Here's How Lawmakers Can Slash Medicare Spending Without Cutting Benefits
Forbes | By Sally Pipes
Politicians don't agree on much these days, but one thing seems to bring even Democrats and Republicans together. And that's refusing to cut Medicare.
That position may be politically popular. But it's at odds with the long-term sustainability of the program. Medicare's hospital insurance trust fund is set to go bankrupt by 2028. The program costs taxpayers $747 billion each year—12% of total government spending.
Fortunately, there's a way for lawmakers to rein in Medicare spending without cutting benefits. By giving seniors vouchers to spend on privately managed Medicare plans, lawmakers can cut costs while increasing quality of care.
Such a model, which already works in one part of Medicare, will help keep seniors healthy while protecting Medicare for future generations.
About 35 million Americans were enrolled in "Traditional Medicare," a fee-for-service system that covers hospital insurance, Part A, and medical insurance, Part B. The federal government administers Traditional Medicare directly, paying out nearly every claim submitted—including about 8% of improper claims, which cost the government around $32 billion each year.
Shifting to a premium support model would rein in Medicare payments. The federal government would give each senior a voucher for a fixed amount of money that they could spend on privately administered insurance or Traditional Medicare.
In other words, insurers would have to compete for seniors' business. They'd have to assemble benefits packages that appeal to potential customers. Competition would drive down costs and improve quality. And that's good news for John Q. Taxpayer, who would ultimately be footing the bill.
According to the nonpartisan Congressional Budget Office, if lawmakers had shifted to a premium support model in 2022, Medicare spending could have fallen between $21 billion and $419 billion by 2026, depending on whether existing beneficiaries participated in the model.
Making the shift today would save beneficiaries $333 billion over a decade, and taxpayers $1.8 trillion over 10 years, according to former CBO director and current American Action Forum president Douglas Holtz-Eakin.
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Resources About Alzheimer’s and Dementia
Care for Veterans with Alzheimer’s or dementia is provided throughout a full range of Department of Veterans Affairs (VA) health care services.
Based on the Veterans’ needs, services may include Home Based Primary Care, Homemaker and Home Health Aide, Respite Care, Adult Day Health Care, outpatient clinic, inpatient hospital, Nursing Home, Palliative Care, or Hospice Care.
Caregiver Support is also an essential part of these services. If you’ve been diagnosed with dementia, Alzheimer’s disease, or are caring for someone who has, become familiar with the types, stages, symptoms, and treatments.
Over 50 video and print resources have recently been added to the sections on:
Topics include daily plans, communication, behavior changes, next steps, and more. The Veterans Health Library has helpful resources about Coping with a Dementia Diagnosis.
Need more help or information? Find a VA social worker in your area or visit www.va.gov/Geriatrics. |
Debt Ceiling Deal: What’s in, What’s Out of the Agreement to Avert US Default
AP News | By Kevin Freking and Farnoush Amiri
WASHINGTON (AP) — President Joe Biden and House Speaker Kevin McCarthy have reached an agreement in principle on legislation to increase the nation’s borrowing authority and avoid a federal default.
Negotiators are now racing to complete the bill’s text. McCarthy, R-Calif., said the House will vote on the legislation on Wednesday, giving the Senate time to consider it before June 5, the date when Treasury Secretary Janet Yellen said the United States could default on its debt obligations if lawmakers did not act in time.
While many details about the deal are unknown, both sides will be able to point to some victories. But some conservatives expressed early concerns that the compromise does not cut future deficits enough, while Democrats have been worried about proposed changes to work requirements in programs such as food stamps.
A look at what’s in and out of the deal, based on what’s known so far:
TWO-YEAR DEBT INCREASE, SPENDING LIMITS
The agreement would keep non-defense spending roughly flat in the 2024 fiscal year and increase it by 1% the following year, as well as provide for a two-year debt-limit increase — past the next presidential election in 2024. That’s according to a source familiar with the deal who provided details on the condition of anonymity.
VETERANS CARE
The agreement would fully fund medical care for veterans at the levels included in Biden’s proposed 2024 budget blueprint, including a fund dedicated to veterans who have been exposed to toxic substances or environmental hazards. Biden sought $20.3 billion for the toxic exposure fund in his budget and Republican negotiators ensured Sunday that funding was left untouched.
WORK REQUIREMENTS
Republicans had proposed boosting work requirements for able-bodied adults without dependents in certain government assistance programs. They said it would bring more people into the workforce, who would then pay taxes and help shore up key entitlement programs, namely Social Security and Medicare.
The agreement would expand some work requirements for the Supplemental Nutrition Assistance Program, or SNAP, formerly known as food stamps. It would raise the age for existing work requirements from 49 to 54, similar to the Republican proposal, but those changes would expire in 2030. The White House said it would at the same time reduce the number of vulnerable people — including veterans and people who are homeless — of all ages who are subject to the requirements.
Many of those changes will sunset in 2030, allowing Congress to measure the effectiveness of these changes and make changes if need be.
UNSPENT COVID MONEY
The agreement would rescind about $30 billion in unspent coronavirus relief money that Congress approved through previous bills, with exceptions made for veterans’ medical care, housing assistance, the Indian Health Service, and some $5 billion for a program focused on rapidly developing the next generation of COVID-19 vaccines and treatments.
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Win: Medicare Contractors Will Continue to Pay for Remote Therapeutic Monitoring
APTA
More good news for providers and patients under Medicare: Medicare administrative contractors, or MACs, will follow the recommendations of APTA and other organizations and not move toward developing local coverage determinations for remote therapeutic monitoring. The win came after APTA and others participated in a meeting of MACs in February.
What it means: For the time being, Medicare fee-for-service beneficiaries can expect coverage of RTM and remote physiologic monitoring procedures, and PTs can continue to bill for RTM codes under the Medicare Physician Fee Schedule. The decision was announced in a recent email from the MACs and a post on MAC websites.
The decision came after a Feb. 28 meeting of the Multijurisdictional Contractor Advisory Committee to discuss the potential development of a local coverage determination, or LCD, for RTM. During the meeting, the committee members specifically sought input from APTA and other organizations on the pros and cons of adopting an LCD.
Alice Bell, PT, DPT, APTA senior specialist for health policy and payment, served as a subject matter expert panelist and offered input on the clinical importance of RTM along with evidence to support its use by PTs. Other APTA representatives were on hand to add to Bell's perspective, advocating against adopting local policies that would create patchwork coverage.
"Remote therapeutic monitoring provides an opportunity to enhance the care offered by physical therapists," Bell said. "It can be a very useful tool to ensure that the plan of care is optimized, goals are achieved in a timely manner, and a patient is able to sustain self-management during the course of and after discharge from therapy, and APTA is pleased that the MACs recognize the patient benefits."
PTs were first added to the list of providers able to bill for RTM in 2022. Since then APTA has successfully worked with the U.S. Centers for Medicare & Medicaid Services around code denials made in error by some MACs. The association also offers a practice advisory on RTM, an APTA member benefit that includes background on the codes, descriptions of each, documentation requirements, and guidance on which codes are subject to payment adjustment under the PTA differential system, as well as real-world examples that clarify application. |
Big Win: CMS Extends Temporary Telehealth Use to All Facility-Based Settings
APTA
In what now amounts to a total reversal of its initial post-public health emergency policies around telehealth, the U.S. Centers for Medicare & Medicaid Services has listened to APTA and other organizations and will allow the provision of telehealth services across a range of facilities, just as they were permitted during the PHE. The major advocacy win means that PTs in skilled nursing facilities, home health, and rehab agencies can continue to provide remote services under Medicare Part B — although CMS has yet to say when those allowances might end.
As with an earlier clarification around hospital-based settings, the latest news from CMS comes by way of an FAQ document on post-PHE policies (see question 22). In the latest iteration of the resource, CMS says that therapy providers working across the range of facility settings can continue to provide telehealth services as they did via waivers granted during the PHE. The announcement follows an earlier, more limited reversal that applied only to telehealth provided in hospital-based facilities.
Originally, CMS' post-PHE telehealth policies appeared to exclude any facility-based provision of telehealth from coverage if that facility used a particular claim form, the UB04. APTA was among the first organizations to call attention to the inconsistencies and patient access problems with this position, and was joined by the American Speech-Language-Hearing Association and the American Occupational Therapy Association in advocacy to press CMS to maintain telehealth allowances across the board. While CMS warned that it could take some time to provide definitive guidance, in the end the agency's decisions arrived relatively quickly.
While the guidance from CMS is clearly good news for the physical therapy community and its patients, one major detail was left out — namely, if and when these telehealth allowances would end. In its earlier hospital-based telehealth decision, CMS stipulated that telehealth could continue through the end of 2023 in those settings. That ending date, opposed by APTA, doesn't jibe with telehealth end dates for PTs and PTAs in private practices, which are expected to be extended through Dec. 31, 2024. APTA, ASHA, and AOTA are pushing for answers, which CMS will most likely provide when it issues the 2024 proposed Medicare Physician Fee Schedule. Meanwhile, APTA and other organizations are pushing for lawmakers to permanently include PTs and PTAs in the list of providers allowed to provide telehealth services under Medicare.
"The conversations we were able to have with representatives from [the U.S. Department of Health and Human Services] were extremely beneficial in helping CMS understand why it's so important to maintain telehealth allowances after the PHE, particularly for patients in rural and underserved communities," said Kate Gilliard, JD, APTA's director of health policy and payment. "We're extremely happy that CMS sees the value in continuing coverage." |
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