Medicare Anniversary: All Is Not Well

(10/4/12)- A report issued by the Medicare Advisory Commission in June showed that adults ages 50 to 64 are having more trouble getting an appointment with a new physician. About 30% of privately insured individuals who were looking for a new primary care physician in 2011 reported problems finding one, compared with 26% in 2008.

Finding a specialist was easier, since only 14% reported having a problem in this area.

The following is an extract from our article on different helpful sites:

"Medicare Payment Advisory Commission (MedPAC)- The Medicare Payment Advisory Commission (MedPAC) is an independent federal body established by the Balanced Budget Act of 1997 (P.L. 105-33) to advise the U.S. Congress on issues affecting the Medicare program. The Commission's statutory mandate is quite broad: In addition to advising the Congress on payments to private health plans participating in Medicare and providers in Medicare's traditional fee-for-service program, MedPAC is also tasked with analyzing access to care, quality of care, and other issues affecting Medicare. The Commission's 17 members bring diverse expertise in the financing and delivery of health care services. Commissioners are appointed to three-year terms (subject to renewal) by the Comptroller General and serve part time. Appointments are staggered; the terms of five or six Commissioners expire each year. The Commission is supported by an executive director and a staff of analysts, who typically have backgrounds in economics, health policy, public health, or medicine. MedPAC meets publicly to discuss policy issues and formulate its recommendations to the Congress.

Our thanks to Margo Harrison, a research analyst at the commission for emailing us with this info."

(1/27/03)- According to a study by the Centers for Medicare and Medicaid Services the quality of care for Medicare patients is improving. The study is an update of a government report on patients treated in 1998-1999, and covers the period 2000-2001.

The proportion of Medicare patients receiving appropriate care increased to 73.45 from 69.5%. States improved on average on 20 of the 22 indicators used by the researchers. Among the biggest gains were:

"This report shows we are making important progress on quality health-care delivery," said Health and Human Resource Services, Secretary Tommy Thompson. New Hampshire and Vermont retained their No.1 and No.2 rankings. Louisiana which ranked 49th in the earlier study, dropped to No. 51 in the present study, while Puerto Rico ranked last in both studies.

With unemployment in the U.S. rising, one of the few industries that still have a substantial number of job openings is the health care industry. According to a recent VHA Inc. study, hospitals with a high turnover rate can experience an increase in the average cost-per-discharge of patients and a substantial decrease in profitability.

Current data reports a turnover rate in health care staffing of 20.7% for all positions. Replacement costs, lost productivity and temporary staffing cost between 50% and 150% of an individual's base salary.

The year 2000 was the 35th anniversary of Medicare. Donna Shalala, the former Secretary of the Health and Human Services, remarked on the anniversary of the Medicare program that "This is a great celebration of an important Federal program which has been helping millions of older Americans stay healthy. Since its creation in 1965, Medicare has served more than 93 million Americans, and has added home health care, hospice care, and many preventable benefits. One of the best ways to celebrate the success of Medicare is by making sure that the millions of seniors and disabled Americans who have come to rely on it take advantage of the preventative benefits that the program covers."

The preventative benefits that are covered by Medicare include the following:
1. Annual screening mammogram
2. Pap smear
3. Colorectal cancer screening
4. Bone mass measurement
5. Glucose monitoring and diabetes education program
6. Flu, pneumonia and hepititis B vaccinations.

Medicare, the nations largest health care program covers about 39 million Americans and their families. It all began on July 1st 1965. Today about 70,000 of those individuals who first enrolled in the program are still receiving benefits. They are reaching their 100th birthday. In 1965 there
were only 3000 individuals aged 100.

While the health of seniors continues to improve, not is all well with the Medicare program. Nancy-Ann De Parle, administrator of the Health Care Finance Administration, the Federal agency that runs Medicare stated "Despite the vital assistance that Medicare provides, today's seniors continue to spend about 18% of their income on health care costs because gaps in benefits and high out-of-pocket costs."

One American in 8.7 is over the age of 65. There are more Americans older than 65 than there are younger than 25. Physicians devote more than 40% of their hospital time to adults above age 65. Ninety-seven percent of older adults use more than one drug per day. The expenses of senior care will consume 75% of the total health care dollar by the year 2030. Is our nation alert to these figures and the potential they may have for creating astronomical monetary problems for the Medicare system?

Our Federal legislators have the capacity to think, reason and plan for the coming years to guarantee that the Medicare program remains solvent and viable, and that it provides for all the needs of eligible seniors. They will need to put aside partisan politics and develop a program that protects all seniors in every aspect of the final years of their life from medical attention to home care, to hospital care, to hospice care, to medication, and to residential living.

The percentage of seniors in our population is increasing along with extended life span of these seniors, but when costs of service are rising faster than revenues, a critical point will be reached which could spell bankruptcy or downsizing of benefits. Already there are nursing home closings, HMOs not taking seniors or dropping them, shortages of qualified individuals to perform services needed by the elderly etc. Wealthy people are opting for Assisted Living Facilities where the costs are high and where the quality of service may be good, but may "the services" may not be able to handle the nature of the difficult medical problems these individuals present. (See Gayle Feldman's article in the NY Times entitled "Life's End: Little Help. No Dignity" Tuesday Jan. 9, 2001, Section C) Are these events a harbinger of things to come?

We urge all our readers to keep up with the latest developments in Medicare. This site will try to provide the latest information. We would urge you to check with your Federal and State representatives, letting them know of the gaps in benefits that impact on your daily life. Stay aware of all the proposed changes and the long-term implications of these changes. An informed constituency does make a difference.


Harold Rubin, MS, ABD, CRC, Guest Lecturer
updated October 4, 2012

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