Medicare Levy Budget Case Study

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.

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.

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.

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.”¬¬

In order to make insurance affordable to all there were extensive private health insurance regulatory reforms, particularly in the small group and non-group markets, there were tax credits offered to the smallest lowest-wage employers for the purchase of health insurance, there were reductions in cost-sharing associated with recommended preventive care. For example if you signed up with a fitness center you can get a 50% discount on your insurance. The market exchange was established for the purchase of private coverage plus subsidies for the individual purchase of coverage and for the cost-sharing of the modest income. “The affordable care act also expanded the eligibility for the Medicaid program to all non-elderly with incomes up to 138 percent of the federal poverty level ($23,000 to $32,000 for a family of four in 2012) starting in 2014, which helped phase out the Medicare prescription drug benefit coverage gap, a.k.a. the “doughnut hole”.” To make sure that everyone is complying with the rule of everyone needs to have healthcare coverage there was a penalty set up for those that failed to comply. The penalty was if you did not have insurance by the set date you will receive a tax penalty that you will have to pay when filling your taxes. There are financial requirements that large- and medium sized

In 2016 the American population again saw their insurance plans increasing their premiums from 10%-13% across the board. This is much more than expected, and even worse the co-op insurance plans have failed. The government sponsored non-profit plans offering lower rates have not proven sustainability in result of the majority going bankrupt even after receiving 1.2 billion dollars of taxpayer’s money. The Affordable Care Act is already becoming a huge tax expense amongst Americans leading to the U.S. increasing the overall national debt. Starting 2018 all high end health insurance premium plans will come with a 40% excise tax. Also, changes in flexible spending accounts have occurred as over the counter medicines are no longer qualified expenses for flexible spending accounts and health savings accounts. The health care tax deduction threshold account increased to 10% from the previous established 7.5%. All these changes through different avenues account for more reasons we continue to see costs increase through the ObamaCare.

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.

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,

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

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.

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,

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.

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.

Medicare is the United States' health insurance program for individuals age 65 or older. However certain people younger than age 65 can also qualify for Medicare, including those who are disabled, has permanent kidney failure or amyotrophic lateral sclerosis, known as Lou Gehrig’s disease). The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care. Many Medicare participants must also have supplemental health care coverage in order to cover these charges that are not covered as part of the Medicare program. Is Medicare the perfect program? Well Medicare is financed by a percentage of the payroll taxes paid by workers and their employers. Also this program receives another

think that Medicare is one of the greatest and most important programs for US society that was ever created. Followed by National Defense and Social Security program, Medicare is the third largest program in the Federal budget. In 2013 cost of Medicare was $492 billion which is 14 percent of total federal spending. According official information by the end of 2014 49,435,610 people received health coverage through Medicare program.