Medicare Primer Page: 25 of 27
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Medicare Primer
Independent Payment Advisory Board created by PPACA be in controlling costs?
Will existing financing mechanisms be sufficient to support program spending
over the long term?
" Medicare cost-sharing is generally higher than it is under private insurance plans
for workers. For example, under Medicare there is no limit on out-of-pocket
expenditures, limited nursing home and home care services, and significant co-
payments for some services. Consequently, many beneficiaries pay additional
premiums for insurance to supplement Medicare (e.g., Medigap). How will the
level of beneficiary out-of-pocket expenses be affected by health care reform
changes? What is the impact of high out-of-pocket costs and gaps in Medicare
coverage on beneficiaries' health and access to care?
" Under health care reform legislation, Medicare is tasked with expanding or
developing demonstrations and pilot programs to explore whether the use of
accountable care organizations (ACO), bundled payments for care provided to a
patient across various settings, reduced payments for preventable hospital
readmissions, and value-based purchasing can lead to lower medical costs and/or
improved quality of care. How long will it take before results can be
demonstrated? What elements are key to successful implementation (for
example, adequate number of participating primary care providers, advanced and
integrated information systems, legal requirements for establishing ACOs, and
adequate financial incentives)? Can these models be successful if only used by
Medicare and not by other private or public payers?
" PPACA requires Medicare, through the implementation of a Community-Based
Care Transitions Program and an Independence at Home Program, to test whether
payment for care coordination can result in quality-of-care improvements for
chronically ill individuals and reduce unnecessary hospitalization and acute care
expenditures. These programs experiment with different kinds of care
coordination-that which is delivered to individuals during their transition from a
hospital stay into a post-acute or home care setting, and that which is delivered to
persons in their homes by primary care physicians and other interdisciplinary
teams of nurses, physician assistants, pharmacists, and other health and social
services staff. Will payment for care coordination help improve patient
outcomes? Can such coordination help to reduce Medicare costs by avoiding
preventable admissions to more expensive care settings, such as hospitals and
nursing homes?
" CMS was given significant new authority under PPACA to better coordinate care
for individuals eligible for both Medicare and Medicaid. In establishing the
Center for Medicare and Medicaid Innovation as well as the Federal Coordinated
Health Care Office, Congress provided options that can be used to experiment
with new service delivery and payment options for beneficiaries of both
Medicare and Medicaid. Will these changes help to maintain and improve quality
of care while decreasing medical care costs to both the Medicaid and Medicare
programs for these dually eligible beneficiaries? What new approaches or
authority might be necessary to ensure that acute and long-term care are
integrated, while maintaining or improving quality of care for dual eligible and
other chronically ill beneficiaries?Congressional Research Service
22
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Medicare Primer, report, July 1, 2010; Washington D.C.. (https://digital.library.unt.edu/ark:/67531/metadc819894/m1/25/?q=medicare: accessed April 23, 2024), University of North Texas Libraries, UNT Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.