safety concerns and implement innovative safeguards.

The IOM’s suggestions are particularly timely, given that policymakers are looking to reform Medicare as a means of bringing down health care costs and reining in the nation’s deficit. The report’s findings underscore that rising health care costs in the system overall—not just in Medicare—must be addressed. The IOM details mechanisms for controlling costs withoutcompromising the health and economic security of Americans. Several current Medicare proposals, such as the proposal to convert Medicare into a premium support model or to eliminate first dollar coverage by Medigaps, supplemental insurance for Medicare, would lower the federal debt only by shifting expenses to beneficiaries who cannot afford to pay more.

The IOM findings and recommendations demonstrate that there are many mechanisms for controlling costs that would shield beneficiaries from paying more. Medicare households already spend, on average, 15 percent of their annual incomes on health care, three times what non-Medicare households pay, and the average person on Medicare pays nearly $4,500 on health care costs.

Read the IOM report, “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America.”

See the IOM infographic detailing its recommendations.

Building a Better Medicaid Enrollment System in New York

This week, the New York State Health Foundation (NYSHealth) released a report by the Medicare Rights Center detailing our contributions towards creating a new, more streamlined Medicaid application process for people in New York State. In addition, the report outlines steps other states can take to implement improved eligibility and enrollment systems. Under the Affordable Care Act (ACA), states are required to build a new, simplified Medicaid enrollment system that will make it easier and quicker for a segment of the Medicaid-eligible population to enroll. The mandate does not, however, extend to dual-eligibles, or people with both Medicare and Medicaid. In some states, this oversight may result in a bifurcated Medicaid program: a streamlined enrollment system for most people with Medicaid, and an antiquated, more onerous process for dual-eligibles.

The report explains how creating a bifurcated Medicaid system would be costly to both states and dual-eligibles. Duals would be more likely to lose their coverage or be denied coverage solely because of a complicated enrollment process.

With the support of NYSHealth, Medicare Rights worked with state and federal partners to ensure that New York will establish a single Medicaid enrollment system for all Medicaid beneficiaries, including dual-eligibles. In addition, in part due to Medicare Rights’ advocacy efforts with federal policymakers, federal guidance now moves all states in the direction of a uniform Medicaid program and prohibits states from using federal funds to maintain two enrollment systems. 

To assist other states in building an improved Medicaid enrollment system by 2014, Medicare Rights developed a set of recommendations that can make these systems more responsive to people with Medicare. The recommendations include simplifying the application and renewal processes for all Medicaid applicants, including duals, and utilizing electronic data sharing to verify eligibility, thereby reducing the burden on beneficiaries to prove information that may already be available to states.

 “Creating a single system not only ensures dually eligible beneficiaries have access to a simpler, more streamlined application and enrollment process, but it also saves state dollars by operating one system, rather than two,” said Doug Goggin-Callahan, Director of Education and NY State Policy at Medicare Rights. “By creating a single system, states achieve both equity and cost-savings.”

Read the NYSHealth report, “Lessons from New York: Building a Better Medicaid Eligibility and Enrollment System for Duals.”

Medicare Reminder

If you are enrolled in Original Medicare, your provider is required to file a Medicare claim for services she provides to you, unless she has opted out of Medicare. All providers who take Medicare—providers who take Medicare assignment and providers who take Medicare but do not accept assignment—are required to file Medicare claims. Generally, doctors and suppliers of medical equipment file claims with Medicare soon after they provide services. Providers are allowed to wait to file your Medicare claim, but there is a limit on how long they can wait.

If your provider does not think that a service will be covered by Medicare, she may have you sign an Advance Beneficiary Notice (ABN). When you sign the ABN, there will be an option on the ABN to check whether or not you want your doctor to submit a claim to Medicare for the service. You should always select that you want your doctor to submit the claim to Medicare because Medicare may still pay for the services. If you do not, your doctor is not required to submit the claim. If you sign an ABN but ask your doctor to bill Medicare, and Medicare then denies coverage, you can always appeal.

Learn more about Medicare claims at www.medicareinteractive.org, or call our helpline at 800-333-4114.

Spotlight

This month, the Medicare Rights Center is asking its followers on Facebook, “What would you do with $5,000?” For many people on Medicare, $5,000 is the difference between staying afloat and sinking financially each year. Half of all people on Medicare earn $22,000 or less annually, and many may qualify for benefits known as the Medicare Savings Program (MSP) and Extra Help. These benefits could save them up to $5,000 each year on their health care and prescription drug costs. The programs help pay for Medicare premiums and, in some cases, other out-of-pocket expenses. For those eligible, the programs help beneficiaries avoid stark choices such as forgoing necessary medications, canceling doctor’s visits or splitting pills.

Join Medicare Rights on Facebook, and tell us what you would do with $5,000. For every 25 likes on the page in the month of September, a Medicare Rights volunteer will donate an extra hour of their time to assisting people with Medicare in enrolling in programs that can help them get access to needed care.

Join us on Facebook today!