Medicare Levy Budget Case Study

Quality physician documentation is not only essential to providing superior clinical communication, but also allows for the delivery of useful data that “supports quality metrics, acuity of care, billing, and accurate representation of medical conditions” (Rosenbaum et al., 2014). The Centers for Medicare and Medicaid Services (CMS) uses a system to classify Medicare patient’s hospital stays into various groups in order to facilitate payment of services called Medicare Severity-Diagnosis Related Group (MS-DRG). Some payers also use all patient refined (APR)-DRG reimbursement systems. MS-DRG groups are outlined by a specific collection of patient characteristics which include areas specific to the “principle diagnosis, specific secondary diagnoses,

Comment on the following statement: “The proposal to increase Medicare cost sharing (increasing premiums, deductibles, and coinsurance) will deprive the elderly poor of needed medical services.”¬¬

The Medicare trust fund is a government insurance program that finances medical care for three different groups of individuals: people that are 65 years of age or older, disabled individuals who can receive Social Security benefits, and people who have end-stage renal disease (Shi & Singh, 2015). Individuals in these three categories can enroll regardless of their annual income. In 2015 there were 55.3 million beneficiaries and the expenditures for the year totaled $648 billion ("Trustees report," 2016). Medicare is funded by payroll taxes, general tax revenues, and premiums that are paid by individuals enrolled in the plan.

The Medicare Trust Fund was established in 1983. It was a mass shift and strategy in social and Medicare. In the past, social security and Medicare had a “pay as you go” system. That means workers were compensating current retirees and retirees benefits. The founded system was unsustainable for baby boom generation. Moreover, Medicare Fund is by law to request to buy U.S Treasury Bonds. It has one only asset to fund the government, so if it collects taxes of the assess of expensive it needs, it has essentially have to load the money to itself. Throughout the history of 1980’s and 1990s was a federal deficit that was mass by large parts of social security and Medicare trust fund purchases of those bonds. The Medicare is a traditional trust

You have been invited to participate in a panel discussion to address the Medicare Funding crisis. The panel has asked you to respond to a proposal to enroll participants in HMO’s to reduce Medicare expenditures. I have taken the liberty to prepare the following responses for the panel discussion.

Informative post, I did not know that Oregon was and still is the only state that passed a bill that mandated that private insurers pay NPs in independent practice the same rates they pay physicians for the same services. I would say more states should be following suit if this state can as you pointed out, can maintain spending on Medicare. For their fiscal year of 2015 Oregon’s total Medicare spending was 8,066,724,366. For my state of Nevada, which also has full practice authority it was 2,127,537,716 (Kaiser Family Foundation, 2015). This is a difference of $5,939,186,650! I wonder how much of this could be attributable to NPs being paid at the same rate as physicians.

The Medicare Modernization Act, or Medicare Prescription Drug Improvement and Modernization Act of 2003, was passed into law to amend and modernize the current Medicare system. There are a few problems that this law aims to solve or provide relief towards. First, it will allow seniors to save money on their prescription drugs because many have the problem of not being able to afford them on their own or have a lack of drug coverage with their existing plan. Low income seniors and those with limited resources will receive further assistance paying for medication. The second problem addressed by the MMA is that all seniors are receiving a standard Medicare and are not given choices of alternatives to better fit their needs. They will

Please read and review the outside and background sources/readings listed in your Syllabus. Please select one healthcare issue (policy/position/topic) that is of interest to you and discuss how it should be addressed politically and as a healthcare policy. Be sure to include the economic impact of such. Support your position with outside sources.

Since the late 1980s, Medicare has reimbursed physician services using the Medicare Physician Fee Schedule (MPFS), which encompasses 10,000 procedure codes. Each code is assigned resource-based relative value units (RVUs), which are designed to reflect physician work, practice expense, and malpractice expense. To adjust for local differences in cost of living, each RVU is modified using geographic practice cost indexes (GPCIs) and then converted to dollars using a “conversion factor.” This system rewards physicians who produce a high volume of services; not surprisingly, Medicare Part B expenditures have grown rapidly.

As the newly appointed chief of staff I have been tasked with responding to a proposal for reducing Medicare expenditures by enrolling participants in HMO. I understand that we have some key questions must be addressed and that we must justify our position on either economic efficiency or equity grounds. Outlined below are some of the questions that must be answered in order address this issue properly.

Fifty years ago, Lyndon B. Johnson signed the Medicare program into law. “It has been a reliable guarantor of the health and welfare of older and disabled Americans by paying their medical bills, ensuring their access to needed health care services, and protecting them from potentially crushing health expenses.” (Hamel, Blumenthal, Davis, & Guterman, 2015, p. 479). With the encouragement of George W. Bush, congress passed the Medicare Modernization Act of 2003 (MMA). The MMA extended Medicare to include prescription-drug coverage, known as Medicare Part D. In 2013, Medicare covered the health care expenses for 52.3 million Americans, costing $583 billon. Originally, Medicare had difficulty controlling costs; physicians and hospitals were

One of the major functions of a nurse manager is managing a budget and allocating resources necessary to manage the unit or facility effectively. “Major steps in the budgeting process include gathering information and planning, developing unit budgets, developing cash budgets, negotiating and revising, and using feedback to control budget results and improve future plans”(Yoder-Wise, 2012, p. 244). The nurse manager must be able to accommodate variances and acclimate the budget in both the projections and up-to-date expenditures. Proficiency in managing a unit level budget is essential for both a favorable variance and optimal patient outcomes. Budgeting entails reviewing revenues and expenses, staffing costs, supplies, and capital equipment costs (Contino, 2001). This case study examines personnel, overtime (OT), supplies, travel, equipment, and staff education and the manner in which management can address these factors.

Public policy, such as subsidies in the form of tax credits for the purchase of health plans through the exchanges, have been in existence since the inception of the ACA, but one could contend that this falls short on many fronts. Subsidy thresholds and amounts are simply too low and premium costs too high for many middle-income earners to make ends meet. In some cases people would rather risk going without insurance and pay the penalty, than pay for a plan they can’t afford to use anyway (Bernard,

As we become older, issues with our health begin to take affect and finding ways to fund for that care is becoming even more difficult. In the article “Some Elders Must Take Drastic Measures to Obtain Long-term Care”, national magazine journalist Mary A. Fischer (2011) states that many Americans must face demeaning and disempowering choices in order to qualify for Medicaid or Medicare—federal funded health insurance programs— such as refusing to pay for a spouses institutionalization, divorce, and spending down assets. The author argues that these choices leave the healthy spouse with decreased funds to plan for their own retirement expense (Fisher, 2011). Working in the health care field for 4 years, along with my family’s own personal experiences I can relate to this article, since I have seen a variety of ways that federal funded health insurances have been unable to meet the expectations and demands of its beneficiaries.

Australia’s free universal health care system (Medicare) is one of the best in the world; however, it is also one of the most expensive (The Commonwealth Fund, 2012). The Abbott government is due to release the Australian federal budget in May, and with an expect deficit of $120 billion (Australian Government Productivity Commission, 2014), Prime Minster Abbott has warned of serious policy changes. While the federal government has been coy about the Commission of Audits report, and when they will release its findings, rumour has been rampart in the media about one suggestion, a proposed $5 - 6 co-payment when visiting a General Practitioner (GP). They have inferred this is the death of Medicare. There have been discussions all over the