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Trump Attempts to Alter Medicare

Published on September 7th, 2018

The Trump administration is now trying to alter Medicare.  The Centers for Medicare and Medicaid Services has issued a slew of proposed rules in recent months which would change how doctors and nursing homes are compensated for treating beneficiaries.  The changes will increase the amount providers get but lessen accountability and transparency.

Health policy experts say the changes will make it harder for them to see their doctor of choice or get medicines their physician recommends.
One controversial proposal would radically overhaul how the agency compensates physicians for the most common medical service — a doctor’s appointment.  Currently, Medicare has five levels of payments, ranging from a quick visit with a nurse to an in-depth evaluation of patients with cancer, heart failure or other serious illnesses.  The agency is proposing to reimburse doctors the same amount regardless of the person’s condition and the length of the visit.  Physicians who are specialists treating complex medical issues will no longer be compensated for their expertise.  Many will cut back on the number of Medicare patients they see or limit the time they spend with seniors, requiring them to come back for additional evaluations, experts say.
“This would create incentives for many more short visits,” said Robert Berenson, an institute fellow at the Urban Institute who was in charge of Medicare payment policy at the agency during the Clinton administration.  Health care providers, consumer advocates, and policy experts say the proposal could impede patients’ access to care.
“While the agency inappropriately characterizes these clinic visits as “check-ups,” the reality is that hospitals serve some of the sickest, most medically complex patients in our clinics, evaluating them for everything from metastatic breast cancer to heart failure,” said Tom Nickels, executive vice president at the American Hospital Association, in a statement.
Trump also wants to make significant changes to the main Medicare Accountable Care Organization program, which has 10.5 million participants.  Established by the Affordable Care Act, these organizations are groups of doctors, hospitals and other providers who voluntarily work together to better coordinate patients’ care and reduce health care costs by avoiding duplication of services and medical errors.  The proposed changes would shake up the ACO industry. The agency projects that just over 100 — or roughly one-fifth — would drop out of the program. But the industry group for ACOs say that number would be much higher.
Joe Pioletti
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