Medicare Patients Need to Stay Informed

Medicare Patients Need to Stay Informed

A recent article in the Washington Post caught my attention and reminded me how important it is for anyone on Medicare to keep up with rule changes. This article is especially timely for any patient scheduled for a surgery because of some drastic changes to the list of surgeries that can be performed as a hospital in-patient. This new rule, put in place by the previous administration, forces many quite invasive surgeries to be done on an outpatient basis. In my view, this attempt to save money is very short-sighted and risks jeopardizing patient safety in outcomes.

According to the article, “for years, the Centers for Medicare and Medicaid Services (CMS) classified 1,740 surgeries and other services so risky for older adults that Medicare would pay for them only when these adults were admitted to the hospital as inpatients. Under the new rule, the agency is beginning to phase out that requirement. On Jan. 1, 266 shoulder, spine and other musculoskeletal surgeries were crossed off what is called the “inpatient-only list.”

By the end of 2023, the list — which includes a variety of complicated procedures including brain and heart operations — is scheduled to be gone.

CMS officials said the change was designed to give patients and doctors more options and help lower costs by promoting more competition among hospitals and independent ambulatory surgical centers. But they forgot one thing.

While removing the surgeries from the inpatient-only list, the government did not approve them to be performed anywhere else. So patients will still have to get the care at hospitals. But because the procedures have been reclassified, patients who have them in the hospital don’t have to be considered admitted patients. Instead, they can receive services on an outpatient basis.

CMS pays hospitals less for care provided to beneficiaries who are outpatients, so the new policy means the agency can pay less than it did last year for the same surgery at the same hospital and Medicare outpatients will usually pick up a bigger part of the tab.”

Besides the Medicare site, good sources to keep up with Medicare rules and regulations include the Medicare Rights Center, the Kaiser Family Foundation and newsletters, such as the Dear Marci column, at the Medicare Rights Center.

Posted in Elder Care, Government Agencies, Health Care Reform, Insurance, Insurance Topics, Medicare, Patient Centered Care, Patient Safety
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