CMS may cut up to 44% of Medicare payments for cancer treatments....

according to Bay News 9 in Tampa. Here we are talking about health care reform, and the Centers for Medicare and Medicaid Services are talking about huge cuts in cancer treatment for Medicare patients.

This will affect many millions of seniors.

From BayNews9:

Doctors: Reimbursement cuts may affect cancer treatment



I would love to see someone from this administration, specifically Kathleen Sebelius of HHS, address this issue pronto.

what department in the hhs decided to do this when the right-wing is saying obama is going to kill grandma?

god are these people stupid

Cut the f'n military budget for war and apply it to health. What a novel idea. Apparently, much to novel to take hold. :banghead:

and the other perks that come along with the New Christian Crusade.

I know medical equipment is expensive, in fact $2MM is relatively cheap. Equipment is amortized and expected to last a specific period of time. How many treatments is this equip. used for in one year? How many years is it amortized? It doesn't make sense for each treatment to increase 45% just because of new equip.

There's more to this story than we've heard so far,

I missed where it says they are cutting the pay because of new equipment.

claiming that's the reason their costs & billing amounts went up.

and have the superior treatment.

Hard Assets such as Medical Machines are depreciated.

Loans and contracts are amortized.

Nothing short of Universal Healthcare or something like that will work. I am afraid the name of the game is pay us a lot or die.

will find a way to provide it at the lower cost and still make a profit.

Seniors don't deserve so much health care anyway.

:sarcasm:

costs.

I should have known better than to post here about seniors or schools.

yet, you are now saying that medicare does do that and seem to agree it's good for them to do. Don't worry the doctors are not going to stop stealing from medicare, I'm sure their bills were at least 44% over the agreed payments anyway.

Rejoice, my friend. They are phasing it out apparently

statements from seniors on Medicare. You seem to be very anti-Medicare, and I find that a shame.

The bad old seniors and bad old doctors screwing everyone else. I mean that's terrible of them to do that. :sarcasm:

docket. And that's just the ones they've had the time and resources to catch and prosecute. I don't know where you think I've said anything about seniors. I guess if you want to just make things up, I can't stop you.

Most are very caring about the seniors they treat.

Most bill fairly, and get very little indeed.

control the medication costs.

What will happen is that outpatient infusion centers will refuse to see Medicare patients, and force them into hospitals. It will shift the burden from Part B to Part A, and an infusion that used to cost $1000 will now cost $5000.

shoot bankers... there's nothing wrong with our medical system that getting the debt slavers out of it won't cure.

Phasing out Medicare

That's about all that makes sense if they are cutting what has already been cut to the bone.

Many here will rise up and celebrate that seniors won't use up so much money. And yes, I am beoming disillusioned.

like Medicare.

Because what I have heard many DUers insist instead is that we already have rationing by insurance companies. I guess that was just me, or I must have misheard many DUers, or perhaps there is another explanation, but I can't imagine what that other explanation might be, can you?

Everyone knows there will be rationing. What we argue against is the idea that there will be "death panels".

It isn't possible to have a system with no rationing. Why is it wrong and evil when the government does it, but perfectly acceptable when private insurers do it? That is the point DUers have made over and over. You are simply wrong.

Cardiologists Crying Foul Over Obama Medicare Cuts

" Aug. 28 (Bloomberg) -- An Obama administration plan to cut Medicare payments to heart and cancer doctors by $1.4 billion next year is generating a backlash that’s undermining the president’s health-care overhaul.

While President Barack Obama and members of Congress have spent August debating health insurance and medical costs at public forums, specialists are waging what one advocate calls a “tooth and nail” fight against a separate initiative to boost the pay of family doctors, and cut fees for cardiologists and oncologists. The specialists, in newspaper columns and meetings with lawmakers, say patients will lose access to life-saving care, from pacemakers to chemotherapy.

The proposal by Medicare, the government insurer for the elderly and disabled, is an effort by Obama to focus U.S. medicine on preventive care. The fight by physicians who work with the most expensive patients is weakening support for Obama’s broader goal, legislation to remake the health system, said Mark B. McClellan, 46, a former Medicare chief.

“If you can make the health-care debate all about moving slices of the pie around, it’s very easy to generate opposition and very easy to get derailed,” said McClellan, a physician and analyst at the Brookings Institution, a policy research center in Washington, in an interview."

In case you don't get it, the subject line is sarcastic.

They have already cut Medicare until it is squealing, and the propaganda is working....just as it always does.

A cardiologist is all upset he'll net $400,000 a year instead of $600,000. You know I thank the good lord every day for the cardiologist that saved my husband. I really do think the man deserves to be extremely well paid. But if I heard him screaming because he's just not getting enough taxpayer money in his pocket anymore, and how unfair it is that some of that money is being shifted to primary care doctors - I would probably tell him he's a jerk.

We need to get the hell out of Iraq and Afghanistan and put that money towards single-payer health care instead. Oh, and while we're at it, we can cut the defense budget to about 1/10 of what it currently is and still be spending more than any other country on defense. However, Halliburton/KBR/Xe wouldn't like that so our bought-and-paid-for elected "representatives" will never allow that to happen.

treating people at home for the diseases we've given them. Priorities!

The folks who are yelling about death panels and death books will be out in force. :shrug:

I can only hope not. My MIL's expenses were paid through Medicare. My spouse stated to me that he didn't think that a procedure would've been done on her (making an incision in her chest, applying talcum powder around a lung, then leaving an incision open after the drainage tubes were removed) if the doctors had realized at the time that she also had brain cancer. I've determined that should become standard procedure for anyone with lung cancer. (Back story, she originally was diagnosed with breast cancer 25 yrs. ago, had a spot in her throat later which was cleared, this was a pop-up many years later that metastasized to her brain). It was a blessing in disguise for her and those caring for her because people who are very weak are cracking ribs trying to cough up what was draining, and no suctioning machines were required with her.

All of her expenses were taken care of under Medicare. I'll send this to my Mom, and perhaps she'll get politically active for the first time. She was actually shocked when she learned that I'd been in contact with Reps. and Sens. for years. For some reason she just didn't think that it was the thing to do. :crazy:

I admire you for all that you do. :hug:

This time blame our party for hurting seniors.

Good doctors don't cheat Medicare. Yes, if there is a supplemental, seniors pay very little.

accused of ripping off Medicare.

I always say go after the waste, fraud and abusers and prosecute them, but stop f'n it up for everybody else!

At least I don't think so.

The Medicare Advantage plans that are private plans get government help, I forget what they call the payments to them.

Most doctors treat their patients well and bill Medicare fairly.

I remember Frist's group, and I wonder how he gets enough credibility to be on TV.

I'm sure some who do are good doctors, just not ethical

I want to say this will get nixed promptly but the proposed rules were published he proposed rules were initially published in July 13 and July 20 so it is too late to be prompt. Providers have till end of day to submit their comments, nothing is finalized.
I'm sure all costs need to be looked at...but this is so tone deaf

the deathers will be dancing in the streets! Not good.

When I saw it on the news tonight, I was shocked. The 44% shocked me.

Seniors will have to buy more and more expensive supplemental private insurance to cover the gaps in Medicare A & B. Its all part of the plan. The insurance companies and their congress people are all high-fiving each other and licking their lips because of all of the early boomers that start into the medicare system next year. The boomers have no idea how much they will be required to pay for private insurance to cover the greater and greater gaps in medicare A & B. It will be a tsunami.

Meanwhile, everyone else already on medicare will have to go get a job to pay their private insurance premiums or risk bankruptcy. I don't think my 93 year old father can even be a greeter at WalMart. Maybe he can sweep the streets.

Increasing the benefits under supplemental policies wouldn't have any effect because by law, providers who accept Medicare payments cannot bill anyone, not patients nor supplemental policies nor any other entity, for any amount above Medicare's allowable amount. Only the 20% coinsurance on that allowable amount can be billed.

The providers of service, hospitals and doctors, will just be forced to eat it. Or stop accepting Medicare patients.

...."Seniors will have to buy more and more expensive supplemental private insurance to cover the gaps.......".

What gaps? Just using round numbers, if Medicare used to allow $1000 for a procedure, the patient's portion of that bill would have been $200, which could be billed to their supplemental policy if they have one. So then Medicare cuts that allowable amount by 44% to $560, and now the patient's 20% coinsurance is $112, and the provider of service cannot bill anyone for the $440 cut by Medicare.

A more expensive supplemental policy, whether or not it covers more or pays more, won't be of any help to anyone in this situation. Or the similar situation with convalescent facilities which you also made the same silly comment about farther down the thread. These cuts penalize doctors and hospitals and no one else. Well, except the Medicare patients who will have more difficulty finding providers who accept Medicare patients because the reimbursements are so low.

"These cuts penalize doctors and hospitals and no one else. Well, except the Medicare patients who will have more difficulty finding providers who accept Medicare patients because the reimbursements are so low."

This thread makes me feel that though seniors pay monthly for this, and have paid into social security for decades....that they have no right to real quality care...just care if they are lucky.

Of course, Medicare patients can still see those doctors, but they are taken on a cash-only basis.

Using my example above, let's say that the doctor's regular charge for a procedure is $1500. Medicare used to allow $1000 and paid 80%, leaving $200 to be paid by the patient or his/her supplemental insurance and the doctor gets to write-off the $500 balance. Now Medicare will only be allowing $560 and paying 80% of that, the patient's balance is $112, and the doctor is eating a whopping $940 of the original charge. How are they going to keep their practices going if they have to keep taking losses like that?

Now let's take an actual example. The surgeon's bill to remove my Dad's cancerous kidney was $3,220.00, which included his pre-op care and 30 days of inpatient care post-operatively. Medicare only allowed $1,515.93, less than half, and he was prevented by law from billing anyone for the balance. The hospital got beat-up even worse. That bill was $43,931.36 of which Medicare only allowed $12,038.72. Mind you, that was for 3 days in ICU, followed by 11 days in a semi-private room, followed by 10 days in their continuing care facility, followed by three more days in ICU, and finally three days in the oncology unit, including three additional minor procedures, physical therapy and radiation treatments at various times in there. Doctors and hospitals have to cover losses like that somehow, and in the case of physicians, some are just not taking new Medicare patients. Hospitals don't have that option, which is at least a large part of the reason why hospital charges are spiraling out of control.

So over time, more doctors are declining to accept Medicare patients. Now what happens is that the doctor charges his/her regular $1500 fee, for which the patient is 100% responsible. The doctor will send the bill to Medicare for the patient as a courtesy, but Medicare will still only pay $448 (80% of $560) to the patient and he or she is going to have to come up with the other $1052. And even if the patient has a supplemental policy, it's still only going to cover 20% of Medicare's allowable amount, so the patient is still on the hook for the $940 balance. Which is tantamount to not accepting Medicare patients in many cases because many of the elderly can't afford that. And a fair percentage of those doctors are just flat-out not accepting new Medicare patients because often they can't collect.

That's not being cavalier, and it's not age discrimination. It's just cold, hard economic facts.

It does not have to be that way.

I find your defense of cutting Medicare almost too disturbing to handle right now. It is personal, and I find it offensive to defend the cuts under a Democratic administration.

It shows our party is not willing to provide for senior care anymore than the other, and it is scary.

I think Medicare reimbursements are shockingly low already, particularly when doctors and hospitals are prohibited from billing anyone, even a supplemental policy, for their balance or any part of their balance beyond the 20% coinsurance.

I was arguing against Durham's assertion that cuts in Medicare reimbursement levels will force people to by more expensive supplemental policies to make up the difference because no supplemental policy at any price can even be billed for the difference.

Because that's not the way it works here.

Here, if a doctor doesn't accept Medicare assignment, Medicare won't pay anything on it, and, of course, a Medicare supplemental policy won't pay anything on something Medicare doesn't cover. So the patient would be stuck for the entire amount.

I don't know of any doctor in our small city who doesn't accept Medicare assignment, but that can always change, of course.

and other issues. Plus these policies are really expensive. I can't believe that they are proposing such drastic cuts right now.

but they can be expensive for those with limited incomes.
Not having them is quite a problem for them too though. The deductible, the 20% co-pay for everything can really add up.

However the supplemental insurance doesn't pay more for the cut services, just means they do the co-pay instead of the individual.

I can't believe the timing of this either.

If this is true, I am disappointed beyond belief. I thought we elected a Democrat last November?

What the FUCK could this administration possibly be thinking right now? Are they trying to sabotage their own efforts to fix health care?

There is not long term care under Medicare, but there is a stay in a nursing home after a hospital stay if needed. I believe my father had about 2 weeks after hip surgery, and it was absolutely necessary.

Here is the piece from Roll Call:

Proposed Medicare Cuts Put Seniors’ Care at Risk

Just buy private insurance to cover the gap. Premiums are skyrocketing already.

The younger generations wants single payer like medicare - little do they know the dramatic changes taking place to this previously public program that is turning it into a private program.

Many of them on Medicare Advantage plans don't realize those are privatized already.

The last administration put no regulations on insurance companies hustling seniors to change from traditional, and it is time this one did that.

But during the Bush admin the Medicare advantage plans were set up, and they are able to send ads to seniors in deluges to get them to join their plan. I have seen ads geared to convince seniors they have to change. They don't.

A person is automatically on Medicare at age 65, and they don't have to do anything much at all.

I just did a search on the words Medicare Advantage plan, and here is a lot of stuff.

http://www.google.com/search?pz=1&ned=us&hl=en&q=Medicare+advantage+plans&btnmeta%3Dsearch%3Dsearch=Search+the+Web

If they don't do anything but enroll in medicare A & B and pay the $96.40 a month premium they face this:

$1,068 deductible for each hospital stay. 20% of all of the costs of procedures, etc. Those surgeon's bills and hospital costs can add up fast.

For doctor visits - $135 deductible and 20% of all other costs for tests, out patient services, doctor visits.

For prescriptions - they pay 100% of costs.

To cover the gaps and deductibles and because seniors know they need to be fully covered they obtain private insurance coverage. Could be Medicare Advantage or could be Medicare Supplemental or some other program. Regardless insurance premiums go up while government covered benefits go down.

Medicare Advantage are confusing to seniors because no one is explaining them to them.

I think we are agreeing on this basically. Medicare could be much better in many ways, but drastic cuts will not help it right now.

So who is making the decisions?

Be sure to read the article and don't miss the comments at the end of it.

Lack of Medicare Appointee Puzzles Congress

I knew it was under the HHS, but I thought he had a person in there. I really wonder who is making these decisions right now.

:hi:

He is having a hard time getting people through the vetting process. And there is a backlog of people waiting to be confirmed by the senate. To many out there want perfection and it chases away perfectly good people. Its a nightmare I certainly wouldn't want to go through and our partisan politics isn't making it any easier as every party looks for advantage through the perceived inadequacies of the candidates.

http://edition.cnn.com/2009/POLITICS/08/25/obama.vacancies/

I just looking and could not find it.

I do hate being accused of demanding perfection when they are cutting 44% from cancer treatment.

I have no idea who the candidate is. My point is he is trying to fill these positions and it hasnt been a cake walk. Its not through lack of effort or "inaction" that these positions arent filled.

The article I linked spells it out pretty well.

I don't think this issue of cutting Medicare to the bone makes sense, and it is a stressful issue to seniors right now.

I am sure he is trying to fill positions, but this one is a major one. I am just trying to find out who is making the decisions for these drastic cuts.

I resent people who disagree just to be disagreeable when I have posted something sensible and important.

This forum is so protective right now that anything honest said is put down. I understand that.

But this will keep many doctors from taking Medicare patients.

I was replying to a poster who asked if you were surprised by his inaction on getting this possition filled implying that obama was doing nothing. You aparently agree with that poster or you wouldnt have replied to my post.

I didnt adress the cutting in medicare coverage at all. I will reserve my judgement on that till I know more.

What I do know is Obama is not willfully sitting on his butt leaving this position open as the poster I was responding to was implying.

http://massdevice.com/blogs/edward-berger/cms-administrator-does-anybody-want-job

Several highly qualified candidates have reportedly turned down offers from President Barack Obama's administration to take the helm at Medicare. Why?

President Barack Obama's healthcare reform initiative, after what many had seen as a badly compromised and possibly debilitating start when the nomination of Tom Daschle as Dept. of Health and Human Services secretary crashed and burned in early February.....

As far back as January 28, the In Vivo Blog reported being told by multiple sources that selection of the CMS Administrator had been made, floating a number of names, including:
— Denis Cortese, Mayo Clinic CEO;
— Donald Berwick, CEO of the Institute for Health Care Improvement;
— Robert Berenson, former head of Payment Policy and Group Contracting at CMS, member of Obama's transition team, a Medicare Payment Assessment Commission (MedPAC) commissioner, and Senior Health Policy Fellow at The Urban Institute;
— Hamburg (recently named to the top FDA post);
— Judy Feder, Clinton health policy advisor, member of Ira Magaziner's ill-fated Clinton administration health reform task force and former DHHS assistant secretary for planning and evaluation;
— and David Blumenthal, director of the Massachusetts General Hospital's Institute for Health Policy.

At least one Washington insider has told me that it is widely believed that at least two of those candidates, Berwick and Berenson, have been offered and have declined the administrator's position. That same source added the name of Glenn Steele, head of Pennsylvania's Geisinger Health System, to the list of candidates — but In Vivo reported just last week that Steele had withdrawn from consideration.


--------------------------------------------------------------------------------------



Pretending its a conspiracy by obama to leave the spot open is silly.

But I want to know who is recommending the drastic cuts. It is a fair question.

I said nothing whatsoever about the cuts and I didnt respond to you to begin with.

There was no malice intended. I don't know why you are angry?

Who said I was angry? I replied to a poster asking if you were suprised by the "inaction". implying that obama was holding out on trying to fill the spot.

I wasnt responding to you and all I did was point out that it had nothing to do with inaction.

To which you have been responding to me with phrases like

I do hate being accused... and I resent people who disagree just to be disagreeable.

I wasnt doing either. I was pointing out that it had nothing to do with inaction?

Why are you continuing to take offense at that?

Taking on the helm of Medicare at this point in time would be career suicide no matter who was in the White House. What has to be done is not pretty and will easily be spun in a bad light. I have no doubt in my mind, if the McGrandpa was in the WH the Democratic party would be in full attack mode on whoever was stupid enough to take the Medicare job.

That could be one thing to be fixed. Then the Medicare cuts would not have to be so drastic.

$43 Billion In Extra Payments Have Been Made To Private Medicare Advantage Plans Since 2004

are a scam. They are privatization of Medicare, pure and simple. Too many people have fallen for this, I fear. Since "Medicare" is still in the name, seniors think it is still part of Medicare. It isn't. The first year that Part D came out (under the Bush administration), some people were lured these "Disadvantage" plans by the offering of free Part D (prescription) coverage. Since then, the premiums have skyrocketed. The private insurance companies get the Medicare Part B premium (which is deducted from Social Security checks), and the beneficiary is no longer under the rules of Medicare. The private insurers are free to make up their own rules, which they do. It's terrible.

be more covered but not less.

They are what Obama wants to completely cut though as big money saver.
But if that needs congressional approval I wonder if the same lobbying money will make that difficult.

premiums in two years. $29 a month. Private insurers are not free to make up their own rules, save that they can offer more than Trad Medicare, but never less. So fact check is your friend.

Unlike many youthful people who don't know many facts, most Medicare beneficiaries do in fact know exactly who they are paying. For example, kid, premium checks are written out to Private Companies, and most folks understand what writing a check means, no matter what you want to think about 'seniors'.
Rather than make assumptions, anyone approaching these issues needs to learn all of the facts, and never ever make false statements, and also cease writing that 'seniors' do not understand this or that, because most do, and also because one third of beneficiaries are not even seniors, duh, but are disabled people. I guess you think that wheelchair makes them too stupid to understand a basic business transaction? That a check to United Health is in fact a check to United Health?
Being arrogant and uninformed will gain nothing for no one.

And I don't think I'm uninformed, either.

When I checked out a Medicare Advantage Plan, it did not cover as much as Medicare. The representative told me "forget what you know about Medicare — it doesn't apply." That was enough to keep me away from the plan he was touting. And I am one of those disabled people you're talking about. He told me that instead of the Part B premium that comes out of my Social Security going to the government (Medicare), it would go to his employer (a private insurance company, in this case Humana). When I called the doctor's office, they said, "Don't do it. They don't fall under the same rules as Medicare" (which the representative had already told me), "and they don't cover nearly as much as Medicare."

So unless both the representative that was selling the plan and my doctor are wrong, then I have my facts straight.

It would seem to be that you are the arrogant one.

:puke:

If we want the government to spend more to take care of our grandma's for us, then we are going to have to give our government more money to do it.


As for CMS cutting payouts to doctors who invested in expensive machines thinking they would get full time payouts for part time use of the machine. Tough shit on them for making an ignorant business decision based on pure fucking greed rather than based whether patients who might not benefit from less expensive forms of treatment needed access to the technology.

That said, some adjustment will need to be made to keep some of this technology available in the western US where the closest neighbor is an hour away and demand on advanced machinery is limited because of the low density of the population.

http://www.emaxhealth.com/2/98/32869/radiation-therapy-equipment-use-rates-low.html

and cause less longterm damage to tissue are not meant for seniors?

Gee, my neighbor with prostate cancer might differ with you. They target a much smaller area than just a couple of years ago, and they cause less damage to surrounding tissue.

If there are so many machines in a major city that they only need to be used part time then there are too many machines. CMS is telling the owners of the machines the payments will now be based on a 90% usage rate rather than a 40% usage rate. Naturally, since there are too damn many machines in the marketplace, that is going to put the redundant one's out of business.

At a 90% usage rate there should not be ANY problem with seniors having access to the technology if they really need it. Seniors aren't being denied anything.


We do all this screaming about obscene profits in healthcare, but when the government actually makes a move that will keep the technology accessible and also force some of the greed out of the system, we all come unglued about killing and maiming grandma. I don't get it.

We have been through it. The doctors were wonderful and deserved far more than they got.

They had to struggle and file and refile with just the right terminology to even get that.

I am grateful for the technology and want it to be available to everyone. Paying for twice the machines we actually need is wasteful and takes money away from other things. A *NOT* greedy doctor will support the same I would think.

pharmacist who admitted watering down expensive chemotherapy drugs. He'd done it for alost a decade, affecting thousands.
http://www.nytimes.com/2003/06/08/magazine/the-toxic-pharmacist.html
It shocked those who knew him as he was highly respected
It was such a disgusting crime...but you get a sinking feeling others might do it sometimes too and just are not caught. It's not like pain pills where everything is closely tracked and anything fishy is picked up right away.

How much greed is there in cancer care? I'm sure there is an immense amount, money is there. You can find a lot of fraud regarding cancer "treatment" but it usually is billing for services not provided or patients who don't exist or billing for infusion drugs that they got free...not doing things that endanger people with cancer

But that doesn't mean a majority are not just as you describe.
60 minutes had that segment on the only oncology center that would treat the uninsured (in Nevada?) closing down due to budget cuts. Most of the people just got no more treatment. Horrible when they showed the single mom with advanced breast cancer getting her rented home hospital bed that use to be paid for being taken away.
But the gyn-oncologist just kept treating his patients because he felt he could not abandon them. I don't recall if he was going to take new cases too but thanks God for him, for his choice.

I hate it when people keep saying the uninsured can go to the emergency room. They can't get treatment for chronic conditions that way, can't get chemo or radiation or cancer surgery. And it's not free care...they get billed...and sent to collections and dunned and bankrupted.
That's another story.

The main heartbreak of it is having something like cancer and no treatment.

ownership to the crisis.

and how worthy are those price increases higher and higher....

they are PART of the problem

this doesn't exactly show it in a light that will be looked upon favorably, does it?

with Medicare, but in addition to the $96.40 that comes out of my Social Security for Part B (outpatient care), I pay $199 a month for a Medicare supplemental policy (private insurance) to pick up the deductible and co-pay and $93.50 for a Medicare Part D Prescription plan (private insurance) and I hit the "gap" in prescription coverage by April. Very pricey. Every year, the prescription plans change and I have to go hunting again for the one that's best for me, and it's not an easy thing to figure out.

I have decided to die so that what I have been able to acquire can pass to my children.

espouse that policy. But when it gets right down to it, the survival instinct is pretty strong, coupled with the fact that it's likely that your children would trade their inheritance for a little more time with you.

One of my sons also has a disability.