Mar 9, 2009 | Laboratory News, Laboratory Pathology
New demonstration project bundles Part A and Part B payments for certain clinical services
In January, the Centers for Medicare & Medicaid Services (CMS) launched its test drive of a proposed bundled payment concept it hopes will generate improved quality of care and cost efficiencies. The Acute Care Episode (ACE) Demonstration project replaces fee-for-service (FFS) with global payments for orthopedic or cardiovascular inpatient procedures or both at the five participating hospitals.
A bundled payment is a single payment for both Part A and Part B Medicare services provided during a single inpatient stay. Currently, Medicare Part A pays hospitals a single predicted amount under the Inpatient Prospective Payment System for all care provided during an inpatient stay. Physicians, laboratories, and other providers with a role in a patient’s care are paid separately for services performed under Part B. (more…)
Oct 25, 2006 | Laboratory News, Laboratory Pathology
Remember Medicare+Choice during the 1990s? That was the private sector Medicare HMOs encouraged by Congress during those years. Now the program is back, in a new form. In August, The Wall Street Journal reported that hundreds of thousands of seniors are signing up for private fee-for-service Medicare Advantage plans. These plans deliver traditional benefits without the usual restrictions on access to doctors and hospitals. Some of the nation’s biggest health insurers, such as WellPoint and Humana, are launching more such plans and marketing them in more areas.
Medicare Advantage plans are set up so that the federal government pays a flat rate to insurance companies to manage care, rather than paying beneficiaries’ claims directly. To encourage seniors to sign up for these plans, the cost to the patient for private plans are cheaper, on average, than those for traditional Medicare fee-for-service program. The government recently raised the reimbursement rates for Medicare Advantage plans to $10,000 per enrollee per year. This has motivated insurers to reduce premiums and add additional benefits, such as vision insurance and prescription drug discount plans, to attract more seniors to enroll in the private Medicare Advantage insurance plans.
Enrollment in Medicare Advantage plans jumped to 802,068 as of August 1, up from just 20,000 three years ago. Seniors like the plans because they offer more freedom of choice in doctors in contrast to Medicare Advantage HMOs and PPOs. Those plans may provide no coverage or lesser coverage if patients go outside of the plan’s provider network of doctors and hospitals.
WellPoint will be offering Medicare Advantage fee-for-service plans in all 50 states by 2007. Humana, which already offers the plans in 35 states, and WellCare Health Plans, also plan to expand the geographic area of their fee-for service offerings during the next 12 months.
The rise in private fee-for-service plan participants is likely to be felt strongly by laboratories doing business in rural areas. The new arrangements of Medicare Advantage plans encourage rural patients, physicians, and hospitals to participate. This was not true of Medicare+Choice in the 1990s because of the closed provider panels and restrictions on utilization of services by patients. For local laboratories in urban areas, increased enrollment in Medicare Advantage plans may cause them to lose access to those patients. That’s because the private payers offering Medicare Advantage plans often only incorporate the national laboratories as network providers.
We will also note that enrollment in Medicare Advantage is likely to increase only as long as Congress is motivated to fund Medicare Advantage plans generously. A change in leadership in Congress or the Administration may lead to reduced support for private sector solutions in the Medicare program.
See Seniors Flock to Private Medicare Plans for the complete article.
