Medicare may require an ACO(HMO) by 2030

[VanWinkle]

In an effort to reduce the cost of Medicare, those on original Medicare may join the ranks of the HMO or ACO(accountable care organizations) as the government likes to use a new name that seniors won't reject. An interesting article from Humble Dollar.

https://humbledollar.com/2022/06/rx..._medium=email&utm_campaign=another-ses-test_7


"By the time the Affordable Care Act was formulated, health maintenance organizations had fallen into such disfavor that they needed a rebranding. ACOs are thinly veiled cousins of health maintenance organizations. The goal: Put the onus on the health care organization to control the cost of care."

 

[Gotadimple]

In an effort to reduce the cost of Medicare, those on original Medicare may join the ranks of the HMO or ACO(accountable care organizations) as the government likes to use a new name that seniors won't reject. An interesting article from Humble Dollar.
...

"By the time the Affordable Care Act was formulated, health maintenance organizations had fallen into such disfavor that they needed a rebranding. ACOs are thinly veiled cousins of health maintenance organizations. The goal: Put the onus on the health care organization to control the cost of care."

That's what they call Medicare Advantage today. Same deal: use of HMO or PPO organizations who take on the risk and surely would cut costs. They also receive a cut of the Part B premium for bearing the burden. But the Medicare Advantage program has not cut costs, in fact it is more expensive to the US Taxpayer than Traditional Medicare.
https://www.kff.org/medicare/press-...osted-medicare-spending-by-7-billion-in-2019/

Why? Because Medigap expenses are included in the cost of Medicare Advantage plans, while those on Traditional Medicare who want to cover the gap must get Medigap directly from the insurer. That's one explanation. The second is a quality measurement bonus awarded to Medicare Advantage Plans who meet certain targets for the quality of care, which has nothing to do with the cost of the care.

As noted in the article, this is a top-down approach to cut costs (without, it seems, any plan to get to reason for the cost of care - in my opinion).

This is pending legislation, probably won't look the way the author describes, and very painful to watch developing over the next 8 years.

We'll see.

- Rita

 

[ivinsfan]

An interesting article that doesn't directly address the quote "extra cost" is actually going into insurance companies pockets and not direct care.

The insurance companies get well over part B costs they get hundreds of dollars per recipient every single month. IMO advantage programs started as grifting by the insurance lobby. This is what people pushing Medicare for all don't understand.

 

[ncbill]

The above is my fear...no matter the name, being forced into what is a HMO & then needing some sort of therapy where the standard of care is, say, several weeks.

But the HMO will only pay for a few days & with its byzantine appeals process I'm forced to pay out-of-pocket thousands of bucks to complete my course of treatment...and even that amount is too little to litigate, assuming I'm not bound by arbitration.

 

[Aerides]

Do you have other sources besides the "humble dollar" blog that substantiate the theory or is this basically editorial opinions?

 

[mf15]

So far medicare and a supplement work great,they should not mess with it too much.

Oldmike

 

[ivinsfan]

Do you have other sources besides the "humble dollar" blog that substantiate the theory or is this basically editorial opinions?

How about the fact that advantage premiums can be paid with HSA money and traditional Medicare supplements cannot . It's the future IMO.

How about the fact if you leave traditional Medicare for Advantage that after 12 months its a lifetime decision for most people due to underwriting issues.

 

[MichaelB]

There was a previous thread with some informative links provided by Telly, here https://www.early-retirement.org/fo...iginal-medicare-into-managed-care-111974.html

From what I have read this is still part of the CMS Innovation Center, so a program alternative under study and not a policy decision being fully implemented.

 

[VanWinkle]

There was a previous thread with some informative links provided by Telly, here https://www.early-retirement.org/fo...iginal-medicare-into-managed-care-111974.html

From what I have read this is still part of the CMS Innovation Center, so a program alternative under study and not a policy decision being fully implemented.

Thanks for the link MichaelB

 

[Out of Steam]

The change required to reduce Medicare costs is a societal one, for doctors, seniors, and families to reduce the amount and intensity of futile treatments and procedures provided near the end of life.

The 90+ mother of someone I know has been transferred repeatedly from assisted living to the hospital for a string of illnesses, mainly urinary tract infections. Can't a doctor or nurse practitioner just show up and authorize antibiotics, IV or otherwise? If the treatment fails, perhaps it was her time. Notwithstanding the financial waste, the whole process seems cruel to me.

 

[VanWinkle]

The change required to reduce Medicare costs is a societal one, for doctors, seniors, and families to reduce the amount and intensity of futile treatments and procedures provided near the end of life.

The 90+ mother of someone I know has been transferred repeatedly from assisted living to the hospital for a string of illnesses, mainly urinary tract infections. Can't a doctor or nurse practitioner just show up and authorize antibiotics, IV or otherwise? If the treatment fails, perhaps it was her time. Notwithstanding the financial waste, the whole process seems cruel to me.

It's only cruel when it is someone else's mother? You might feel different if it was your mother. Who decides when it's time to reduce treatment? It is called hospice and the family/patient decide. This is a tough subject and I agree with some of your points.

 

[ivinsfan]

OOS assisted living is different than a full blown nursing home. That might be the reason for her hospital visits.

 

[Turbo29]

The change required to reduce Medicare costs is a societal one, for doctors, seniors, and families to reduce the amount and intensity of futile treatments and procedures provided near the end of life.

The 90+ mother of someone I know has been transferred repeatedly from assisted living to the hospital for a string of illnesses, mainly urinary tract infections. Can't a doctor or nurse practitioner just show up and authorize antibiotics, IV or otherwise? If the treatment fails, perhaps it was her time. Notwithstanding the financial waste, the whole process seems cruel to me.

Here is a good example of end of life care run amok: Too much medicine disrupts end-of-life care

 

[youbet]

So far medicare and a supplement work great,they should not mess with it too much.

Oldmike

I think the point is that if they don't "mess with it," they'll have to increase our premiums for both.

I agree about Medicare and a supplement working just fine and I've been a happy camper for 10 years now. But what we pay in will eventually have to cover all the costs. Combined, DW and I are already paying in the mid-teens annually for a Medicare Advantage plan for her and traditional Medicare, Part D and a type F supplement for me.

 

[Rianne]

Here is a good example of end of life care run amok: Too much medicine disrupts end-of-life care

Very sad story. I try to tell myself, that I can always say no to any medical treatment. I've made the decision when closer to the end of life, I will say no. And my POA knows that.

 

[RetMD21]

Do you have other sources besides the "humble dollar" blog that substantiate the theory or is this basically editorial opinions?

Howard Rohleder is just speculating. He provides free content for Jonathan Clements over at Humble Dollar. This isn't actual journalism

 

[ncbill]

It's only cruel when it is someone else's mother? You might feel different if it was your mother. Who decides when it's time to reduce treatment? It is called hospice and the family/patient decide. This is a tough subject and I agree with some of your points.

Even after my mom was confined to bed simply because of the progression of her dementia she did not qualify for Hospice.

Back then she would have had to have had an infection not responding to antibiotics or a massive open bed sore not responding to treatment to qualify.

So her facility treated every little infection that came along, extending her unable to communicate, no ADLs, bedridden, end-of-life period for the better part of a decade.

 

[Helen]

Very sad story. I try to tell myself, that I can always say no to any medical treatment. I've made the decision when closer to the end of life, I will say no. And my POA knows that.

I want to go ala Whitney Houston, a nice hot bath, some Xanax and some really good wine or champagne. Hopefully that won't be for a long time, life is good.

 

[Turbo29]

This doesn't apply only to Medicare but there are some examples from Medicare.

"Research suggests low-value care is costly, with one study estimating that the U.S. health care system spends $75 billion to $100 billion annually on these services. Ganguli published a paper in 2019 that found the federal government spent $35 million a year specifically on care after doctors performed EKG heart tests before cataract surgery — an example of low-value care. "Medicare was spending 10 times the amount on the cascades following those EKGs as they were for the EKGs themselves. That's just one example of one service," said Ganguli."


NPR--When routine medical tests trigger a cascade of costly, unnecessary care

 

[NW-Bound]

Here is a good example of end of life care run amok: Too much medicine disrupts end-of-life care

In the above case, the 85-year-old patient wanted to get all fixed up so he could live a long life.

I think this mentality of hoping to live forever has a lot to do with the problem.

If a patient insists on having a risky surgery, can a surgeon deny it, and say "no, you are too old and not worthy"?