Medicare

Patients pay when Medicare care coordination codes go unused

Conditions

May 6, 2026

In my years as an ICU nurse, I learned to recognize a pattern. The patients I cared for in trauma surgical intensive care often arrived after a cascade of preventable events. A missed medication. A symptom that went unaddressed. A follow-up appointment that never happened. By the time they reached my unit, the question was no longer how to keep them well at home. It was how to bring them …

Medicare practice expense cuts will hurt patients

John Birkmeyer, MD

Policy

April 25, 2026

Recent federal cuts to how Medicare pays physicians are likely to deliver significant negative consequences to independent medical practices.

The Centers for Medicare and Medicaid Services’ (CMS) final rule for the 2026 Medicare Physician Fee Schedule imposes a dramatic reduction in payment rates for medical services performed in hospital settings by independent clinicians.

The payment reduction fails to account for the true resource costs incurred by independent physician practices, creating an …

Medicare payment is failing rural health

Saravanan Kasthuri, MD

Policy

December 5, 2025

Ten years ago, I quit my job and started a solo office-based practice in rural Washington. I serve patients like Mr. G, an elderly gentleman who drove over 70 miles through mountain passes and rural highways to receive care for gangrene of his foot, as nearby hospitals were either too full or too far away. But Medicare’s broken payment system is endangering practices like mine, quietly dismantling access to affordable …

Congress must make telemedicine permanent now

Ryan Nadelson, MD

Policy

September 30, 2025

On October 1, unless Congress acts, millions of Americans will lose access to telemedicine. A proven tool that has kept patients safe, doctors present, and costs down will vanish not because it failed, but because lawmakers failed to make it permanent. That would not just be bad policy. It would be malpractice by Congress.

I think of a patient of mine in northeast Georgia who lives 90 minutes from my clinic. …

How the Medicare Prescription Payment Plan transforms health care [PODCAST]

The Podcast by KevinMD

Podcast

January 24, 2025

Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Brian Whorley, a health care executive, dives into the groundbreaking Medicare Prescription Payment Plan (MPPP), exploring its potential to revolutionize medication adherence and patient outcomes. With 54 million beneficiaries eligible, this initiative promises …

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

Stephanie Marcovici

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 …

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

Brian Whorley, MBA

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 …

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

Jonathan Staloff, MD & Joseph H. Joo, MD & Joshua Liao, MD

Policy

December 13, 2024

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 …

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

Shawn Bloom

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 …

Medicare for all could work if doctors lead the way

Drew Remignanti, MD, MPH

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 …

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

Ripley Hollister, MD

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 …

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

Robert Pearl, MD

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, …

Medicare’s 14-day rule is hurting cancer patients

Sean Jordan, MD

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 …

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

The Podcast by KevinMD

Podcast

January 11, 2024

Subscribe to The Podcast by KevinMD. Catch up on old episodes!

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. …

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

Catherine L. Chen, MD, MPH

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 …

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

Kevin Haselhorst, MD

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 …

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

The Podcast by KevinMD

Podcast

February 16, 2023

Subscribe to The Podcast by KevinMD. Catch up on old episodes!

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 …

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

The Podcast by KevinMD

Podcast

January 21, 2023

Subscribe to The Podcast by KevinMD. Catch up on old episodes!

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. …

Medicare “Advantage” for my indigent patients

Aniyizhai Annamalai, MD

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 …

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

Nisha Mehta, MD

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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