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Maybe the single payor Medicare model isn't the best
Posted on: August 26, 2017 at 21:34:36 CT
JeffB MU
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for our health care system...
Declining Medicare rates restricting access to home oxygen for COPD patients
http://thehill.com/blogs/congress-blog/healthcare/348002-declining-medicare-rates-restricting-access-to-home-oxygen-for
...Reimbursement cuts resulting from flawed methodologies in Medicare’s competitive bidding program for home respiratory care have been steadily chipping away at the level of services that beneficiaries have come to depend upon. In some cases, providers are opting to suspend services in specific geographic areas, particularly in rural and remote communities... In addition to the greater number of Medicare patients who need home oxygen but aren’t getting it, there are other signs of things going terribly awry.
...
The unfortunate result, of course, is that there will be a growing numbers of Medicare beneficiaries who will not be able to get the care they need, or can’t get it in a timely fashion. In the most drastic cases, delayed oxygen therapy is keeping patients hospitalized longer. In one rural area, the local hospital couldn’t find an oxygen supplier willing to take on new Medicare patients at the reduced reimbursement rate, delaying patient discharge by several days.
The Centers for Medicare and Medicaid Services (CMS) who oversees the nation’s Medicare program has reported that there has been no access to care issues. We were surprised by that declaration, given CMS’s own data show a marked decline in service, while the population has increased. Our own experience in these markets reflects the same.
In discussions with CMS, the way they measure access to care does not take into account whether a patient can actually access care. CMS measures the “acceptance of assignment” of remaining providers, after a competitor exits the market. However, this does not mean that the patient actually secures access to care. Our own experience with purchasing the assets of liquidated providers shows that approximately 50 percent of the patients maintain access to care after being stranded by their previous provider.
This leaves the remaining patients without care, putting them at risk for respiratory exacerbations and hospitalization. The expense to the healthcare system of one day in the hospital is over 100 times the monthly allowable reimbursement cost for oxygen therapy, so this current policy makes absolutely no practical sense for the patient or the taxpayer who funds the Medicare program.
So why is CMS sticking to policies that could drive patients back into the hospital when in fact it is less expensive to take care of a patient at home? Much of the situation we currently find ourselves in is attributable to the way CMS defines “access.” ...
Declining Medicare rates restricting access to home oxygen for COPD patients
http://thehill.com/blogs/congress-blog/healthcare/348002-declining-medicare-rates-restricting-access-to-home-oxygen-for
...Reimbursement cuts resulting from flawed methodologies in Medicare’s competitive bidding program for home respiratory care have been steadily chipping away at the level of services that beneficiaries have come to depend upon. In some cases, providers are opting to suspend services in specific geographic areas, particularly in rural and remote communities... In addition to the greater number of Medicare patients who need home oxygen but aren’t getting it, there are other signs of things going terribly awry.
...
The unfortunate result, of course, is that there will be a growing numbers of Medicare beneficiaries who will not be able to get the care they need, or can’t get it in a timely fashion. In the most drastic cases, delayed oxygen therapy is keeping patients hospitalized longer. In one rural area, the local hospital couldn’t find an oxygen supplier willing to take on new Medicare patients at the reduced reimbursement rate, delaying patient discharge by several days.
The Centers for Medicare and Medicaid Services (CMS) who oversees the nation’s Medicare program has reported that there has been no access to care issues. We were surprised by that declaration, given CMS’s own data show a marked decline in service, while the population has increased. Our own experience in these markets reflects the same.
In discussions with CMS, the way they measure access to care does not take into account whether a patient can actually access care. CMS measures the “acceptance of assignment” of remaining providers, after a competitor exits the market. However, this does not mean that the patient actually secures access to care. Our own experience with purchasing the assets of liquidated providers shows that approximately 50 percent of the patients maintain access to care after being stranded by their previous provider.
This leaves the remaining patients without care, putting them at risk for respiratory exacerbations and hospitalization. The expense to the healthcare system of one day in the hospital is over 100 times the monthly allowable reimbursement cost for oxygen therapy, so this current policy makes absolutely no practical sense for the patient or the taxpayer who funds the Medicare program.
So why is CMS sticking to policies that could drive patients back into the hospital when in fact it is less expensive to take care of a patient at home? Much of the situation we currently find ourselves in is attributable to the way CMS defines “access.” ...
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Maybe the single payor Medicare model isn't the best - JeffB MU - 8/26 21:34:36