...currently at $2.1 trillion. This translated into $7,026 per person and 16% of the Gross Domestic Product (GDP) (ajronline.org, 2008, pg. 1). 31% of this is for hospital spending, which is above the nationa health care expenditures. 5.9% for physician expenditures, which is currently lower than the overall expenditure rate due larglely to the 2% medicare fee for physicians. 19% for overall Medicare part D which caused a spike in prescription drugs. 8.8% in admisistravie fees, which grew faster than the overall rate because of the of the high number of members who joined the Medicare Advantage plan. Medicaid for the first time in history shrank because of the high number of people who enrolled in Medicare Part D. Heath care spending is to high and continues to grow, which means the health care growth rates continue to exceed the overall gross domestic product (GDP) and eventually will surpass other spending. This means that the national health care expenditures will not be sustainable for the future health care system to run efficentlty or at all. In the private sector Medicare has had a sufficent increase in Medicare Advantage making managed care more important currently putting the fee-for-sevice...
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...Medicare will be improved through a quality payment program which helps Medicare to target the goal for care quality and making patients healthier which is the most important part of the mission. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) discontinued the Sustainable Growth Rate formula, which made doctors and primary care physicians who participated in Medicare worried about possible payment cliffs for 13 years. The Quality Payment Program has 2 pathways to choose: 1. Advanced Alternative Payment Models (APMs) - To earn an incentive payment, you have to participate in an Advanced APM, through Medicare Part. You can be a part of the Quality Payment Program in 2017 if you joined the Advanced APM or if you have more than $30,000 worth of Medicare bill which is the allowed charges a year in Part B. The healthcare provider must also see and treat more than 100 Medicare patients a year. It has to meet both the...
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...currently at $2.1 trillion. This translated into $7,026 per person and 16% of the Gross Domestic Product (GDP) (ajronline.org, 2008, pg. 1). 31% of this is for hospital spending, which is above the nationa health care expenditures. 5.9% for physician expenditures, which is currently lower than the overall expenditure rate due larglely to the 2% medicare fee for physicians. 19% for overall Medicare part D which caused a spike in prescription drugs. 8.8% in admisistravie fees, which grew faster than the overall rate because of the of the high number of members who joined the Medicare Advantage plan. Medicaid for the first time in history shrank because of the high number of people who enrolled in Medicare Part D. Heath care spending is to high and continues to grow, which means the health care growth rates continue to exceed the overall gross domestic product (GDP) and eventually will surpass other spending. This means that the national health care expenditures will not be sustainable for the future health care system to run efficentlty or at all. In the private sector Medicare has had a sufficent increase in Medicare Advantage making managed care more important currently putting the fee-for-sevice...
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...Memorandum To: | Senator X | From: | Christoph B. Mund | Date: | April 25th, 2012 | Subject: | Health Care Spending Growth and Reform | SUMMARY The following memo seeks to highlight the past and current problems facing federal health care expenditures within the U.S. It tries to answer the question if health care spending is now on more sustainable path along with giving projections for its current outlook. More specifically it addresses “supply-side” reforms, “demand-side” reforms and “voucher” reforms within the Medicare program, analyzing the benefits and downsides of each and what underlying problems these approaches contain. The memo summarises with recommendations as to which reform should be put in practice to achieve the desired results within the health care market. PROBLEM ANALYSIS 1. Health care expenditures are on an unsustainable path Reasons: * Aging of the population * Increase in health care costs due to excessive coverage * New medical technologies Under current law, spending for mandatory health care programs would increase from 5.6% of GDP today to about 9% of GDP in 2035. Total health care spending grew by 3.9% in 2010 and reached $2.6 trillion, or $8,402 per person. This is mainly caused by an aging of the population, an increase in retirement of the “baby boomer” generation, a rise in health care costs and a rapid innovation of medical technologies. All these factors lead to an increase in the federal budget deficit...
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...consumption of hospital resources and the length of stay. This system was adopted by Medicare in 1983 to reimburse hospitals for inpatient admissions. Some hospitals are excluded from this form of reimbursement such as psychiatric hospitals, rehab facilities, long term and cancer hospitals. The CMS administers the DRG system and issues all the guidelines for it. DRG’s are updated on October 1st every year. This includes base rates, wage directories, establishment of new DRG’s and elimination of others. On October 1st, 2007, CMS established a new set of codes known as Medicare Severity Diagnosis Related Groups (MS-DRGs). These codes are more specific and take into account the severity of a patient’s illness and the resources used. As a result, a more suitable reimbursement is issued. There is about 750 MS-DRGs and 538 DRGs. The payment method used by Medicare for hospitals is known as DRG weight of one. Payments are made per admission where the hospital and payor agree on a base rate that is multiplied by DRG weight to determine reimbursement. Length of stay don’t factor in unless there is an outlier case. The Ambulatory Payment Classification (APC) system uses Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) to classify outpatient hospital admissions into clinically related groups that reflect the extent of care administered. It was established by Medicare in 2000, and certain hospitals are excluded from APC reimbursement such as Maryland...
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...express world renowned news that American banks were facing economic struggles and had to, “be bailed out by the United States government through the emergency Economic Stabilization Act of 2008” (Steverman, 2008). During the same year, the automobile industry requested $34 billion to aid in their economic struggles (Romney, 2008). Given this chain of events, it should come as no surprise that the health care industry is also facing economic constraints and states, in a frenzy to save money and federal programs, have been forced to slash budgets and cut services in the Medicaid sector. Not all healthcare services will remain at the clinic, but it is important that eliminations do not affect the majority healthcare needs of the Medicaid and Medicare population. These changes are in benefit flexibility, cost sharing, enrollment expansions and caps, privatization, and program financing. Enrollment Expansion and Caps With the economic struggles faced in the banking and automotive industries, millions of Americans found themselves unemployed. With unemployment come a lack of financial resources and an inability to afford some of life’s necessities, including private sector health insurance. Medicaid With slow job growth and lack of reserve finances, many Americans applied for and began receiving Medicaid, a federally and state funded insurance geared to help pay health care expenses for people and families with low income (Dumas, Hall, & Garrett, 2008). They could receive them...
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...The Realism of Rationing Despite being ranked among the richest countries in the worldtopping the charts in terms of financial assets, the United States is often criticized for itscontinues to spend an excessive amount of money on healthcare. In fact, the GDP percentage spent on health care is outrageous percentage of GDP spent on health care. As this number rapidly nearing rises and nears a record high twenty percent. For this reason,, there is are reasonsis evidence to supportbelieve that there are several flaws in the our current system. The problem has escalated at such a rate that there is no longer a question of “if” we address the rising health care costs, but “how” we handle them. Many other Several other countries sustain a more productiverewarding health care system in terms of preventive and curative health services, family planning, nutrition activities and emergency aid while maintaining a lower health care cost per capita (Davidson)at a fraction of the cost of America’s. In order to bring this spending in line with other countries, the United States must be willing to make sacrifices in fields such as insurance, pharmaceuticals, and research among healthcare institutions. heathcare research. This has proven to be a very difficult issue to address due to a longn extensive list of ethical issues within the systemdifferences among American citizens. It has been generally accepted that American’s spending could be brought in line withdown to the level of these...
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...of Vital Statistics the aging population is the fastest growing population and will continue to increase. This dramatic growth in numbers and proportions, increased life expectancies, and energetic life styles, now enables us to live 20 to 25% of our lives in active retirement. Moreover, today's physically and intellectually active younger generations predict that tomorrow's elderly population will be better educated, healthier, culturally literate and, as individuals, more discerning consumers. Changes in Demographics Sustainable development means sustainable and healthy development of the whole human society on the basis of mutual coordination and common development of population, society, economy, resources and environment and under the guarantee of resources and with a benign environment. Its purpose is not only to satisfy demands of contemporary population, but also not to pose threats to development of later generations. Sustainable development is centered with human being and regards the overall development of human being or the society as its...
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...Medicare Funding Crisis David Holt Healthcare Finance Ron Evans July 20, 2013 At the heart of America's fiscal crisis is the impending collapse of our entitlement system. And the primary cause of that looming collapse is the explosion of costs in Medicare, the federal program that provides health insurance to every American over 65. Without major reforms of the program, there is simply no way for us to address the federal deficit, contain the national debt, or save Medicare itself from collapse. Medicare's woes are partly demographic. In 2030, when the last of the Baby Boomers retires, there will be 77 million people on Medicare, up from 47 million today. But there will be fewer working people funding the benefits of this much larger retiree population: In 2030, there will be 2.3 workers per retiree, compared to 3.4 today and about 4 when the program was created. But a bigger part of Medicare's troubles is the rapid inflation of healthcare costs. In 2010, the per capita cost of providing healthcare services in America increased by 6.1%, according to Standard & Poor's, while overall inflation increased by only 1.5%. According to the Department of Labor, over the past decade, healthcare inflation has risen 48%, while inflation in the broader economy has increased by only 26%. Providing an increasingly expensive service to a rapidly growing population, while drawing on a declining pool of taxpayers is a recipe for fiscal disaster. The...
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...is currently at $2.1 trillion. This translated into $7,026 per person and 16% of the Gross Domestic Product (GDP) (ajronline.org, 2008, pg. 1). 31% of this is for hospital spending, which is above the nationa health care expenditures. 5.9% for physician expenditures, which is currently lower than the overall expenditure rate due larglely to the 2% medicare fee for physicians. 19% for overall Medicare part D which caused a spike in prescription drugs. 8.8% in admisistravie fees, which grew faster than the overall rate because of the of the high number of members who joined the Medicare Advantage plan. Medicaid for the first time in history shrank because of the high number of people who enrolled in Medicare Part D. Heath care spending is to high and continues to grow, which means the health care growth rates continue to exceed the overall gross domestic product (GDP) and eventually will surpass other spending. This means that the national health care expenditures will not be sustainable for the future health care system to run efficentlty or at all. In the private sector Medicare has had a sufficent increase in Medicare Advantage...
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...Payment Reform Action Plan: Meeting the New Medicare Payment Reform Target There has been much addressed about the Affordable Health Care Act (ACA). The law was passed to allow preventive care more accessible and affordable to the population. Today, most health care payments are made on a fee-for-service basis, which rewards overuse, promotes waste and inefficiency, and pays little attention to accountability for quality of care. The ACA offered the opportunity to test alternative payment models that pay health providers based on the value of care rather than volume. This change in the law of health care allows payments to healthcare providers on the quality of care, rather than the quantity of care. The models implemented under the ACA rewards health providers who can improve patient outcomes and reduce costs through a variety of approaches, including shared savings, financial risk, and enhanced payments for care coordination and service integration. Some key examples of these new models are patient-centered medical homes, bundled payments, and accountable care organizations. These alternative models are close to meeting the goals of improved quality and reduced cost. The models are also looking to have some promise when it comes to meeting the goal of requiring providers to reduce hospital readmissions and rewarding meaningful use of health information technology (Zeke Emanuel, 2015). Today is the crucial time to apply these new payment models on a more widespread...
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...Health Policy Political Competence Political Competence Senior executives from a variety of organizations are often called to testify about health policy issues. It is in the organization’s best interest if these executives are both politically competent and good corporate citizens. As long as the organizations executives are politically competent and good corporate citizens, whatever statement the corporate representative gives has to be creditable. This means that the representative has to have good ethics, uphold good community responsibility and must show the same level of respect. Although confusing, health policies are the orientation to the health facility by addressing the problems that can be changed. Issues must be identified and executives have to understand the problem and be guided by a model when resolving the issue. Senior executives have to participate in the political process and understand the rules of politics. Excellent executives are able to guild people through excellent ideas and they can generate great results. They must be willing to take action and create the change that is needed, employees need to feel secure and political competence allows them to move forward. In general terms, what knowledge, skills, and individual behaviors must an executive have to politically competent and to be good corporate citizens? The individual must present themselves in a high standard of honesty, have excellent communication skills and most important have...
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...Social Security and Medicare History Present Configuration Future Projection GERO100 March 31, 2012 Hopefully we will all be physically able to work until the age of 65, collect retirement and Social Security and live an enriching life until we leave this world. Not all companies financially support their employees with fully funded retirement plans so it is left up to the individual to actively participate in saving for their future. When someone reaches retirement age, if the finances are there, they are usually only a fraction of what they were making as a full-time employee. This is when one hopes of having Social Security and Medicare benefits to supplement our retirement income for a more stable financial future. There are several reasons the Social Security Act was passed in August 1935. The elderly were living longer due to the availability of better health care, autonomy in workplaces to make jobs easier on individuals, and the modernization of our country’s water systems. Due to this increased longevity in the lives of the elderly, they were also more poverty stricken. An intention of the passage of the Social Security Act was to reduce the burden of loss of income to retired workers aged 65 or older. (Quadagno, 2008) It also included provisions for unemployment insurance, old age assistance and aid to dependent children. Benefits were to be paid based on the primary worker and was to be funded through payroll taxes deducted from the worker’s...
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...large population that are uninsured. There is mounting recognition that our country’s health system is greatly influenced by social determinants, socio-economic status, and environmental factors. The American people continue to face increase cost of health care and insurance premiums continues to increase. Per Cunningham (2010), the percentage of people with a high financial burden increased from 14.4 percent in 2001 to 19.1 percent—nearly one of five Americans—in 2006. The increase in financial burden between 2004 and 2006 (16.4%) occurred at a time when the economy was expanding. “These costs in turn impose a burden on all segments of society—the individuals who pay taxes and premiums, the governments whose budgets are strained by Medicare and Medicaid, and the businesses whose competitiveness is undermined by high health insurance rates” (Daniels & Roberts, 2008). Some evidence have indicated that Patient Center Medical Home models give better quality of care, patient satisfaction with care, care coordination its and better access to care. This model provides the patient not only with a primary care physician but multidisciplinary team with personalized coordinated care across conditions, episodes of care, different providers and settings over time. According to Shortell & Gillies, (2010), the four key elements...
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...Family and Foundation and Altarum Institute, they predict that this dampened spending pattern is unlikely to last much longer. As the economy picks up, health care spending is expected to increase, rising to an annual growth rate of more than 7% annually by the end of the decade (Luhby, 2013). When President Obama released his fiscal 2014 budget he proposed a chained CPI- to shrink cost-of-living adjustments for retirees. The use of chained CPI in Social Security and elsewhere in the budget would reduce deficits by $230 billion over a decade. It is also includes $392 billion in savings from Medicare and other health programs by raising Medicare premiums for wealthy retirees and negotiating for lower prescription drug prices. Of the president proposed allocation of the $3.8 trillion, 25% will go towards Medicare and health (National Priorities, 2013). According to the Centers for Medicare and Medicaid Services (2013), their national health expenditure projections for 2012 and 2013 for health care spending are projected to continue to grow modestly at 4.2 percent and 3.8 percent....
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