...States government spent $1.3 trillion on healthcare, mainly on Medicare and Medicaid, which are the government funded health insurances primarily for seniors and people with disabilities and low incomes. This report not only surprises us but raises a crucial question. Is there a way to reduce the cost of the healthcare, yet provide high quality of medical services? To resolve the high cost issue in Medicare and Medi-Cal, the California state government and the federal government agreed to introduce a new healthcare plan called the Coordinated Care Initiative (CCI), which will combine Medicare and Medi-Cal into one system. The CCI will bring notable plan changes to the people who have both Medicare and Medi-Cal, called the dual beneficiaries. The implementation of the CCI is the solution to the government funded health insurance since it will prevent the abusive use of Medicare and Medi-Cal plans yet provide beneficiaries well-coordinated healthcare and easier access to the healthcare providers. First of all, the CCI is the solution to the high cost in healthcare since it will prevent imprudent use of Medicare and Medi-Cal. Abusive uses of healthcare plans by dual beneficiaries have been a persistent problem. According to the Centers of Medicare and Medicaid Services, the average medical bills spent by the dual beneficiaries, who are 100% covered by their plans, were approximately ten times more than that of beneficiaries who only own Medicare, who are responsible for the 20% of...
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...Rolunda Baker Medicare Crisis Medicare is another project of Lyndon Baines Johnson Great Society. Spending is obviously out of control. On June 5th the government announced that the Medicare Trust Fund would go broke if something isn’t done with the spending (nationaldebt). In 1965 when LBJ started Health and Medicare, the Total Federal Spending for the year was $101 Billion. By the year 2000 we will spend over 4 times than amount on Health and Medicare alone, and Medicare will equal the annual spending for Defense (CNN). Medicare was a program that was not acceptable gracefully by the Liberal/Socialists. You might keep this in mind when we get to the point where we have to choose what we CAN do versus what we would LIKE to do. According to CMS the government predict that if healthcare keeps going the in the current direction the cost of Medicare will have exceeded defense spending, unlike other Healthcare systems the US healthcare has been a problem for the government as well for it has added to the enormous debt the country already has. Another major problem of Medicare is that the government does not regulate Medicare enough (Medicare). Medicare affects all different aspects of different programs. For instance Medicare affects Social Security (national debt). Social Security has already exceeded Defense spending by almost double. Just like Medicare, Social Security is being abused. So many people abuse the system, by that i mean people take advantage of it. It is different...
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...Managed Care & Health Insur Professor: Keri Bahar Week 7 – Webliography Contribution Reforming Medicare in the age of Deficit Reduction Date: 04/16/2014 Webliography Contribution Entry / Reference 1: Urban Institute (2013). Can Medicare Be Preserved While Reducing the Deficit? Timely Analysis of Immediate Health Policy Issues. Retrieved from: http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf404766/subassets/rwjf404766_1 This reference help the current healthcare insurance and managed healthcare issues to reach the right set of policy to make changes that could correct long-standing gaps in financial protections that Medicare beneficiaries face, promote greater efficiency within payment systems, and generate the additional revenues necessary to pay for the impending surge in the number of beneficiaries. Entry / Reference 2: Steckenride, Janie, Parrott, Tonya (1998). New Directions in Old-Age Policies. The Health Care Policies and Older Americans. Retrieved from: http://books.google.ae/books?id=rwR4rpIrvW0C&pg=PA19&lpg=PA19&dq=Reforming+Medicare+in+the+age+of+Deficit+Reduction&source=bl&ots=ZtGKc36-o3&sig=00b8wDb48nxaR4uqWAHTms1slBU&hl=en&sa=X&ei=SKgJU77mK8eb0QW-44C4AQ&ved=0CDUQ6AEwAjgU#v=onepage&q=Reforming%20Med&f=false This reference help the current healthcare insurance and managed healthcare issues to explores the changed political environment in the United States and what it means for the policies...
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...Healthcare Ecosystems LLT Task 2 Jacqueline Sanders Western Governors University Healthcare facilities are required to maintain licensure, certification, and accreditation in order to receive payments from federal government programs such as Medicare. Healthcare facilities must meet the minimum standards in order to operate, such as sufficient staffing, personnel employed to provide services, the quality of equipment, buildings, and supplies, and services provided, including health records. (LaTour, 2013) Medicare has developed Conditions of Participation and Conditions for Coverage, which identifies specific criteria that must be met in order to receive reimbursement from Medicare. Medicare implements these guidelines in order to set a standard for improving quality of care and maintaining the health and safety of its beneficiaries. (CMS, 2013) State agencies conduct annual surveys of licensed facilties to ensure they are operating at or above the minimum standards set forth by the sate and CMS. It is imperative for licensed healthcare agencies to meet the guidelines of the Conditions of Participation in order to receive reimbursement, if they do not meet the minimum standards they could be unable to participate with Medicare, thus losing patients and revenue. Physician Quality Reporting System requires healthcare providers and hospitals to meet clinical quality standards and record them. Physician Quality Reporting System is a program implemented by Medicare that...
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...Memo To: Representative Howard Hughes From: Date: Re: Panel discussion on funding Medicare crisis Message: Below please find outline of current Medicare cost concerns as well as some history on the program as well as some plan options to cutting overall costs. Medicare is facing a major financial crisis. The federal government subsidizes medical care for more than 45 million elderly and disabled Americans through Medicare. Medicare is the third-largest federal program after Social Security and defense, and it will cost taxpayers about $430 billion in fiscal year 2010. Medicare is one of the fastest-growing programs in the federal budget, with spending likely to double over the next decade and to surpass Social Security spending by 2028. Numerous studies suggest that about one-third of Medicare spending is wasted. [ (Edwards, 2010) ] Many elderly people may believe that Medicare is an insurance plan as they pay into the cost and are charged for co-pays. Although it’s been known as welfare program, led by the government there is controversy regarding this. AARP Vise President, Joyce Rogers stated AARP is focused on protecting Social Security and Medicare for the millions of beneficiaries who have paid into the systems over their working lives. Rogers’ statement follows: “Medicare is not a welfare program. Seniors pay into Medicare their entire working lives based on the promise that they’ll have secure health coverage when they retire. Applying a means test...
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...lessen the disagreements among politicians regarding how Medicare should be governed, protect it, and come up with a feasible solution for cost containment? Here in Alabama, there has been close to 98,000 people sign up for the Affordable Care Act (ACA) (arisecitizens.org). This shows that there is a need for healthcare coverage within this state. However, with this increase in people inundating the system, there could be a possible rise in cost. Specifically, there could be a rise in Medicare. This program was signed into law on July 30, 1965 (SSA.gov). It is designed to take care of the elderly at 65 years and older, certain individuals who are disabled, and people who have kidney disease (CMS.gov). Even though this program is not income specific, it does help more low income people and individuals who have bad health issues and it is also a target for political battles (Tietelbaum & Wilensky, 2014).There are Republicans who are opposed to Obamacare and want to run Medicare their way. Then there are Democrats who want the program ran another way. They are in favor of Obamacare and see a positive outcome now and in the future. As for the public, the divide among politicians is equally the same amongst Americans. There are individuals who are in favor of Obamacare and there are others who are opposed to it. There are the hospitals and its doctors and staff who will be affected through the number of patients seen and Medicare payments, to name a couple. Overall, Obamacare gives...
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...provision within the ACA and it is important to note that from a financial standpoint it is in the states’ best interest to take part in this expansion because the federal government is going to cover all expansion costs for the first 5 years and subsequently decrease it afterwards—but only by a nominal margin. However, a problem comes with this expansion when you take a closer look; a newly saturated beneficiary pool with the same or decreasing number of primary care physicians that will accept them. This is going to spell disaster for all Medicaid beneficiaries and the states that partake in this expansion. This expansion should be cut from Obamacare all together and have the funds reallocated in two ways: 1. increase the number of primary care physicians by subsidizing their degrees (i.e. similar to Medicare) and 2. create federal mandated minimums that states must pay doctors who accept Medicaid. Medicaid currently accounts for an average of 24% of state budgetary spending. This is partially due in part to Medicaid beneficiaries going to the emergency room for minor health issues that could better be served by a primary care physician. Individuals are doing this because there is a lack of primary care physicians that will accept Medicaid. Take for example California and its MediCal program; only 54% of doctors in California accept MediCal at all and half of that are accepting new patients. California and many other states pay doctors only 30 to 40 percent of what...
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...------------------------------------------------- medicare trust fund January 17, 2016 Charles gunter January 17, 2016 Charles gunter In 1965, United States instituted the most influential health program in our history. The Medicare and Medicaid program ensured that the aged, disabled, and poor had access to healthcare. The importance of a healthy society had finally made it to the mainstream and become a part of public policy. In this presentation, we will discuss the Medicare program. The Social Security Administration hosts the program and the “Centers for Medicare & Medicaid Services (CMS), a branch of the Department of Health and Human Services (HHS), is the federal agency that runs the Medicare Program” (Centers for Medicare & Medicaid Services, 2015). To enable these programs to work, funds must be allotted for services. The Medicare Trust Fund is one such vehicle. Currently, although suffering a few hits over the years, the Medicare Trust Fund has expanded and contracted through healthy and unhealthy periods (mostly healthy). Fortunately for the rapidly expanding American elderly population, the current state of the fund is promising. The fund has historically faced challenges and may continue to do so, but policymakers are faced with such a large aging (and voting!) population that the health of Medicare will always be top priority. Many factors that create challenge include fund solvency, fraud, and the growth of the population who fall within Medicare eligibility. Here...
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...the Affordable Care Act can apply to Puerto Rico and the impacting the Medicare, Medicare patient services and employees. Most of the people in the island think that the Affordable Care Act is giving more security and help to address the existing disparities in the healthcare system. With the new Patient Protection & Affordable Care Act, the insurance companies can no longer drop the coverage if one becomes sick, bill individual into bankruptcy because of an annual or lifetime limit, and they will not be able to discriminate against anyone with a pre existing condition. Most of the Medicare and Medicaid community suffers do to the imbalance in our healthcare system this situation affects the quality of care and places a financial strain on the government, individuals and families, employers and employees, and public and private providers. Most of the Medicare beneficiaries have to enroll in the MA program to help them to succeed and receive the adequate treatments without MA to help the disadvantaged seniors on the island, Puerto Rico's elderly citizens will be forced to turn to Mi Salud in larger numbers. Although Mi Salud is scheduled to receive an average of $690 million annually during the next five years, the widening deficit in MA funding is likely to create a net negative impact on federal funding for healthcare in Puerto Rico. The Health care Policies and Issues Ethical concerns and issues The Affordable Care Act (ACA) policies are intended to give patients...
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...Healthcare Support Services- Public Health/ Medicare With today’s social, cultural, political and economic shifts, public health has become a huge topic of concern. More and more communities are depending on public health organizations for information, education and assistance in maintaining a healthy society. In The Untilled Fields of Public Health, Charles-Edward Amory Winslow defines public health as “the science and art of preventing diseases, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals” (Charles-Edward Amory). Public health is a non-exclusive entity. In public health, the “community” in which an issue is concerned with includes all people affected by a specific concern, illness, affliction, policy or law. Public health considers the community, not an individual, as the patient in which a proactive stance is taken, rather than a reactive one. Public health uses demographics and statistics to predict health issues and acts in accordance with those predictions to try and prevent illness or disease that a community might be at a high risk for. Public health accomplishes this by promoting awareness through providing education and information, as well as providing services that might be needed for the prevention of said illness or disease. The demographics of public health, as a whole, are non-existent. Public health is an all-inclusive organization...
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...Medicare Fraud: The History, Incidence, Costs and Institutional Remedies John H Everett Wayland Baptist Medicare Fraud: The History, Incidence, Costs and Institutional Remedies What is Medicare fraud? ("F&A," 2011, p. 1) states “Medicare fraud happens when Medicare is billed for services or supplies you never got. Medicare fraud costs Medicare a lot of money each year.” What is Medicare abuse? ("F&A," 2011, p. 1) defines this as “Abuse occurs when doctors or suppliers don’t follow good medical practices, resulting in unnecessary costs to Medicare, improper payment, or services that aren’t medically necessary.” In reviewing the definitions of fraud and abuse by Medicare it may be hard for some people to understand if they do not live in the healthcare world daily. In an effort to help shed some light on this, we will look at the history of Medicare fraud. It has been around since the Civil War, when the False Claims Act (FCA) was created. It was also called the Qui Tam Statue meaning “he who sues for the king as himself.” ("FCA," 2011, p. 1) “The law was targeted at stopping dishonest suppliers to the military Union military at a time when the war effort made it all but impossible for the government to investigate and prosecute the fraud itself. Today it serves a similar purpose because of the enormous size of the federal government and the variety or programs under which it expends taxpayer funds.” In 1986 the FCA has been revised over the...
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...momentum for social reform during the 1960’s, the strongly Democratic Congress decided to enact the Medicare program as a way to provide much needed health care insurance for the large population of elderly Americans. In “Introduction to US Health Policy”, Donald Barr highlights that when Medicare was passed in 1965, only about 56 percent of elderly citizens in the United States had any form of hospital insurance. Since aging is an inescapable fate of every person, there was an American consensus that no one should face financial ruin due to the rising costs of receiving health care during their elderly years which served as a catalyst for this program’s formation. The passage of the Affordable Care Act in 2010 has further...
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...Care. As a direct result of this there are going to be more people on Medicaid and also more “baby-boomers” are going to be turning sixty-five thus qualifying for Medicare. Although fewer doctors are accepting government insured patients! This paper will research the number of doctors accepting governmentally insured patients and also if there is a shortage in the number of providers as the PPACA goes into effect. With data provided from the American Medical Association (AMA), Center for Disease Control (CDC), and other academic journals an evaluation is going to be made of if there is enough doctors to meet the demand of newly insured patients in the US. Issues of access and quality of care will also be addressed in this paper. Are Doctors accepting Government Insured Patients as Obama has Signed the Affordable Care Act On March 23, 2010 President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), also known as Obama Care. As a direct result of this there are going to be more people on Medicaid and also more “baby-boomers” are going to be turning sixty-five thus qualifying for Medicare. Although fewer doctors are accepting government insured patients (Tanne, 2010). This paper will research the number of doctors accepting governmentally insured patients specifically Medicaid beneficiaries and also if there is a shortage in the number of providers as the PPACA goes into effect. Medicaid plays one of the most significance roles...
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...and both major and minor (or easily treatable diseases) can be expensive to treat. The Unites States, like many other counties of the world, is in a health care crisis. Also like other countries, the U.S. government has stepped to the plate to try to find a solution to be sure not only the aging population’s medical needs are met but also all other citizens of the country. Health Care Reform and health care costs are a current hot topic for the U.S., and many ideas, solutions, and opinions exists on the issue. To further evaluate and gain alternative perspective, three articles (each with a different perspective on the subject) have been reviewed and summarized to help reach a better understanding of what the aging population and rising health care costs they will accrue means to the financial state of the Unites States. Article one is an article related to the increasing demand for medical offices themselves. According to a report from Marcus and Milichap’s healthcare real estate group (2007), the next 10 years will be in high demand of medical office space to help aid the aging population. With the 55-plus population expected to increase by 25% (15 million people through 2017), the report projects that investors and developers will increasingly look to this office niche for...
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...The Financial Impact of Medicare Rates on a Health Service Organization in Relation to Baby Boomers Retiring Name: Institution: The Financial Impact of Medicare Rates on a Health Service Organization in Relation to Baby Boomers Retiring Baby boomers are adults nearing retirement age and also those who have already retired particularly from 65 years and above. It is the population that was born between the years 1946 and 1964 (Howard, 2009). Baby boomers retire each day in the U.S, and this compromises health care delivery in health service organizations. Today, long term care is in crisis especially in the United States. Statistics indicate that the current health system in the nation is not meeting the needs of baby boomers. This is expected to worsen as according to the census bureau in US; the number of baby boomers is expected to be 77million by the year 2029 (as cited in Richard & Corina, 2010). Baby boomers affect health service organizations financially in that they require critical, attentive and in most cases expensive care. In respect to this, many of them lack Medicare insurance, and this becomes a problem. The massive number of retiring baby boomers will put pressure on the current healthcare system. Approximately three million baby boomers retire each year. Baby boomers impact on health care is overshadowed due to budget battles and federal reform. This paper explores the financial impact of Medicare rates on a health service organization in relation to baby...
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