User login
As hospitalists, we likely see a disproportionate number of Medicare patients, compared with our primary care colleagues. After all, the healthy 24-year-old newlywed who is seeking counseling on choosing a safe and effective birth control method is unlikely to end up in the emergency department three or four times a year; nor is the 40-year-old who goes to his doctor kicking and screaming because his wife demands he get a checkup at least once every few years.
On the contrary, a typical day in the life of a hospitalist focuses on treating heart failure and COPD exacerbations (plus or minus pneumonia), and controlling the ventricular rate in our atrial fibrillation patients. Naturally, these patient are typically older, often seniors who receive Medicare. So, what will Medicare look like in the future?
There has been a lot in the news recently about vice presidential candidate Rep. Paul Ryan’s Medicare proposal. I, like many others, was ignorant of specific details of the proposal. I heard "End Medicare as we know it" and immediately my mind conjured up images of frail, elderly Americans being unable to access quality health care and systemically falling through the cracks of a scary system. Based on the interpretation and (sometimes hidden) agenda of various media, I heard wildly different takes on his plan, so I went to his website and read up on it.
In a nutshell, starting in 2023, seniors would be able to choose between private plans competing alongside the traditional fee-for-service option through a new system called the Medicare Exchange. Under this plan, Medicare would provide seniors with payments to pay for or offset the chosen plan’s premiums. In addition, to prevent insurers from structuring their offerings to weed out the sickest patients, all participating plans would be mandated to offer insurance to all seniors.
After reading his plan, I became much less apprehensive about the future of Medicare, should the Romney/Ryan ticket be successful in November. Nevertheless, I am concerned about having a voucher program to help pay for the cost of health care. Though under Ryan’s plan, the voucher amount would escalate over time, who’s to say that the cost of health insurance will not outpace even the voucher? Another concern is that since many elderly patients have decreased cognition in their twilight years, won’t they be at risk for being taken by unscrupulous businesses that always seem to find their way to any revenue stream?
And if President Obama is successful in his bid to remain in the Oval Office? What would Medicare look like then? According to the Center for Medicare and Medicaid Services, the Affordable Care Act, President Obama’s signature legislation, is expected to lower costs for Medicare beneficiaries by $208 billion through 2021. And, as we all know by now, there will be lower payments to hospitals relative to hospital-acquired conditions, and, in some cases, readmissions. Meanwhile, patient safety through the Partnership for Patients takes a front seat in the ACA plan.
Regardless of who wins the White House in November, there is the potential for huge changes in Medicare. Let us hope (and pray) that the vast majority of changes will be good ones for our patients, and ourselves.
Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.
**This column was updated on Aug. 22, 2012.
As hospitalists, we likely see a disproportionate number of Medicare patients, compared with our primary care colleagues. After all, the healthy 24-year-old newlywed who is seeking counseling on choosing a safe and effective birth control method is unlikely to end up in the emergency department three or four times a year; nor is the 40-year-old who goes to his doctor kicking and screaming because his wife demands he get a checkup at least once every few years.
On the contrary, a typical day in the life of a hospitalist focuses on treating heart failure and COPD exacerbations (plus or minus pneumonia), and controlling the ventricular rate in our atrial fibrillation patients. Naturally, these patient are typically older, often seniors who receive Medicare. So, what will Medicare look like in the future?
There has been a lot in the news recently about vice presidential candidate Rep. Paul Ryan’s Medicare proposal. I, like many others, was ignorant of specific details of the proposal. I heard "End Medicare as we know it" and immediately my mind conjured up images of frail, elderly Americans being unable to access quality health care and systemically falling through the cracks of a scary system. Based on the interpretation and (sometimes hidden) agenda of various media, I heard wildly different takes on his plan, so I went to his website and read up on it.
In a nutshell, starting in 2023, seniors would be able to choose between private plans competing alongside the traditional fee-for-service option through a new system called the Medicare Exchange. Under this plan, Medicare would provide seniors with payments to pay for or offset the chosen plan’s premiums. In addition, to prevent insurers from structuring their offerings to weed out the sickest patients, all participating plans would be mandated to offer insurance to all seniors.
After reading his plan, I became much less apprehensive about the future of Medicare, should the Romney/Ryan ticket be successful in November. Nevertheless, I am concerned about having a voucher program to help pay for the cost of health care. Though under Ryan’s plan, the voucher amount would escalate over time, who’s to say that the cost of health insurance will not outpace even the voucher? Another concern is that since many elderly patients have decreased cognition in their twilight years, won’t they be at risk for being taken by unscrupulous businesses that always seem to find their way to any revenue stream?
And if President Obama is successful in his bid to remain in the Oval Office? What would Medicare look like then? According to the Center for Medicare and Medicaid Services, the Affordable Care Act, President Obama’s signature legislation, is expected to lower costs for Medicare beneficiaries by $208 billion through 2021. And, as we all know by now, there will be lower payments to hospitals relative to hospital-acquired conditions, and, in some cases, readmissions. Meanwhile, patient safety through the Partnership for Patients takes a front seat in the ACA plan.
Regardless of who wins the White House in November, there is the potential for huge changes in Medicare. Let us hope (and pray) that the vast majority of changes will be good ones for our patients, and ourselves.
Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.
**This column was updated on Aug. 22, 2012.
As hospitalists, we likely see a disproportionate number of Medicare patients, compared with our primary care colleagues. After all, the healthy 24-year-old newlywed who is seeking counseling on choosing a safe and effective birth control method is unlikely to end up in the emergency department three or four times a year; nor is the 40-year-old who goes to his doctor kicking and screaming because his wife demands he get a checkup at least once every few years.
On the contrary, a typical day in the life of a hospitalist focuses on treating heart failure and COPD exacerbations (plus or minus pneumonia), and controlling the ventricular rate in our atrial fibrillation patients. Naturally, these patient are typically older, often seniors who receive Medicare. So, what will Medicare look like in the future?
There has been a lot in the news recently about vice presidential candidate Rep. Paul Ryan’s Medicare proposal. I, like many others, was ignorant of specific details of the proposal. I heard "End Medicare as we know it" and immediately my mind conjured up images of frail, elderly Americans being unable to access quality health care and systemically falling through the cracks of a scary system. Based on the interpretation and (sometimes hidden) agenda of various media, I heard wildly different takes on his plan, so I went to his website and read up on it.
In a nutshell, starting in 2023, seniors would be able to choose between private plans competing alongside the traditional fee-for-service option through a new system called the Medicare Exchange. Under this plan, Medicare would provide seniors with payments to pay for or offset the chosen plan’s premiums. In addition, to prevent insurers from structuring their offerings to weed out the sickest patients, all participating plans would be mandated to offer insurance to all seniors.
After reading his plan, I became much less apprehensive about the future of Medicare, should the Romney/Ryan ticket be successful in November. Nevertheless, I am concerned about having a voucher program to help pay for the cost of health care. Though under Ryan’s plan, the voucher amount would escalate over time, who’s to say that the cost of health insurance will not outpace even the voucher? Another concern is that since many elderly patients have decreased cognition in their twilight years, won’t they be at risk for being taken by unscrupulous businesses that always seem to find their way to any revenue stream?
And if President Obama is successful in his bid to remain in the Oval Office? What would Medicare look like then? According to the Center for Medicare and Medicaid Services, the Affordable Care Act, President Obama’s signature legislation, is expected to lower costs for Medicare beneficiaries by $208 billion through 2021. And, as we all know by now, there will be lower payments to hospitals relative to hospital-acquired conditions, and, in some cases, readmissions. Meanwhile, patient safety through the Partnership for Patients takes a front seat in the ACA plan.
Regardless of who wins the White House in November, there is the potential for huge changes in Medicare. Let us hope (and pray) that the vast majority of changes will be good ones for our patients, and ourselves.
Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.
**This column was updated on Aug. 22, 2012.
