Medicare

News and updates about Medicare.

The evidence has been piling up that properly done CT scans can help doctors find tiny lung tumors in longtime smokers while the cancer can still be treated effectively.

Now Medicare is proposing to pay for annual scans for beneficiaries at a high risk for lung cancer. To qualify, patients would have to first meet with a doctor to talk through the pros and cons of scans, which involve a low-dose of radiation.

Patients would have to be:

  • Between the ages 55 and 74;

Critics of America's health care system say it's really a "sick care" system. Doctors and hospitals only get paid for treating people when they're sick.

But that's starting to change. Health insurance companies and big government payers like Medicare are starting to reward doctors and hospitals for keeping people healthy.

So, many health care companies are trying to position themselves as organizations that help people stay well.

A disabled woman with serious health problems who successfully challenged Medicare for denying her home health care coverage has racked up another win against the government.

stock photo

“Another possible change in health policy now, the Medicare system is considering starting to pay doctors for their time to they spend counseling patients about how they want their lives to end. Five years ago, you’ll remember the political blowup over what were then being called “Death Panels.” I asked Sound Medicine’s health policy analyst Dr. Aaron Carroll what has changed.”

On a recent afternoon at his office in Hartford, Conn., Dr. Doug Gerard examines a patient complaining of joint pain. He checks her out, asks her a few questions about her symptoms and then orders a few tests before sending her on her way.

For a typical quick visit like this, Gerard could get reimbursed $100 or more from a private insurer. For the same visit, Medicare pays less — about $80. And now, with the new private plans under the Affordable Care Act, Gerard says he would get something in between, but closer to the lower Medicare rates.

Medicare's Hospital Insurance Trust Fund, which finances about half of the health program for seniors and the disabled, won't run out of money until 2030, the program's trustees said Monday. That's four years later than projected last year, and 13 years later than projected the year before the passage of the Affordable Care Act.

The fraud scheme began to unravel last fall, with the discovery of a misdirected stack of bogus prescriptions and a suspicious spike in Medicare drug spending tied to a doctor in Key Biscayne, Fla.

Now it's led to two guilty pleas, as well as an ongoing criminal case against a pharmacy owner.

To grasp Medicare's staggering bill for ambulance rides in New Jersey, just visit the busy parking lot of the DaVita St. Joseph's dialysis clinic in Paterson.

More than 20 ambulances were parked outside on a recent morning there. Emergency medical technicians wheeled patients in and out on stretchers. As soon as one ambulance departed, another took its place.

Healthcare Super-Users

Dec 15, 2013

Sound Medicine: December 7, 2008

Dec 7, 2008

Topics for this week include: Medicare Scams Alert; Update on Gulf War Illness; Did You Know?: A Decline in Cancer Diagnoses; Failure of an Anti-Drug Campaign; Acupuncture for Cancer Symptoms; Checkup: Preventing a Flu Epidemic; Sound Ethics: Prescribing Placebos

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