Posted on 10/29/2017 7:58:06 AM PDT by Kaslin
Conservatives have always advocated the idea of keeping the safety net intact, while reforming the big three entitlement programs: Medicare; Medicaid; and, Social Security. Reform is different from cutting programs. The left constantly accuses the right of advocating deep cuts to entitlement programs that benefit low income Americans. The correct position for conservatives is to advocate strong reform to attack waste, fraud and abuse without cutting essential services that people rely upon – especially the elderly.
One plan that falls into the category of a “cut” and not a “reform” is a current plan to cut home health benefits provided under Medicare. Payments for Medicare’s home health benefit are poised to undergo the most substantial change in the last 17 years if implemented as proposed. If not withdrawn, these policy changes could spell big trouble for the 3.5 million American seniors who depend on home healthcare.
In its latest annual home health payment rate update proposal, the Centers for Medicare & Medicaid Services (CMS) proposed a complex new payment system known as the Home Health Groupings Model (HHGM), which would fundamentally alter how Medicare beneficiaries receive home health services. Developed without direction from Congress, and with no input from stakeholders, this proposed model would significantly upend the home healthcare sector – jeopardizing patient care while imposing dramatic cuts to reimbursement rates.This is being proposed as a reform, yet it seems to sound more like a plan just to save some federal cash on the backs of the elderly.
Though it was originally intended to promote efficiency and save Medicare money, the plan will do the opposite. Slated to roll out in early 2019, the rule would place beneficiaries into new payment groups that determine reimbursement based on patient characteristics rather than care needs, meaning some beneficiaries with complex care needs may have difficulty accessing services. The standard episode of care would be cut in half, from 60 to 30 days, and the new case-mix would discriminate against patients with long-term care needs. Obviously, longer term care is more expensive, yet it is exactly the type of safety net that many need.
The reduction in total home health payments is even more of a drastic change well beyond current levels – leading to an estimated $950 million reduction in 2019 alone. Medicare home health benefit has been a favorite Medicare target of cuts over the last decade. Reforming a program to save $950 million in a year is a great idea, unless if that reform comes in the form of ill-advised cuts to essential services that leads to harm to those in need of help. A better idea would be to police these programs to weed out actual waste, fraud and abuse, so as not to cut essential benefits to older Americans.
Cuts to home health are nothing new and a favorite target of government bean counters. It’s worth remembering that the last time CMS pushed through non-budget neutral payment reforms – when it implemented the Interim Payment System between 1998 and 2000 – more than 1.5 million Medicare beneficiaries lost access to care after cuts forced 4,000 home health agencies to close their doors almost overnight. This time around, hundreds of millions of dollars of additional cuts would likely cause further loss of home health services, forcing beneficiaries to seek care in more expensive settings.
Serious questions remain about the legal and policy authority by which CMS has undertaken this massive payment change – especially considering that the changes are not expected to be budget-neutral. And despite ongoing requests for data, CMS has not provided the critical information required to fully assess the impact of the proposal and to replicate CMS’ own analysis. Without these key details, stakeholders are unable to suggest improvements to the proposal or even understand how it was developed. Providers will have difficulty adapting to such a rapid change.
CMS’s efforts to transform Medicare from a volume-based model to one based on the value of care delivered is a good idea. Such a value-based system would spur the industry to pursue new and innovative strategies that would benefit patients and providers alike. However, HHGM does nothing of the sort. Instead, the proposal would redistribute payments away from key home health services – like physical, occupational, and speech therapy – that are generating Medicare savings in value-based payment models.
The good news is that opposition to HHGM is already building on Capitol Hill. A bipartisan group of 49 Senators signed on to a letter in late September asking CMS to hold off on implementing HHGM and a similar effort is underway in the House. Senator Orrin Hatch, who chairs the Senate Finance Committee, urged the Administration to refrain from proceeding with the model until a less disruptive solution can be found.
Absent action from CMS, Congress should take action on its own to protect seniors’ home healthcare by urging CMS to withdraw the proposed Home Health Groupings Model and instead work with stakeholders to develop a true value-based payment system that preserves access to this critical benefit while promoting efficiency and cost-savings.
As far as adding a month or two to your life, there are a number of new drugs that promise just that, but looking at the list of the most expensive drugs, most appear prominently on that list, some of them are as much as $50K to $80K per pill. Hopefully the government isn't paying that much, but who knows? At that stage, even if the patient would rather not undergo the cost and futility, relatives and friends force them to. 0bama's solution was "Death Panels", and you know how well that was received.
The problem of course is that you don't typically know that it's the last 6 month's of someone's life until they die. So you don't know whether to spend or not.
Another problem is that unless you try, you are never going to get better.
But if you want then vote for death panels that are going to cut your care, because your prognosis is not great, or your older than 50. The Nazi's would be proud.
My father got fungal Meningitis at age 81. He was walking 3 miles a day and working an 8 hour shift as a greeter at Walmart before that. He could feel he was suddenly getting weak, so he went to the doc $ and his blood work checked out. Then he fell in the garden, went back to the doc $ and his blood work checked out. Then he fell in the carport and broke the tip of his tibia leg bone. $$$$. Within a week he couldn't stand even with help. So we took him to the hospital. $$$$$$. He was in the hospital a week before they managed to diagnose him. Then they started the anti-fungal medicine. He had a stroke while they were treating him.
He lived 5 years after that. He didn't walk without assistance again. He didn't work again. But he did get to see his granddaughter graduate high school.
It did cost a lot to give him those last 5 years. But there was no way to know before hand what the cost would be or what the outcome would be. And he had paid for insurance to get medical treatment. And he had also bought long term care insurance to pay for caregivers so that he could stay at home.
They know the odds of survival for just about everything and while I’m pleased your father lived another 5 years, there were probably another 19 that lived less than a handful of months. That’s probably $20 million+ in expense for a few years of life between the 20 total. Fine on your own money, but not taxpayers $. The average person, including their employer portion, only put in about $30-50k into medicare over their lifetime - and that’s for people that actually worked full time 30 to 50 years. A huge portion of the population doesn’t work at all or works for a lot fewer years or has a stay at home spouse. If you want to fund $0.5 to tens of millions of dollars in healthcare costs for a 3% chance to extend life by 2-5 years, more power to you. Just don’t demand that taxpayers do it.
Medicaid and Medicare are bigger cost items than SSDI but you are right it is a huge problem and I’d bet 80% fraud.
They didn’t even know what they were dealing with until he had been in the hospital for a week.
Though I supposed they could have just said, he’s 81 so we aren’t even going to try.
When you buy home owners insurance you only pay a fraction of what it will cost the insurance company if your house burns down. But not everybody’s house is going to burn down.
Same thing with Medical care. Sure he probably got out more than he paid in. But my Mom didn’t get out more than she paid in. Because she died fairly quickly.
That’s the way insurance works. Most people are going to pay it and never get anything back. Some people are going to hit the jackpot...if you can call it that.
Trump was clear that Medicare/SS are OFF-LIMITS for cuts, so I don’t worry as long as he’s in charge. His plan is to GROW THE ECONOMY so that tax revenues can increase to cover the shortages - and so far he’s doing just that.
Other Republicans, I guess, still haven’t got the message.
Nothing but a backdoor weasel means to try to scare people away from the Trump economic plans including his tax cuts.
None of it is true.
Nailed it. Sorry folks, but you’re at the bottom of a collapsing pyramid scheme.
If we get the greedy, shareholder driven drug and insurance corporations and government bureaucrats out of American health care in favor of reasonably regulated 501c3 charitable ones, we would have more efficient and responsible healthcare.
United Health Care CEO has base salary of apx.c $31,000,000. Plus pays dividends. Medicine is mission not business.
Insurance works when you cover the costs. They would need to quadruple Medicare premiums and payroll tax to have the average person remotely come close to paying for their Medicare. The only reason it stayed afloat as long as it did without deficits was the no income cap - someone with a 30m/yr salary was contributing was contributing $870k/yr with employer match.
While I agree that there are to many scammers, I can’t wait for a debilitating injury, or disease to strike you and have others speak your words back at you while laughing.
So you want to do away with the insurance altogether and have them become wards of the state when they exhaust their resources. You do realize that indigent care has been a civil responsibility since the 1500’s. Research the poor laws sometime.
Judges in the 13 colonies spent much of their time forcing cities and towns to care for their share of the indigents.
Don’t get me wrong. I’m not against reform that reduces costs while providing care. But I’m not for shirking responsibility either and just cutting people off from care.
McCain certainly never needed Viagra to thoroughly
screw conservatives.
No, I’d simply not have carte Blanche insurance in healthcare. Would cover up to a certain dollar threshold each year. When I get car, house or life insurance, it has a defined maximum benefit. Healthcare today is the only one that doesn’t work that way.
“Hardly anyone paid in enough to cover their medicare....”
While that is true it is also true what we DID pay into
Medicare we could have invested into money making
endeavors instead. In addition, there are those who
paid into the pool (or whatever it is called) for a
whole career but failed to live long enough to utilize
Medicare after coming of age.
Even including a 5-6% market return most people would have at most saved about $50-$100k, barely a fraction of average healthcare cost in retirement...for people that worked for 30-50 years. Not even counting spouses who didn’t work and those on the dole their whole life, or those who go on SSDI and the like. The fact of the matter is medicare and medicaid are on track to bankrupt the country. Those two programs were about 1% of GDP in 1960 and today cost nearly 10%, and still growing at a cost of 8% annually. The money simply isn’t there if it keeps growing 8%.
Stop spending on illegals and deadbeats to make it last longer and wean the People off it over a period of time by picking an age group to stop taxing and forcing them to rely on it.
Take the illegal immigrants out of disability, medicade, and all welfare programs and cuts will not have to be made. They have no rights to benifits the American people have worked for. They all need to go home and suck off of their own countries tit.
Judging from the replies you have posted here, you have the perspective of a millennial. Come back here in thirty years when your medical needs are more acute and tell me you still feel the same way about Medicare and Medicade.
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