Medicare Proposals

The Healthcare Leadership Council has presented a proposal to help Congress find the dollars they seek to take from Medicare. Members of this Council come from the Mayo Clinic and major pharmaceutical manufacturers like Pfizer and Aetna. Pharmacies, hospitals, health plans and many others who also have a major stake in what happens are members of the Council.

There are many things they are proposing that make a great deal of sense. I know that raising the eligibility age to 67 and perhaps then to 70 is practical. The average American life span is somewhere in the 75 year or higher bracket (I am in my 85th year). So many people work longer than before and are often covered by insurance from their workplace.

One of their proposals is to change the rules. They will allow people to shop for a private plan (perhaps federally subsidized) or enroll for Medicare. I am fully aware that the number of people currently contributing to Medicare has been greatly reduced and the number of dollars available will be greatly reduced. This will force new conditions. What can be done to allow sufficient money be available for Medicare?

First thing is that every effort has to be directed to stop the cheating and abuse of the system. Last week 91 people were caught trying to milk the system of 295 million dollars. How many others were not? The administration has stated they had a rise of 85% fraud prosecutions over last year. They still have a very long way to go to stop much more of this. You have to report to HHS any dishonesty and get your clientele involved. We all have to become “policemen” to stop this growing amount of fraud.

HCPS billing codes must be explained to the recipients so they see how much the government is reimbursing and be sure that billings are only for service provided to them.

There should be standards. These must be based on the actual cost of an item to a provider and with a very reasonable profit margin. DME/HME suppliers must be allowed to make a living and the amount of free services they offer must be considered.

I am very cognizant of the fact that there will be many changes coming, some of which will be difficult to live with. As an industry we must stand together and work as a close-knit team. At Medtrade there will be many discussions on this. Most state associations will be manning a booth and you must support their efforts on your behalf. The national association, AAHomecare, I is sponsoring its Stand Up for Homecare fundraiser again. The group purchasing organizations will be there and they also play an important role. But, the most important thing is that you must be there. So much is at stake!