Medicare

Medicare’s decision to stop telehealth coverage in 2025: an urgent call to action

Policy
December 25, 2024

Medicare is planning to stop coverage for telehealth in 2025—unless Congress acts by the end of 2024.

According to Medicare’s website:

Absent Congressional action, beginning January 1, 2025, the statutory limitations that were in place for Medicare telehealth services prior to the COVID-19 PHE will retake effect for most telehealth services.

This means most telehealth visits will not be covered by Medicare in 2025, unless Congress acts by the end of December 2024.

Congress …

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How the Medicare Prescription Payment Plan provides a practical solution to medication nonadherence

Policy
December 18, 2024

Starting January 1, 2025, the Medicare Prescription Payment Plan (MPPP) will give providers a powerful way to address one of the biggest barriers to effective care: cost-related medication nonadherence. With 54 million Medicare beneficiaries eligible, this program has the potential to improve adherence, reduce hospital readmissions, and ensure better health outcomes on a large scale. By helping patients access the program, providers can play a pivotal role in transforming patient …

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How fee-for-service shapes your doctor’s decisions

Policy
December 13, 2024

An excerpt from Reshaping Health Systems: What Drives Health Care and How You Can Change It. Copyright © 2024, Wolters Kluwer.

Clinical case

Jessica is a 67-year-old woman having her very first visit with her new primary care clinician, Dr. Jackson. Jessica is accompanied by her husband, Daniel, and comes in with recent laboratory results from her previous clinician, whom she could no longer see because her clinic stopped accepting Jessica’s …

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Congress must fix the Medicare penalty that’s keeping millions from aging at home

Policy
November 18, 2024

People enrolled in Medicare got good news recently. Their annual out-of-pocket costs for Part D prescription drug coverage will be capped at $2,000 next year. That should provide welcome relief to millions of older adults who worry about how they will afford health care now and in the longer term.

Unfortunately, not every person enrolled in Medicare is eligible for the $2,000 cap. A little-known penalty robs some people of the …

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Medicare for all could work if doctors lead the way

Policy
October 17, 2024

Although Medicare for all seems to have gotten buried by politicians who label it as “socialistic,” it’s still an important idea that could be feasible if we approached it from a fresh perspective.

As patients, we may reflexively see Medicare for all as a panacea that would effectively remove most of our concerns about how to pay for our health care. But on the other hand, we may not realize the …

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How drivers of health screenings led to immediate patient impact and practice sustainability

Policy
September 28, 2024

Recently, an elderly patient at my practice unexpectedly began to miss her monthly appointments.

I was alarmed. The patient has atrial fibrillation—a condition characterized by irregular heart rhythms and an increased risk of stroke. The condition demands consistent and timely medical care. For elderly patients like the one in our care, these appointments are not just check-ups. They are vital for adjusting medications, monitoring heart health, and preventing serious complications like …

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Medicare’s cobra effect: How a well-intentioned policy spiraled into a health care crisis

Policy
September 6, 2024

In the sweltering heat of 19th-century colonial Delhi, legend has it that cobras were taking over the streets. To eliminate the dangerous snakes, British officials offered a bounty for every dead cobra brought to government offices. Soon, locals began breeding and killing cobras for profit. When British officers caught wind of the scheme, they ended the program immediately. In response, the breeders released their now-worthless snakes back into the streets, …

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Medicare’s 14-day rule is hurting cancer patients

Policy
July 5, 2024

It is no secret that we are making great strides in reducing the mortality of lung cancer. From improving screening rates which have reduced the chances of dying from lung cancer due to earlier detection, increased adoption of minimally invasive surgical techniques, and exciting new drugs that have been shown to improve survival even in metastatic disease, there is reason to be hopeful in what has usually been a devastating …

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From denial to redemption: a physician’s Medicare battle [PODCAST]

Podcast
January 11, 2024
YouTube video

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We sit down with Catherine L. Chen, an anesthesiologist and health services researcher. Join us as she shares her personal story of facing a Medicare Part B enrollment denial for her mother during a vacation in Hawaii. …

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Medicare coverage saves lives. Enrolling shouldn’t be this complicated.

Physician
November 11, 2023

I never imagined I’d be crying on vacation in Hawaii, but there I was, overwhelmed with worry because my 71-year-old mother’s Medicare Part B enrollment had been denied. A naturalized U.S. citizen, my mom had been living overseas with a rare blood cancer for 20 years. By December 2021, her end-stage disease required bi-weekly blood transfusions; the only hope for cure was a risky stem cell transplant. Therefore, in …

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April 16th is National Healthcare Decisions Day: Plan for your end-of-life care now

Physician
April 16, 2023

When COVID killed thousands of seniors three years ago, few of them showed up in emergency rooms with advance directives. Even fewer thought about the end of life or how to die. Sadly, many lives were discarded in makeshift morgues/cooling trucks behind hospitals. It’s never too early to plan for the next pandemic, retirement, and the end of life.

On April 16, 2023, National Healthcare Decisions Day, take a moment and …

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Don’t fall for the Medicare Advantage hype: the realities of coverage for low-income enrollees [PODCAST]

Podcast
February 16, 2023
YouTube video

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We’re joined by Aniyizhai Annamalai, an internal medicine-psychiatry physician. Dr. Annamalai’s patients are mostly indigent, not employed due to disability, and have serious mental illnesses. Most of them qualify for Medicaid. In this episode, Dr. Annamalai shares …

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End-of-life choices: Why Medicare needs to change [PODCAST]

Podcast
January 21, 2023
YouTube video

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End-of-life care is a crucial and often overlooked aspect of health care. In this episode, we speak with Kevin Haselhorst, an emergency physician and author who shares his insights on the challenges and opportunities in this area. …

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Medicare “Advantage” for my indigent patients

Policy
December 4, 2022

Despite the aggressive marketing, Medicare Advantage plans offer little benefit for poor and vulnerable patients.

Consider my patient C, who was in pain from her knee arthritis. She was often in pain, but now her new pain medication helped her less than her previous one. She also wanted her old asthma inhaler back as the new one was harder to use. We had changed all her medications since her new Medicare …

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CMS Medicare fee cuts: The altruism of physicians is used against them

Policy
August 7, 2022

It’s hard to concisely put into words how frustrated physicians are right now. How many other professional groups out there have to fight to not have their compensation cut multiple times a year? Recently, CMS released its proposed physician fee schedule for Medicare for 2023, which reduces the conversion factor by 4.42%. This compounds upon additional cuts such as the resumption …

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Patients over paperwork: Medicare has delivered lower costs and regulatory relief for health care providers

Policy
October 28, 2020

The COVID-19 public health emergency has highlighted that government rules and regulations should not hinder providers from delivering high-quality care to patients.  The Trump Administration exhibited an understanding of this principle long before the pandemic when it announced the Cut the Red Tape initiative in 2017. With a healthcare system marked by $200 billion in annual administrative costs that contributes to higher costs for patients and …

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Clearing up the confusion surrounding Medicare for all

Policy
September 18, 2019

The Democratic debates this summer demonstrated massive confusion around Medicare for all. Does it mean Medicare for all who want it? Medicare Advantage? A “public option” on an Affordable Care Act (ACA) exchange?

Democrats need to get their story straight.

The confusion is understandable. Medicare for all has been an aspiration since at least the New Deal, but since 1965, when Congress …

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Medicare for all and the problem of health care on demand

Policy
March 10, 2019

The evolving politics of single-payer health care conflate the concepts of universal coverage, health care on demand and free health care. To the indiscriminate progressive mind, all three are part of the holy grail. The fly in the ointment is that highly attractive and altruistic politics runs into the brick wall of reality. As Thomas Sowell — a noted Stanford economist — wrote: “The first lesson of economics is scarcity: …

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Fix the pay imbalance between specialists and primary care physicians

Policy
August 27, 2017

Reformers have expended considerable effort to change the way Medicare buys health care for millions of Americans, finding a wide range of support across the political spectrum. But Medicare’s current structure may doom these reforms. Some primary care doctors fear that the skewed incentives in Medicare’s pricing system will get built into any new system, whether it is “accountable,” “affordable,” or “value-based.” This fear is well-founded. If special interests buy …

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How to perform services that increase primary care revenue

Policy
April 24, 2016

CMS states it wants to increase pay to primary care physicians.  And while we might quarrel with their strategies or with the speed of achieving the goal, few would quarrel with the goal itself.  In recent years, CMS has developed HCPCS codes and adopted CPT codes, some limited to primary care and some not specialty restricted but all likely to be reported by primary care practices. Meanwhile, although payment systems …

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