March 2024

March 2024

At Last, Congress Funds Government for Current Fiscal Year

They were six months past their deadline but in late March Congress finally managed to pass the last legislation needed to fund the government for fiscal year 2024.

President Biden’s signing of the measure completed a turbulent government funding process during a divided government, featuring a year of haggling, six months of stopgap bills and intense partisan clashes over money and policy along the way.

The full government will now be funded through the end of September, after Congress passed a previous partial funding bill of $459 billion earlier in March. The total spending level for the fiscal year is $1.659 trillion.

The final funding legislation will cover the departments of State, Defense, Labor, Health and Human Services, and Homeland Security, among other parts of the government that had not yet been fully funded.

The divided Congress has narrowly averted multiple shutdowns this session, passing four stopgap bills that kept extending the deadline. And at nearly six months into the fiscal year, it’s unusually late in the game to be haggling over the funding measures.

Part of the delay in getting the funding legislation passed was due to the Republican majority in the House of Representatives ousting GOP Speaker Kevin McCarthy in October and not electing a new Speaker for three weeks.  The House was virtually paralyzed during those three weeks, and nothing was accomplished legislatively.

Now, we are wondering if we will be in for the same drama in the next few days because immediately after the final funding legislation was passed, Republican Congresswoman Marjory Taylor Greene of Georgia filed a motion to kick out Speaker Mike Johnson (R-La.).  While the resolution does not need to be addressed immediately, it represents the most formal and strident challenge to the speaker’s leadership since he took over in late last year.

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Seniors Targeted by Scams that could Cost Medicare Billions

According to an article in Newsweek, seniors relying on Medicare for their health care are being targeted by a widespread "phantom billing" scam that has the potential to rob them of thousands of dollars.

Phantom billing occurs when fraudulent charges are filed to Medicare by health care providers/doctors and medical equipment companies without the recipient's knowledge. Some seniors targeted reported being billed for urinary catheters they never asked for.

While fraud can be orchestrated by health care providers, doctors, and medical equipment companies, all can have substantial impact on the Medicare system and beneficiaries' financial situations.

This fraud contributes to millions of dollars lost, and premiums could end up skyrocketing as a result. In Indiana, the Senior Medicare Patrol said it has received a substantial number of complaints about billing fraud in recent months, but it's likely these scam charges are taking place all over the country.

The National Association of Accountable Care Organizations and the Institute for Accountable Care saw Medicare payments for catheters, for instance, soar from $153 million in 2021 to $2.1 billion in 2023, reflecting the potential widespread phantom billing.

While only 40,000 patients in 2021 saw charges for catheters on their Medicare payments in 2021, just two years later, that number had soared to more than 450,000.

The Federal Trade Commission said fraud and errors end up costing Medicare roughly $60 billion each year that is then passed on to taxpayers.

Senator Mike Braun (R- Ind.) previously requested an audit by the General Accounting Office and also introduced the Medicare Transaction Fraud Prevention Act, which would improve the government's watch of medical equipment purchases under Medicare.

Experts advise beneficiaries to check their monthly statements and report any unauthorized charges immediately. To report suspicious charges, call 1-800-MEDICARE (1-800-633-4227) and speak to an agent.

TSCL has been reporting on the coming insolvency of Medicare if something is not done by Congress soon, but we can all do our part to help the looming Medicare funding crisis by examining the Explanation of Benefits (EoB) we receive from Medicare and make sure there are no charges on there that shouldn’t be there.

As one security expert said, "Just as you periodically monitor your credit card statements and credit reports for unauthorized charges, you should be monitoring your Medicare usage," Jarvis told Newsweek.

"Medicare recipients can log in to the online Medicare portal to review claims or review explanation of benefits reports sent by Medicare. Any charges submitted by unfamiliar medical providers or for unrecognized services should be investigated by the insured."

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Biden Administration Proposes Pay Increases for Hospitals, Hospice Providers

Nursing homes, hospice providers, and inpatient psychiatric facilities would all see Medicare pay hikes next year under proposals recently released by the Biden administration.

Hospice providers would get an additional $705 million in Medicare payments in fiscal year 2025, while nursing homes would get an additional $196.5 million, as part of a proposed 4.1% rate increase.

The proposed hospice rate hike would represent a 2.6% boost in the payment rate, according to the proposed rule from the Centers for Medicare & Medicaid Services (CMS). Another proposed rule calls for inpatient psychiatric facilities to receive a 2.6%, or $70 million, increase in Medicare payment rates.

Medicare’s hospice benefit covers end-of-life care and services for beneficiaries who are terminally ill with a life expectancy of six months or less if the illness runs its normal course. Beneficiaries who enroll in the hospice benefit agree to forgo Medicare coverage for conventional treatment of their terminal illness.

In 2020, more than 1.7 million Medicare beneficiaries received hospice care. In 2021, Medicare paid about $28.5 billion for about 1.7 million nursing home stays for 1.2 million fee-for-service beneficiaries, according to the Medicare Payment Advisory Commission.

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The Burden of Getting Medical Care Can Exhaust Older Patients

By Judith Graham     March 27, 2024   KFF (Kaiser Family Foundation)

Susanne Gilliam, 67, was walking down her driveway to get the mail in January when she slipped and fell on a patch of black ice.

Pain shot through her left knee and ankle. After summoning her husband on her phone, with difficulty she made it back to the house.

And then began the run-around that so many people face when they interact with America’s uncoordinated health care system.

Gilliam’s orthopedic surgeon, who managed previous difficulties with her left knee, saw her that afternoon but told her “I don’t do ankles.”

He referred her to an ankle specialist who ordered a new set of X-rays and an MRI. For convenience’s sake, Gilliam asked to get the scans at a hospital near her home in Sudbury, Massachusetts. But the hospital didn’t have the doctor’s order when she called for an appointment. It came through only after several more calls.

Coordinating the care she needs to recover, including physical therapy, became a part-time job for Gilliam. (Therapists work on only one body part per session, so she has needed separate visits for her knee and for her ankle several times a week.)

“The burden of arranging everything I need — it’s huge,” Gilliam told me. “It leaves you with such a sense of mental and physical exhaustion.”

The toll the American health care system extracts is, in some respects, the price of extraordinary progress in medicine. But it’s also evidence of the poor fit between older adults’ capacities and the health care system’s demands.

“The good news is we know so much more and can do so much more for people with various conditions,” said Thomas H. Lee, chief medical officer at Press Ganey, a consulting firm that tracks patients’ experiences with health care. “The bad news is the system has gotten overwhelmingly complex.”

That complexity is compounded by the proliferation of guidelines for separate medical conditions, financial incentives that reward more medical care, and specialization among clinicians, said Ishani Ganguli, an associate professor of medicine at Harvard Medical School.

“It’s not uncommon for older patients to have three or more heart specialists who schedule regular appointments and tests,” she said. If someone has multiple medical problems — say, heart disease, diabetes, and glaucoma — interactions with the health care system multiply.

Ganguli is the author of a new study showing that Medicare patients spend about three weeks a year having medical tests, visiting doctors, undergoing treatments or medical procedures, seeking care in emergency rooms, or spending time in the hospital or rehabilitation facilities. (The data is from 2019, before the covid pandemic disrupted care patterns. If any services were received, that counted as a day of health care contact.)

That study found that slightly more than 1 in 10 seniors, including those recovering from or managing serious illnesses, spent a much larger portion of their lives getting care — at least 50 days a year.

“Some of this may be very beneficial and valuable for people, and some of it may be less essential,” Ganguli said. “We don’t talk enough about what we’re asking older adults to do and whether that’s realistic.”

Victor Montori, a professor of medicine at the Mayo Clinic in Rochester, Minnesota, has for many years raised an alarm about the “treatment burden” that patients experience. In addition to time spent receiving health care, this burden includes arranging appointments, finding transportation to medical visits, getting and taking medications, communicating with insurance companies, paying medical bills, monitoring health at home, and following recommendations such as dietary changes.

Four years ago — in a paper titled “Is My Patient Overwhelmed?” — Montori and several colleagues found that 40% of patients with chronic conditions such as asthma, diabetes, and neurological disorders “considered their treatment burden unsustainable.”

When this happens, people stop following medical advice and report having a poorer quality of life, the researchers found. Especially vulnerable are older adults with multiple medical conditions and low levels of education who are economically insecure and socially isolated.

Older patients’ difficulties are compounded by medical practices’ increased use of digital phone systems and electronic patient portals — both frustrating for many seniors to navigate — and the time pressures afflicting physicians. “It’s harder and harder for patients to gain access to clinicians who can problem-solve with them and answer questions,” Montori said.

Meanwhile, clinicians rarely ask patients about their capacity to perform the work they’re being asked to do. “We often have little sense of the complexity of our patients’ lives and even less insight into how the treatments we provide (to reach goal-directed guidelines) fit within the web of our patients’ daily experiences,” several physicians wrote in a 2022 paper on reducing treatment burden.

Consider what Jean Hartnett, 53, of Omaha, Nebraska, and her eight siblings went through after their 88-year-old mother had a stroke in February 2021 while shopping at Walmart.

At the time, the older woman was looking after Hartnett’s father, who had kidney disease and needed help with daily activities such as showering and going to the bathroom.

During the year after the stroke, both of Hartnett’s parents — fiercely independent farmers who lived in Hubbard, Nebraska — suffered setbacks, and medical crises became common. When a physician changed her mom’s or dad’s plan of care, new medications, supplies, and medical equipment had to be procured, and new rounds of occupational, physical, and speech therapy arranged.

Neither parent could be left alone if the other needed medical attention.

“It wasn’t unusual for me to be bringing one parent home from the hospital or doctor’s visit and passing the ambulance or a family member on the highway taking the other one in,” Hartnett explained. “An incredible amount of coordination needed to happen.”

Hartnett moved in with her parents during the last six weeks of her father’s life, after doctors decided he was too weak to undertake dialysis. He passed away in March 2022. Her mother died months later in July.

So, what can older adults and family caregivers do to ease the burdens of health care?

To start, be candid with your doctor if you think a treatment plan isn’t feasible and explain why you feel that way, said Elizabeth Rogers, an assistant professor of internal medicine at the University of Minnesota Medical School.

“Be sure to discuss your health priorities and trade-offs: what you might gain and what you might lose by forgoing certain tests or treatments,” she said. Ask which interventions are most important in terms of keeping you healthy, and which might be expendable.

Doctors can adjust your treatment plan, discontinue medications that aren’t yielding significant benefits, and arrange virtual visits if you can manage the technological requirements. (Many older adults can’t.)

Ask if a social worker or a patient navigator can help you arrange multiple appointments and tests on the same day to minimize the burden of going to and from medical centers. These professionals can also help you connect with community resources, such as transportation services, that might be of help. (Most medical centers have staff of this kind, but physician practices do not.)

If you don’t understand how to do what your doctor wants you to do, ask questions: What will this involve on my part? How much time will this take? What kind of resources will I need to do this? And ask for written materials, such as self-management plans for asthma or diabetes, that can help you understand what’s expected.

“I would ask a clinician, ‘If I chose this treatment option, what does that mean not only for my cancer or heart disease, but also for the time I’ll spend getting care?’” said Ganguli of Harvard. “If they don’t have an answer, ask if they can come up with an estimate.”

This article is from KFF Health News and is reprinted with permission.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.


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