Strengthening and Improving of Medicare

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Table of Contents

Introduction
Medical Improvements for Patients and Providers Act of 2008 H.R.6331
Medicare, Medicaid, and SCHIP Extension Act of 2007
Pay-for-performance and payment act 2007
Impact of on stakeholders
References

Introduction

After predictions of the failure of the Medicare program since inception there have been various legislations to reverse the trend and to put it on a development path for sustainability. One major amendment took place in 2003 and thereafter various others have been enacted. This paper reviews some of the three amendments that have occurred since Medicare Modernization Act (MMA) was passed in 2003 and evaluates the effects on patients on the various subdivisions of Medicare as parts A, B, C and D.

Medical Improvements for Patients and Providers Act of 2008 H.R.6331

This amendment was passed in July 2008 to change the titles XVIII and XIX of the Social Security Act to reinstate some provisions in the Medicare Program that would have been nullified after expiry. In essence, the amendment sought to improve beneficiary access to preventive and mental healthcare services, to boost healthcare/ Medicare oriented low-income assistance programs, and to maintain and improve access to healthcare and pharmacy services.

This amendment was presented in different sections with each section seeking to address a more specific issue. For instance some sections address issues such as: Provides a 5% pay increase for certain mental health services from July 1, 2008, through Dec. 1, 2009, provides teaching anesthesiologists 100% payment for two concurrent cases starting in 2010, extends the exceptions process for therapy caps through December 31, 2009. Other major provisions by the act are prohibitions on marked sales and marketing behavior under Medicare Advantage (MA) plans and prescription drug plans such as bribing, giving away gifts to seek favor etc.

Medicare, Medicaid, and SCHIP Extension Act of 2007

This amendment touches on Medicare Physician Fee Schedule (MPFS), and Extension of the 2008 Participation Open Enrollment Period by Medicaid. It was designed to revise Medicare Physician Fee Schedule (MPFS) rates starting from January 2008 to the middle of the year in June by updating the conversion factor to 0.5%. Past July 1 the same year, conversion factor was to be maintained at -10.1%. This new development had some more deep running effects on other players in healthcare provision in the US as we shall discuss later.

Pay-for-performance and payment act 2007

Though this was initially addressed in 2003, there have been more recent additions that were to be presented by the new administration. However, its implementation will highly rely on the view on the administration which Kelis (2009) says views all pending reforms by the Bush administration skeptically. Despite these fears, the amendment if implemented through MIPPA seeks to bring dialysis clinics to a 1% composite rate increase in 2009 and 2010. To supplement this, another site-neutral composite will be introduced in 2009. This was meant to change the address the issue where hospital-based clinics charge $4 higher than free standing clinics. This was to be implemented between 2007 and 2009 where the system was to be based on a facility’s during that period or the national average. This system was implemented to amend it in 2012 showing that its authors had predicted its lifespan and relevance.

Impact of on stakeholders

The Medicare Improvements for Patients and Providers Act of 2008 triggered some changes in the industry. This amendment stipulates the removal of late enrollment penalties for Medicare part D by subsidy-eligible individuals. It also increases Medicare hold harmless provision under the prospective payment system for certain hospitals offering outpatient services. With this amendment also, there is increased surveillance on disease and establishment of pilot projects in remote areas to asses and report on the prevalence of such. Beneficiaries in all parts of Medicare are set to benefit with the most affected being in part A, B and C where revisions for payments on renal diseases analysis are revised downward.

The Medicare, Medicaid, and SCHIP Extension Act of 2007” seem to have its greatest and immediate impact on the Centers for Medicare & Medicaid Services (CMS) which had to extend its 2008 Participation Open Enrollment period to February 15, 2008. With this date changed, the effective date for any Participation status changed to the first of January 2008 from July 1. As a result other fee schedules were affected such as the anesthesia conversion factors purchased diagnostic file, and ambulatory surgical center (ASC) facility rates. Contractors were thus required to inform stakeholders of the new rates in their websites.

Despite this change, no additional findings were to be provided by CMS giving way to increment in fees to beneficiaries in all Parts A, B, C and D who pay premiums.

The implementation of a national pay for performance is being supported by the new administration as the Baucus plan which will extensively affect the average patient’s medical treatment. This is because new drugs are expected to be more costly and so the comparative effectiveness agency could cut down on government costs by ensuring that public programs only pay for new pills that are sufficiently more effective than their preceding versions which might be cheaper. This will also bring a conflict of interest between physicians and patients in drug prescription. This amendment will thus have its greatest impact on beneficiaries in the Part D of Medicare. They will have a wider choice on the type of prescription they need while at the same time physicians serving them will have a hard time in personalizing treatment.

References

Bettelheim, A. (2003). Will policy makers agree on prescription-drug benefits? Medicare Reform, 13(28), 1-31.

Centers for Medicare and Medicaid Services (2008). Web.

HIGHLIGHTS H.R. 6331, “Medicare Improvements for Patients and Providers Act of 2008” As Passed by the Senate on 2008. Web.

Kelis, C. (2009) “Healthcare reforms” Washington Times. Web.

Medicare, Medicaid, and SCHIP Extension Act of 2007. Web.

Medicare Improvement for Patients and Providers Act of 2008 H.R.6331. Web.

Medicare Parts A-D. (2008). Web.

Pay-for-performance and payment act 2007. Web.

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