Do you know about the Medicare hospital bonus program? Hospitals can get cash for better results. The idea sounds good in theory, but there is a dangerous underbelly to this plan. (UPDATED 6/28/2020)
The Centers for Medicare and Medicaid Services said on Tuesday that 55%—more than 1,500 hospitals out of approximately 2,700 facilities participating in the program—got a slightly higher Medicare payment under the program. Overall there will be $1.9 billion in incentive payments for hospitals in federal fiscal year 2020, which runs from Oct. 1 until Sept. 30, the same amount as fiscal 2019.
“The highest performing hospital in FY 2020 will receive a net increase in payments of 2.93 percent, and the lowest-performing hospital will incur a net decrease in payments of [negative] 1.72 percent,” the agency said.Fierce Healthcare
Quality of Care and Medicare Hospital Bonus
Quality of care bonuses. What could possibly go wrong?
So how does Medicare decide winners and losers?
Eight of the current 25 quality standards, Yahoo News reported, are based on patient satisfaction: communication with nurses; communication with doctors; responsiveness of hospital staff; pain management; communication about medicines; cleanliness and quietness of hospital environment; discharge information and overall rating of the hospital.
The rest are based on how often hospitals followed clinical standards of care, such as controlling heart surgery patients’ blood sugar levels and giving them beta blockers to lower their blood pressure.Georgia Health News
All sounds so simple. If a hospital delivers better results, and you are a satisfied customer, they can get a Medicare hospital bonus.
Do you think hospitals might “cherry pick” the Medicare patients they take in and the type of services they will provide to Medicare patients? And does it matter if you have a Medicare Advantage plan or original Medicare and a Medicare supplement plan (where you can choose your doctor and hospital)?
The maximum amount any hospital could gain or lose was 1 percent of its regular Medicare payments.
For nearly two-thirds of the hospitals, the changes are less than a quarter of a percent, KHN said. Still, for hospitals with a high number of Medicare patients, hundreds of thousands of dollars are at stake.
The caps will rise to 2 percent over the next four years.
The maximum Medicare hospital bonus (or penalty) now is 1%, rising to 2%. But will it stop there or keep climbing?
If a hospital can game the system in hopes of qualifying for the maximum bonus, how many really sick patients with expected poor outcomes do they have to reject in order to earn the highest kickback from Medicare?
This is about more than money. It is about your health and quality of care. Georgia Medicare Plans is concerned about your health and the health of your wallet. Save money by comparing your existing Medigap rates with an instant GA Medigap quote.
How Do Georgia Hospitals Compare to Other States?
How does quality of care in Georgia stack up against other states?
Georgia Health News reveals
Some other Southern states had higher percentages of hospitals getting bonuses than did Georgia. In both North Carolina and South Carolina, 69 percent of hospitals are receiving the extra payments; Alabama, 64 percent; Florida, 57 percent; Kentucky, 53 percent.
Louisiana equaled Georgia’s 51 percent performance. Performing worse than Georgia were hospitals in Tennessee, at 40 percent, and Mississippi, at 39 percent.
Does this mean you can receive better care in other states?
Not necessarily, but these are figures that cannot be ignored.
Budgeting for Healthcare Costs
It is impossible for most retirees to cover the OOP (out of pocket) cost of health care without insurance.
Original Medicare pays 80% of your outpatient health care costs but the remaining 20% can be staggering.
Most retirees worry about paying hospital bills, but the MAJORITY of medical claims are OUTPATIENT.
Original Medicare does not cap your OOP health care costs. You pay until you get better, run out of money or die.
A cost effective Medicare supplement plan from Georgia Medicare Plans can give you piece of mind.
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