by Margo Corbett – Trickling out ever so slowly and quietly new rules and regulations are devastating Medicare patients. No fan fare. Barely a bit of news coverage. No need for “death panels”, many of these changes are causing great hardship and some will shorten our lives. We were told the Affordable Care Act (ACA) would not affect us, but we are finding out differently. Embedded in the ACA are deep reductions in Medicare reimbursements including payments to doctors, hospitals, nursing homes, and Medicare Advantage programs totaling $716 billion over ten years.
Cuts in 2014, with more coming in 2015, to Medicare Advantage (MA) plans have caused higher deductibles and co-pays, premium increases of 50-200 and the loss of plans and doctors for seniors many of whom are not able to find a new one who will accept Medicare patients. The media talked about the general population being affected in these ways, but did not mention the impact on seniors. Many seniors are losing specialists and now receive care from doctors, nurse practitioners and physician assistants who don’t have the specialized knowledge to provide needed care. Some seniors are being forced off MA plans altogether and have to take Medigap plans costing them thousands more per year.
The “carrot” to make seniors feel they are gaining something and to camouflage the loses when the ACA was rolled out was the $4 billion for drugs to help close the doughnut hole, “free” wellness appointments, and free screening tests that don’t come close to the $716 billion taken out of Medicare, changes that will cause far more hardship and devastation than the doughnut hole ever has or will.
“Free” annual checkup not so free for many people. Medicare patients find they are being charged a co-pay for a “sick” visit or expensive clinic charges ranging from $15 to hundreds of dollars at their free annual health screening appointment because the doctor asked them a question about a chronic condition or they mention a problem. The doctor is then allowed to bill for both the annual visit and a sick visit.
A 14% cut in home health services will cause 40% of all home health providers to experience a 40% net loss by 2017 causing a significant decrease in service to the poor and ill homebound seniors. Home health care has proven to decrease costs and improve quality of life. Home healthcare agencies have already started cutting back staff and hiring. Why this cut?
Over time, the ACA calls for a decrease in payment to doctors who take Medicare patients while increasing payments to those who take Medicaid patients. With the increase in the number of Medicaid patients (including the prison population in many states) a doctor shortage is being created with a disproportionate amount of harm to seniors.
Drug program changes include a decrease in accessibility to life saving cancer drugs with increased co-pays, a tripling of out-of-pocket costs for transplant drugs and in 2015, a limit on the availability of depression and anti-psychotic drugs – from 57 to 15 drugs available for use.
A May 1, 2014 article on Medsacpe reported that the Medicare Evidence Development and Coverage Advisory Committee (MEDAC) panel decision rolled out in April of 2104 states that high risk Medicare patients will not be eligible for payment of more effective, safer low emission CT screening for lung cancer.
The 2-Midnight Rule – a Medicare patient admitted to the emergency room must be hospitalized for at least 2 nights or Part A will not cover the ER visit. If a patient is admitted under the status of “Observation” Part B will only cover certain aspects of their care – the patient pays the rest resulting in thousands of dollars of out-of-pocket costs. Hospitals are readmitting patients under observation rather than a regular admission when they have to return to the hospital within 30 days of being discharged. This, like the wait list measure in the VA system is causing serious consequences to patients, as they have to bear significant out-of-pocket costs
I was told by my personal physician that in order to have someone in the room to do electronic health record EHR documentation as he/she interacts with me, the patient, he must have a non-medical person do the documentation while another medical person is in the room – that is three members of his staff when only he/she and one other is needed – decreasing amount and quality of time with the patient. The non-medical person cannot possibly capture information they don’t understand correctly. I found my personal record to be incomplete and inaccurate even after several appointments where I repeatedly shared the same information. Important medical history was not in my record because the software didn’t include the appropriate choices to fit my history.
There is a backlog of over 460,000 appeals to Medicare rejected claims that could take more than two years to go through the five levels of appeals before resolution. 35,000 of these cases are for individuals on fixed incomes and likely to cause great hardship as the providers try to collect money from the patient that Medicare won’t pay. This situation is said to be causing doctors to no longer accept Medicare patients.
Affecting everyone and adding insult to injury, so far this year the health care sector has announced 41,085 layoffs jeopardizing care by 1) forcing full time workers to go part time and then get second jobs to make ends meet. 2) inadequate staffing. Staff comes to work exhausted and care is jeopardized. In October 2014 (just found out it is delayed until 2015), a new medical code system , ICD-10 will be enacted, sending hospitals and doctors into a documentation tailspin. The number of insurance codes will explode from 17,000 to 155,000. Add this increased complexity to staff cuts, documentation errors are liable to increase causing nightmares for everyone, with patients paying the real price.
For more information on the impact of Obamcare on seniors check out Obamacare Watchdog here on the AMAC website.
This is the “real hidden story” of healthcare. A new round of cuts to Medicare is slated for 2015. What further hardship will we face? Will the story be told then?
This information was not easy to find. I compiled it by searching on reliable websites for changes that someone in some part of the media had identified through June, 2014. Who knows how many changes have been made that have not gotten someone in the media’s attention. I contacted the Centers for Medicare and Medicaid (CMS), but they said they could not provide any information as to changes that have been made that impact Medicare patients.
Margo Corbett, Patient Advocate, Speaker & Author of The Savvy Patient’s Toolkit