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Discussion: P.L. 110-275, The Medicare Improvements for Patients and Providers Act of 2008 (43 comments ↓ | 9 wiki edits)
- This item is from the 110th Congress (2007-2008) and is no longer current. Comments, voting, and wiki editing have been disabled, and the cost/savings estimate has been frozen.
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Visitor Comments 
Mel Lair
June 24, 2008, 6:32pm (report abuse)I am afraid if this bill is not passed there will be doctors leaving practice - the baby boomers will be seriously affected in the near future. I am a baby boomer, I believe this bill is necessary to protect our access with Medicare doctors.
jb
June 24, 2008, 9:30pm (report abuse)This bill is piggbacking with HR6252. Which is delaying the competitve biddding implementation for July 1st. Pray to God The Senate approves it like the House did. yay 355 nay 59. If not you will not recognize the healthcare system in the United Stats.
Ron Melton
June 25, 2008, 7:08pm (report abuse)I understand that if this plan passes that it will end Private Fee for Service Medicare Advantage Plans.(Part C of Medicare)
These plans save seniors on average $800 per year in health care cost per Congress' own numbers. Seniors in poor health will save thousands.
Fee for service plans allow low income and seniors with special needs to see any doctors that agrees to bill the plan. They are not limited to HMO or PPO networks. They are best suited to people in rural areas and for those who cannot afford to pay $160-$200 month for Medigap plans.
If you want to help the health care system, keep the insurance companies from telling the doctors how to do their job. We're not talking about Direct repair shop here for autos. We talking about people's lives. Place a cap on prescription drugs since they are being handed out like candy, and address the cost regarding malpractice insurance. You can't fix America's health care crisis by moving benefits around.
MT/WY/SD
June 25, 2008, 10:22pm (report abuse)Medicare Part C isn't even an option in rural america. Sure, Medicare recipients can enroll in a Medicare Part C plan, but finding a doctor or a specialist that accepts the Medicare Advantage Plan is the problem, that is what this plan is doing-fixing the limited access problem. The other issue is too many seniors today are being balanced billed by doctors, even after the doctor or facility stated they accepted the plans limitations, and currently they have that right. It is time to change the plans, so they are all PPO's if at all.
Bob
June 25, 2008, 10:24pm (report abuse)Private-fee-for-service plans have cost members I know personally hundreds of thousands of do$$ars. An example, recently an 88 year old man living in Montana went to have the batteries changed in his pacemaker-the cost was $35,000.oo, his Humana Gold paid $9,000.oo. He thought he would only have to pay $3,000 maximum toward medical expenses per calendar year. He did, but was balance billed for the difference of $23,000.oo. Total he paid for one simple procedure in rural america: $26,000.oo/Humana $9,000.oo.
The system is flaud while these plans are sold fraudulantly, never telling the senior that they are buying garbage.
id
June 25, 2008, 10:26pm (report abuse)It's not even insurance. Not only can doctors balance bill, and do, according to all of the Private-fee-for-service plans summary of benefits, they also can limit benefits for a member, not having to meet the same requirements and DRG's as Original Medicare. Most of the Medicare Advantage Plans started in November 2005, as did the Medicare Part D plans, now over 1/3 of them are valued at over a Billion dollars in net worth, according to an issue of Inc. Magazines Top 100 companies growth performance. Wellcare started with less than $1 million dollars and in 2 years time was valued over $3 Billion just in Medicare Part D. The system does need fixed. I am in full support of HR 6331 and S 3101, and you should be too, otherwise your abusing the elderly. The real matter is that they should eliminate Medicare Advantage.
8662206598
June 25, 2008, 10:29pm (report abuse)You are all right, except for Ron Melton. Medicare Supplements with a number of carriers that I work with are $80/month for a Standard Plan F for someone age 65, and $125/month for someone age 80. The insurance companies offering higher premium costs for a Medicare Supplement are doing the same thing as the Medicare Advantage Plans, milking the consumer for every dollar and then raising their cost until they can't pay. The solution is simple, get on the internet and type in www.insureme.com and you'll get flooded with rates, not people at your door, but instant quotes for insurance. This is valuable for those needing better costs or a better plan for their healthcare. So stand up and support the HR 6331. It's the right thing to do, and its time to stop the soap selling Medicare Advantage companies and agents.
John Dvorak
June 25, 2008, 10:31pm (report abuse)Support the bill, its time to fix Medicare for our childrens sake. Next they need to fix Social Security or come up with another plan like it.
judith
June 25, 2008, 10:37pm (report abuse)As a concerned constituent and Medicare beneficiary, I am writing to ask you to cosponsor The Medicare Access to Rehabilitation Services Act (S 450/HR 748). The bill would repeal financial limits, or 'therapy caps,' on my Medicare outpatient physical therapy, The therapy caps limit my outpatient rehabilitation coverage to $1,810 for combined physical therapy and speech-language pathology services in 2008.
Congress has recognized the potential harm in this policy and repeatedly has passed moratoriums on its enforcement. In 2007, Congress passed legislation providing exceptions for beneficiaries who need care above the financial limit — but only through June 30, 2008. Now is the time to provide a long-term solution to the flawed therapy cap policy. I urge you to take action to pass legislation to remove the therapy caps once and for all and prevent harm to Medicare beneficiaries who need rehabilitation services.
As you may know, there are inherent problems with the therapy cap
SP
June 26, 2008, 8:41am (report abuse)I'm an agent and I don't like these plans. But I also know I have rural clients who can't pay even $80 for a medicare supplement. This is better than nothing. It is better than regular medicare alone.
Darren
June 26, 2008, 10:10am (report abuse)The other reality is simple: Why should Doctors offices have to effectively further subsidize Medicare by having their rates cut?
In every industry, if one of your major clients comes along and says, "We have no increased volume for you at the moment, but we want a 10% price break," you can and should make reconsider if you then want to remain in business with that client. Especially when your costs have done *nothing* but gone up due to inflation.
Why should any Doctor then not reconsider their participation in Medicare, if the rate cut scheduled for July 1 (which this bill would postpone) goes through?
Norman
June 26, 2008, 10:12am (report abuse)PFFS are a must if you can not afford a medicare supplement at 175.00 a month. Please keep them, it works great for everyone I know
Carol
June 26, 2008, 10:38am (report abuse)Please pass this!! Many doctors will not be able to practice and will leave and then what! Let's not take the docs for granted as many seem to want!!
Gail
June 26, 2008, 3:03pm (report abuse)The Medicare Advantage PFFS plans provider senior's with important coverage. On the average PFFS plan save senior $800.00 per year.
Alan
June 26, 2008, 10:30pm (report abuse)Medicare Advantage plans are NOT Medicare Supplements. They are simply an alternative coverage to Original Medicare. You guys talk about balanced billing, that happens with Medicare as well.(15% Excess charge)
You need a Medigap plan for Medicare if you wish to have full coverage. Their are also Med Advantage plans with premiums that cover more.
Force the doctors to accept the plans IF they accept Original Medicare.
Encourage Advantage gap coverage for those who can afford it or want it.
But for those who cannot afford the high cost of supplemental, it is still better benefits that Medicare alone.
As response to "8662206598" I suppose that you would supply internet access to every senior living in a trailer with a pair of rabbit ears. Get real, Stiff penalties and jail time to agents going around screwing seniors and making a mockery of "helping people" will bend the corruption as well as leveling commissions will discourage "churning."
Allen
June 27, 2008, 7:48am (report abuse)Medicare Advantage plans are good only for the agents and companies that sell this sorry excuse for health care. This stuff is not going to work. It cost the taxpayer way more than Original Medicare. If someone can not afford a medicare supplement I believe they are better off with The original medicare and no insurance rather than have to deal with the Medicare Advantage option.
Ron
June 27, 2008, 8:34am (report abuse)From the Medicare.gov website, comparing health plans with a person in poor health in the Atlanta area:
Estimated Annual Cost:
Original Medicare- $8950 vs.
PFFS MA-PD - $6650
That's $2300 more a year that a senior on a fixed income would have to pay out with Original Medicare. Original Medicare doesn't even pay drugs, an add'l premium.
How can you say that Original Medicare alone is better?????
Granted MA plans are not perfect and they need some refining, but they are way better than Medicare alone.
Jacob
June 27, 2008, 10:04am (report abuse)The bill did not pass the senate!
I am a cardiologist and this makes me quite upset. Currently doctors are the only people who HAVE to provide care for uninsured people in the ER for free. What other service in our country is FREE! Can you get a free hamburger from McDonalds? NO! BUT you can get a free heart cath.
Private insurance reimbursement will also drop due to this.
Soon there will be NO doctors caring for the elderly, but don't worry I am sure another bill will be passed MANDATING us to provide that swervice too.
What a joke, I am not proud to be an American today!
JC
June 27, 2008, 12:38pm (report abuse)I agree with Jacob. I am a Home care provider and this bill was a necessity to pass. Unfortunately these Republican senators all care about the money in their pockets from these Insurance companies (aka humana, united, aetna) Let's get real here folks. Look at what these Medicare advantage plans are making on average $1000 per more each senior.) Put that into the pot with the trainwreck aka Part D donut hole program and this is one Cluster you know what of a healthcare system. It is amazing how a bipartisan bill passes the house with flying colors and these clows in the Senate have to vote with their wallet and not the heart of the elderly beneficiary who is being harmed.
Bill
June 27, 2008, 12:38pm (report abuse)I dont knock all MA plans however, if you look at the creative marketing tactics used to enroll these people i am sure there are a large % of elders enrolled in MA plans that dont need to be. Aside from low-income and rural areas, MA are not a WIN-WIN. Traditional medicare offers the same benefits to about 95% of seniors. MA works at best in 5% of cases.
Montana Man
June 27, 2008, 1:08pm (report abuse)What are you people talking about. Seniors and minorities are insanely benefiting from these PFFS plans. I have over 100 people in these things and never seen ANY balance billing. The doctor is prohibited from doing that according to the terms and agreement of providing the service and billing the insurance company directly. HE CANNOT BALANCE BILL 10000 dollars! Not only are these plans better than orig. medicare but people that can afford supps. find these much more cost effective. Max out of pocket $2500/ year! thats almost what a medigap costs and that doesnt even have a premium! Beware democrats if you try to pull this crud when obama gets in seniors and the aarp are going to maybee take notice. Then your arse is grass! ha!
Geriatric Doc
June 28, 2008, 7:20am (report abuse)Since our practice is 99% dependent on Medicare for our revenue,I have seriously considered getting out of practice entirely. There are already many docs who won't accept new Medicare patients in the office. Unfortunately those of us with training and expertise in caring for seniors will have even less incentive to practice our specialty.If doctors won't see these patients in the office, then they will all wind up going to the emergency room when they are ill, and they won't be getting good management of their chronic diseases or preventive services. It will also further increase the wait time and decrease quality of care in the ER. Not passing this bill will be a disaster! Unfortunately the ruling elite play by a different system, as they have open access for them and their families at military hospitals and can just show up and demand free care on the spot for them and their families.
Please contact your senators and ask them to vote yes for this bill.
Virginia
June 28, 2008, 6:51pm (report abuse)I sell Medicare Advantage plans. Took me awhile to get on board with the plans, but knock on wood...so far so good. I too wonder how can the govt keep up with all of this. My cholesterol is high and my health insurance to get a decent plan will cost me $750 to $1,000 per month. Who can afford that...who can afford to be without? I do not know where we need to go with this, but I do think Medicare Supplements are the answer...except when my Dad's cost almost $300 per month for plan F. So I put him in Advantra Freedom for $98 per month. I do hold my breath every time he has anything done. In my area Doctors seem to be accepting the Med. Adv. plans without any questions...except Human Gold. Where do we go from here? I do like Med Adv for the people on Medicare under age 65, what else is there for them? At least let them keep the plan or allow them to get Med Sup. in open enrollment. Thanks.
frank tells
June 29, 2008, 3:28pm (report abuse)I FEEL THAT THE MEDICARE BILL VOTED ON JULY 1, 2008 IS NOT BENEFICIAL TO PHYSICAL THERAPY PATIENTS. THE BILL SHOULD BE VOTED DOWN BECAUSE IT LIMITS THE NUMBER OF VISITS ALLOWED FOR PHYSICAL THERAPY. THE PATIENTS MEDICAL WELL BEING WILL BE JEOPARDIZED.
Texas Steve
June 30, 2008, 12:06am (report abuse)I am a Family Physician and share call with 8 other family docs. We get calls every day from frustrated elderly who cannot find a doctor to accept Medicare (or Medicare Advantage). We have closed our doors to new Medicare in anticipation of the rate decrease. I will probably quit going to the nursing home. Three of my older call partner-colleagues (who have very heavy proportion of elderly patients) will likey retire earlier than planned. Two have chosen to close their doors as we have. Two others are going to send their patients notices that they will be no longer participating Medicare providers. The end result will be more use of emergency departments which costs more in the long run. The doctors who will still see Medicare will try to make up for the cuts by adding on Physician Assistants to incrase their patient volume.
GA BOY
June 30, 2008, 3:30am (report abuse)Most MA plans pay 102%-104% of Medicare's fee schedule as well as they are electronically billed. This means that doctor's get their money in 30 days instead of 90 w/Medicare.
Sounds to me that they should bill more MA plans.
I realize that doctors are upset by this bill not passing, but it would harm to many seniors taking away the MA plans. I agree w/ the guy above who stated that we need to address the issues that increase health care and expenses to the doctors themselves. I have two friends who are doctors, who both retired early because they couldn't afford their malpractice insurance!
What a travesty!
Cardiologist
July 2, 2008, 10:40am (report abuse)I am afraid that Standard of care will suffer and collapse Health care system. Costs of running practice is going up with way economy is, poor collection . This will be a great mess and unthinkable blunder
mkh
July 8, 2008, 9:19am (report abuse)I believe that we are going to have a health care system breakdown if this bill is not passed. I do work for a primary care physician that make far less than the senators that are voting on this bill. What everyone does not seem to understand is that the majority of health insurances are tied to the rvu's that Medicare uses. That means a 10 percent cut across the board for physicians. I believe that the Senators need to spend some time in a family practice office to understand that we were just holding our heads above the waters as it was.
Entrench
July 8, 2008, 2:51pm (report abuse)This only addresses a minor problem in the PFFS plans and does nothing to address healthcare's root problem which is unjust fee schedules all of which are based off of what Medicare pays. Even with that said this is a good bill with minor problems and that's coming from someone who works for a Medicare Advantage Plan. However don't let the well intentioned but poorly informed AMA frighten you, the solution to Medicare's woes lays in the private sector. The rapid expansion of Medicare benficiaries cannot be sustained by Federal funding and while not perfect we need to continue to pursue privatization as a means of maintaining Medicare without crippling physicians with horrific fee schedules.
Doc302
July 9, 2008, 3:11pm (report abuse)Not all Medicare advantage plans are created Equal. Some are HMO or PPOs yet others are PFFS. Many Seniors do not know what they have signed up for.. They often believe that these are Medicare supplements not replacements. I have former patients that must travel 60 miles to see a participating specialist. These plans profit by blocking access to providers. Although there are some good PFFS MA plans most are just another way for insurance companies to make profit. Medicare is not perfect and if the fee schedule is cut may collapse. In their current incarnation, as system in which insurance companies profit from blocking access and forcing seniors to pay out of pocket to see a physician that would have taken Medicare assignment if the patient had stayed with traditional Medicare, Medicare advantage plans are not the solution. of course if you are UHC CEO William McGuire your $1.2 million salary, plus $165,000 ( 2005) new stock options may make you see it differently.
George James
July 9, 2008, 4:33pm (report abuse)Citizens should watch to see who votes no on this bill and vote them out of office come November
INS. AGENT
July 9, 2008, 7:22pm (report abuse)I must say that I really get tired of the ignorance of doctors.
PFFS plans ARE NOT PART OF A NETWORK! There are no participating providers. If you accept Medicare I can't think of a good reason why you would not accept a PFFS plan. They are based on Medicare's fee schedule. You bill them the same way, just with different codes.No one is blocking providers except you own stupid billing staff. As for Doctors accepting assignment and not taking MA plans...wakeup, that is exactly what MA plans are all about. THe biggest problem with PFFS plans (no so with contracted HMO,PPO plans) is the doctors failing to agree to bill the plan. How weak is that? I have insurance and a doctor won't agree to bill it? If a person has to drive 60 miles to find a doctor, is it because the local doc won't bill a plan the pays him 102% of Medicare's fee schedule should he take the time to bill it. I assume this doctor accept Medicare?
NC DME Provider
July 9, 2008, 9:38pm (report abuse)When grandma, who is on medical oxygen at home, has to switch from her local independent durable medical equipment provider to one many miles away, what happens when she has a concern in the middle of the night with her equipment and the out of town provider takes hours to get to her? She will probably call on state-funded EMS services and local hospital's ER services. Too bad her previous local DME provider from down the road can not help her! Glad that the Senate passes Cloture HR 6331 today, they need to reform national competitive bidding!
doc302
July 10, 2008, 8:55am (report abuse)INS Agent if you read the posts above you will find that it is the HMO and PPO/POS plans that block access and limit providers, not PFFS plans. medicare advantage plans consist of all of these plans not just PFFS.
Gqoted from medicare.GOV " Medicare Advantage Plans are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan. This coverage can include prescription drug coverage. Medicare Advantage Plans include:
* Medicare Health Maintenance Organization (HMOs)
* Preferred Provider Organizations (PPO)
* Private Fee-for-Service Plans
* Medicare Special Needs Plans
INS AGENT
July 10, 2008, 9:43am (report abuse)This bill does not address MA-HMO or MA PPO plans. Just MA-PFFS plans. PFFS plans allow you to go see "ANY" provider who will accept their terms and conditions. What are "their" terms?
1."Referrals or preauthorizations of health care services are not required.
2. Provider reimbursement is based on published Original Medicare rates, reimbursement guidelines and methodologies, less the member’s cost-sharing amounts. Medicare Local Medical Review Policies apply.
3. (your Company) PFFS directly reimburse physicians and other health care professionals for non-dual-eligible members. Reimbursement for dual-eligible members will be paid first by Medicare through (your comany) PFFS. The difference will be paid by Medicaid, up to the state payment limit.
4. Physicians, hospitals and other providers who render services to (your company) PFFS members must adhere to all industry standards and state and federal requirements.
The only person blocking access to a PFFS plan is you!
FlashRetro
July 10, 2008, 5:11pm (report abuse)Yes, Fee For Service Advantage plans are good at any provider that will accept them. "Monopoly" money is also good at any provider that will accept it. In rural Oklahoma, the chances of either are about the same.
RONI
July 14, 2008, 11:57am (report abuse)I AM INQUIRING ABOUT THE ACCREDITATION FOR PODIATRISTS THAT IS PART OF THIS BILL. DO THEY STILL HAVE TO OBTAIN ACCREDITATION? FROM WHAT I'VE SEEN ELSEWHERE THEY STILL HAVE TO BE ACCREDITED. CAN SOMEONE POST IF YOU KNOW. THANKS.
Muru
July 14, 2008, 5:14pm (report abuse)Without this bill signed in to law, many doctors would stop taking new Medicare patients. Several would leave rural community based practices to join larger groups or hospitals in cities. As a result patients and families in particular elderly cancer patients would need to travel hundreds of miles for treatment.
spptmike
July 14, 2008, 5:50pm (report abuse)Passing of HR 6331 is important to rehabilitation beneficiaries who choose seek services in an outpatient enviroment. They are presently capped at $1,810.00 per year which is roughly 12 - 15 visits per calender year, which is not enough for patients who are recovering from a CVA, orthopedic surgery, or sa debilative disease such a Parkinsons. Also, all medical providers of these services are asked to take a 10.6% pay cut for services which will create possible job losses for those who have substantial overhead. This imposed cap is arbitrary, unconstitutional, and restricts the provider to base care on finances instead of need. We all suffer if the health care system becomes a budgetary game instead of providing the quality care we were trained to perform.
Bill M
July 15, 2008, 3:21pm (report abuse)It's to bad the president vetoed this Bill. Does he not care what its for.
AL Gal
July 15, 2008, 4:20pm (report abuse)How many of you will be decreasing staff, and hours to absorb the cut? How many will stop taking Medicare? This is bad for the seniors, Veterans and Physicians.
MA can cost seniors more money in the long run. Medicare 20% patient responsibility for an office visit can run between $7.00 to $23.00 depending on location and service. While with MA seniors have flat co-pay of $30.00 and up.
I have had many low income patients confused to why they are now paying more per visit than when they had the standard Medicare.
I which the politicians would come spend a week with me!!
Tony P
July 15, 2008, 9:14pm (report abuse)Thank fully this finally passed with veto override. It amazes me to see how many educated people do not realize how poorly designed this system is. Pharmacies are blamed for drug costs when a drug companies actually set the prices. General practitioners are punished by insurers for excessive costs charged by specialists, and then hit again for malpractice insurance. Insurance companies are given nearly free control to run Medicare-D making record profits while providing little real benefit to the patients, and running many independent pharmacies out of business with unreasonable reimbursements and slow payments. This was only a small step toward the level of reform that is needed. There is so much to fix that our great-grandchildren may not see real improvement.
Ezara
July 16, 2008, 11:24am (report abuse)The more they fool with the system the worse it seems to get, finally they have made at least some improvement.
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