Biden reverses course: ends the National Covid-19 Emergency. Says he still opposes the change.
Was the Pfizer Covid vaccine properly vetted?
Study: Competition with Medicare Advantage plans makes traditional Medicare better.
Third Party Tracking: What happens when you go into the hospital is not just between you and the hospital.
RFK, Jr. is suing top-ranking U.S. officials, alleging collusion with Facebook, Google, and Twitter to censor social media platforms, re Covid.
1 thought on “Wednesday Links”
The news item above on “Competition with Medicare Advantage plans” is of great interest to me.
The article that is cited has a deceptively bland tone, as though traditional Medicare is having a spirited, friendly competition with Medicare Advantage plans.
What is actually going on is this:
Close to 10 per cent of Medicare spending goes to post-acute care in skilled nursing facilities.
The most common usage of this benefit is for knee and hip replacement cases.
Traditional Medicare pays $500 a day for this care. The first 21 days are free to the patient, with a co-payment afterwards. These patients are the “cash cow” for many nursing homes.
Medicare Advantage plans contend that many patients will do just as well by going home and getting nursing services there for an hour or two a day. The MA plans will often deny coverage when a patient goes into a skilled nursing facilities; if a patient does get admitted, the plans will deny coverage every three to five days, and the patient’s family has to file one appeal after another. (my own cousins went through this recently.)
The MA plans contend that their insured patients who are sent home do not get re-admitted any faster than patients on traditional Medicare. This appears to be the key data point that MA plans rely upon.(It is kind of a thin reed in my opinion, but what else is there?)
MA plans get a fixed monthly payment for each covered enrollee. The high payments for skilled nursing facility care come right off their bottom line.
It is easy to understand why there is bitterness in these disputes. The unpleasant fact is that caring for a senior citizen at home with recent hip or knee surgery can be damned hard work.
The adult children who usually have to do this care look on Medicare as a god-send — 40 or 60 days of not changing bed pans and not dressing their parents and not being on call 24 hours a day looks fantastic.
So you have the nursing homes and the adult children on one side, and big Medicare Advantage insurers on the other. This is the not-so-bland reality.