MHA Press Room

MedPAC report estimates regional variations in Medicare service use

The use of Medicare-covered services varies by up to 30% from the highest to the lowest use regions of the country, according to a new report by the Medicare Payment Advisory Commission. The report estimates regional variations in Medicare service use by adjusting Medicare spending to account for differences in Medicare payment rates, beneficiaries’ health status and other factors.

“Medicare spending varies in part because of the factors Medicare uses to account for differing wages, payment rates, and health status,” the report concludes. “We must adjust for those factors to arrive at service use, but the appropriate levels of those payment factors are separate issues that deserve consideration in their own right.”

The report also found that growth in the use of services varies by region, and that regions with high service use “are not always the regions with high growth rates.” 

AHA issues data on uncompensated care, Medicare/Medicaid shortfalls

U.S. hospitals provided $36.4 billion in uncompensated care in 2008, according to the latest data from the AHA’s Annual Survey of Hospitals. That’s $2.4 billion more than in 2007.

Underpayment by Medicare and Medicaid to U.S. hospitals reached $32.4 billion in 2008, up from $31.9 billion in 2007 and $3.8 billion in 2000. Medicare reimbursed 91 cents and Medicaid reimbursed 89 cents for every dollar hospitals spent caring for these patients.

The data are summarized in two AHA fact sheets, available online.

Prevention and Health Promotion Could Save Medicare $1.4 Trillion Over 10 Years

Government health promotion and prevention programs for pre-Medicare and Medicare populations could save the country as much as $1.4 trillion over 10 years—and add on average as many as 6 years on Medicare beneficiaries' lives, according to a new report.

Better Integrated Care for Medicare/Medicaid Dual Eligibles Could Lower Costs

Adults who are dually eligible for both Medicaid and Medicare coverage are among the most chronically ill and costly patients. Most of these eight million "duals" frequently are receiving fragmented, uncoordinated, and ultimately high-cost care, according to a new report.

New Brief Analyzes Medicaid and Medicare Spending for Dual Eligible Beneficiaries

A new issue brief from the Kaiser Family Foundation's KCMU analyzes Medicare and Medicaid spending on the "dual eligibles" - those who are simultaneously enrolled in both programs. These seniors and non-elderly people with disabilities are among the nation's most vulnerable populations. They are generally low-income, in poor health and have considerable health care needs, making them one of the most costly populations covered by public health programs.

The brief fills in important gaps in information about dual eligibles by analyzing the demographic and health characteristics of the dual eligible population and their patterns of service utilization and spending under both the Medicare and Medicaid programs. The brief can be viewed online here.

Study estimates 1 in 5 Medicare patients re-hospitalized within 30 days

A study in the April 2 New England Journal of Medicine estimates that Medicare payments for unplanned re-hospitalizations totaled $17.4 billion in 2004. Based on Medicare billing data for fiscal year 2003-2004, the authors estimate that one in five Medicare patients were re-hospitalized within 30 days of discharge, with only about 10% of these re-hospitalizations planned.

The most frequent reasons for re-hospitalization were heart failure (8.6%), pneumonia (7.3%), psychoses (4.3%) and chronic obstructive pulmonary disease (3.9%). Half of patients re-hospitalized within 30 days did not visit a physician after discharge to the community.

Nancy Foster, American Hospital Association vice president for quality and patient safety, said, “There are many reasons for readmissions, including the natural course of disease, treatment regimens that involve repeated hospitalizations, lack of access to appropriate health support after discharge, difficulty in patients' understanding and adhering to care directions following discharge as well as missteps in the care that was delivered during the patient's stay. This set of complex issues can only be understood by looking at a much richer set of clinical information than is available from the billing data, and its resolution will certainly require coordinated action from hospitals, doctors, public health officials, patients and their families, public policy makers, payers and others. We look forward to collaborating with others to drive down the number of readmissions that can be prevented through better, more coordinated care.”

Survey Shows Most Medicare Beneficiaries Do Not Understand Prescription Drug Benefit 'Doughnut Hole' Coverage Gap

Sixty-two percent of Medicare beneficiaries do not fully understand the so-called "doughnut hole" in the prescription drug benefit, and 28% do not understand the coverage gap at all or are not aware of the gap, according to a survey released on Nov. 17 by Medco Health Solutions. For the telephone survey, conducted by Directive Analytics and funded by Medco, researchers interviewed 1,000 randomly selected Medicare beneficiaries nationwide.

According to the survey, 39% of Medicare beneficiaries who had reached the doughnut hole said that they had received adequate information and fully understood the coverage gap. However, 26% of Medicare beneficiaries who had reached the doughnut hole said that they received no information about the coverage gap, and 27% said that the information they received had confused them, the survey found.

The survey also found that more than three-fourths of Medicare beneficiaries who had reached the doughnut hole had at least one chronic condition.Woody Eisenberg, chief medical officer at Medco, said, "At this point the majority of members do know that there's a gap in their coverage but they don't understand how they arrive there, and there's a few different points of confusion there," adding, "People know there's a gap but there's still lots of confusion about how they get there"

Study: Medicare benefits less generous than large-employer plans

Medicare on average provides less generous benefits than the typical large-employer health plan or the most popular plan available to federal employees, according to a new study by the Kaiser Family Foundation. The study compared the traditional fee-for-service Medicare benefit package, including the drug benefit, with the typical large-employer PPO plan and the standard national PPO plan available to federal workers.

It found the average benefit value of Medicare in 2007 ($10,610) lagged behind the value of both the private ($12,160) and federal ($11,780) employer plans. Medicare has a relatively high inpatient deductible and does not include a limit on beneficiaries’ out-of-pocket spending, other than for prescription drugs covered under Part D plans, the authors note. In addition, Medicare does not generally cover dental care and its standard prescription drug benefit has a coverage gap.

Study: 3.4 million Part D enrollees reached coverage gap in 2007

An estimated one-quarter of enrollees in the Medicare drug program who filled prescriptions in 2007 reached the program’s coverage gap, according to a new study by the Kaiser Family Foundation. That’s about 3.4 million people.

Enrollees who reach the coverage gap must pay the full cost of their prescriptions until they spend enough to qualify for catastrophic coverage. Beneficiaries taking drugs for serious chronic conditions were more likely to reach the coverage gap, including 64% of enrollees taking drugs for Alzheimer’s disease and 51% of those taking oral anti-diabetic medications.

At least 15% of enrollees taking drugs for chronic conditions stopped their drug therapy when they reached the coverage gap, while 1% reduced the number of drugs they were taking.

Long-term care should be part of Medicare: survey

Health care experts overwhelmingly support adding a long-term-care benefit to Medicare as part of a comprehensive solution to the coming onslaught of baby boomer retirees, the latest Commonwealth Fund/Modern Healthcare Opinion Leaders Survey finds.

The survey of 196 leading experts in academia, health care delivery, health care-related business and government found that 79% of respondents support such a new benefit, which would be backed by a premium. Such cost-sharing was in line with other results of the poll. Some 55% of respondents said individuals and the government should share long-term-care costs, while only 8% thought such costs should be paid mostly by the government.

Another 64% of respondents favored providing tax incentives for individuals to purchase private long-term-care insurance, and 63% backed transferring the responsibility for Medicaid long-term care from the states to the federal government. Respondents also broadly agreed that ensuring adequate financing and a workforce able to meet the needs of the nation’s aging population were at the top of the list of long-term-care policy challenges. Full coverage of the survey results will be published July 21 in Modern Healthcare and online at modernhealthcare.com and at commonwealthfund.org.