Your Weekly Medicare Consumer Advocacy Update
Medicare Works to Increase Quality of Care
Best and Worst Performing Hospitals for Hip and Knee Replacement
Medicare recently announced the best and worst hospitals for hip and knee replacements for Medicare beneficiaries. A vast majority of hospitals—about 95 percent—were reported as average; however, Medicare identified 95 hospitals that are below average and 97 hospitals that are above average.
Medicare examined information from July 2009 through June 2012 to rank the institutions. The analysis considered how often patients were readmitted to hospitals within 30 days of discharge and how often they suffered one of eight complications after the hip or knee replacement. Releasing this data is part of Medicare’s effort to increase hospital quality of care. Additionally, Medicare now tracks 30 day readmission rates for patients with pneumonia, heart attacks, and heart failure. In October 2013, Medicare began penalizing hospitals with high rates of readmission for these conditions. Beginning fall 2014, hip and knee joint replacements will be included when calculating the penalties.
This new information can also be used when Medicare beneficiaries are selecting where to have hip or knee replacement surgery. Hip and knee replacement surgeries are often elective procedures, which gives beneficiaries the opportunity to choose the hospital in their area that has the best quality ratings. Much of the previous hospital quality information that Medicare has published could not be used in the same way, since it relates to non-elective conditions and procedures such as heart attacks. This new data is available, along with other hospital quality information, on Medicare’s Hospital Compare website at http://www.medicare.gov/hospitalcompare.
Millions of People with Medicare Continue to Benefit from the Affordable Care Act
This week, the Centers for Medicare & Medicaid Services (CMS) announced that between January and November 2013, more than 25.4 million people with Original Medicare accessed at least one preventive care service at no out-of-pocket cost—this number is up from 24.7 million during the same period last year. Also between January and November of this year, more than 3.5 million people with Original Medicare received their free Annual Wellness Visit, which is up from 2.8 million people during the same period last year.
The Affordable Care Act (ACA) improves access to preventive care. Regardless of whether beneficiaries are enrolled in Original Medicare or Medicare private health plans, also known as Medicare Advantage plans, most preventive services have no cost sharing. The ACA also added a new Annual Wellness visit. While this visit is not a head-to-toe physical, it gives Medicare beneficiaries the opportunity to meet with their doctors and set up a preventive care plan based on their individual needs.
At the same time, the ACA reduces out-of-pocket costs for beneficiaries in the Medicare prescription drug coverage gap, also known as the doughnut hole. Before the ACA, Medicare beneficiaries who reached the doughnut hole were required to pay 100 percent of the cost of their drugs out-of-pocket. Since the passage of the ACA, older Americans and people with disabilities have saved $8.9 billion on their medications. By the year 2020, the doughnut will be completely phased out.
Volume 4, Issue 48
Medicare covers many preventive services at little to no cost to you. As long as you meet basic eligibility standards, you have the right to receive these services no matter if you have Original Medicare or a Medicare Advantage plan (Medicare private health plan).
If you have Original Medicare you will have no coinsurance or deductible for certain preventive care services if you see a doctor or other health care provider who accepts assignment. Doctors who accept assignment cannot charge you more than the Medicare approved amount.
If you are in a Medicare Advantage plan, your plan will not be able to charge you for preventive care services that are free for people with Original Medicare as long as you see in-network providers. If you see providers that are not in your plan’s network, charges will typically apply.
Be sure to follow the Medicare guidelines for receiving these services in order to ensure that Medicare will cover them. Some are covered only once every few years and others are only covered if you meet specific criteria. The preventive services you receive may be subject to charges, depending on when and how you receive your services, and if the services become diagnostic.
This week, the Coalition to Protect the Rights of New York’s Dually Eligible hosted a roundtable on care coordination at the New York State Health Foundation. The roundtable featured presentations from the New York State Department of Health; the Medicare-Medicaid Coordination Office; the New York Legal Assistance Group, a consumer organization; and Independence Care Systems, a managed care plan. The purpose of the roundtable was to facilitate discussion about New York’s current care coordination standards, explore best practices utilized by health plans and supported by consumer groups, and to learn more about New York State’s proposal to create Interdisciplinary Teams in its financial-alignment demonstration. Several health plans and community-based organizations attended the roundtable. A common discussion theme included how to balance the development of standards for care managers that ensure coordinated care alongside the need to provide health plans with flexibility to solve problems.