Five Things People with Medicare Should Know

By Don Berwick, Administrator, Centers for Medicare & Medicaid Services. Cross-post from

Do you have Medicare? Have questions about what the Affordable Care Act does for you?

Here are the five things people with Medicare should know about the law:

1. It makes prescription drugs more affordable.

If you enter the coverage gap known as the “donut hole,” you will receive a 50% discount when buying Part D-covered brand-name prescription drugs. This discount will be automatically applied at the counter of your pharmacy; you don’t have to do anything to get it. And over the next ten years, you will get additional savings until the coverage gap is completely closed in 2020.

2It gives you preventive care services for free.

If you have Medicare, you can get free preventive screenings and services like colorectal cancer screening and mammograms. You can also get a free yearly wellness visit to develop and update your personal prevention plan based on current health needs. Again, these services are free: no co-pays or cost-sharing for you.

3. It provides incentives for your doctors to work together for you.

The law makes it easier for your doctors to work together by offering them support and resources for patient-centered care.  If you’re hospitalized, the new law also helps you return home successfully—and avoid going back—by helping to coordinate your care and connecting you to services and support in your community.

4. It strengthens Medicare Advantage.

If you have Medicare Advantage, you will be protected from large increases to your premiums or decreases in your benefits.  Medicare reviews changes to your plan before they happen to stop the ones that are unreasonable. Beginning in 2012, Medicare Advantage plans will have even more reason to improve the quality of care you receive.  Plans that have a rating of three stars or more on the quality rating system will receive a bonus, part of the national effort to improve quality.

5. It helps ensure your access to care.

You can still choose your doctor. The law increases the number of primary care doctors, nurses, and physician assistants to provide better access to care through expanded training opportunities, student loan forgiveness, and bonus payments. Support for community health centers will increase, allowing them to serve some 20 million new patients.

For more information, please check out the online brochure, Medicare and the New Health Care Law – What it Means for You. (PDF – 314KB)

Helping States Improve Care and Reduce Costs

By Don Berwick, Administrator, Centers for Medicare & Medicaid Services. Cross-post from

Over the past two years, this administration has worked constantly to improve care while lowering costs. One important component of this effort has been partnering with states to stabilize Medicaid costs. A special area of focus for the department has been those beneficiaries who are eligible for both Medicare and Medicaid. They make up only 15% of Medicaid beneficiaries, but account for almost 40% of costs.

These beneficiaries are known as “dual-eligibles” because they receive coverage from both Medicare and Medicaid. For example, a “dual eligible’ may be a person who has longstanding diabetes, depression, hypertension and a history of strokes. This individual who has three chronic conditions, multiple medications, limited mobility and inadequate food intake is at risk of hospitalization and requires significant personal assistance to maintain independence. Their health care costs are high because they have substantial health needs. But their costs are also higher because these beneficiaries must navigate two different programs. This fragmentation leads to needlessly expensive, inefficient, and often duplicative care.

Under the Affordable Care Act, the Medicare-Medicaid Coordination Office was created to help solve these problems of fragmentation – to ensure that beneficiaries receive the highest quality, most coordinated care possible. Today, the Department of Health and Human Services (HHS) made three announcements that will help states improve care and reduce costs for these patients.

•Two new financial adjustment models: States can test one or both of these options changing the way we pay for care and providing stronger incentives to keep these patients healthy.
•New demonstration project: This will help nursing facilities across the country test strategies for keeping their patients out of the hospital.
•Establishing a resource center: Providing technical assistance to any state interested in improving care for their highest-cost Medicaid enrollees.

These new efforts help provide a long-term, sustainable solution to slow Medicaid spending by improving care. By providing states with the tools to help deliver care more effectively, we are able to provide better care to vulnerable populations that need it the most. Instead of cutting costs and leaving states to fend for themselves, we are instead assembling a toolbox that will let states choose the best option for themselves and the people they serve.

Raising Patient Safety Awareness Across the Country

By Joe McCannon, Senior Advisor to the Administrator, CMS. Cross-post from

Thanks to the Affordable Care Act, the Department of Health and Human Services (HHS) is continuing to work with a wide variety of public and private partners to improve the care and services patients receive in our health system.

We are proud to announce that we have collaborated with nearly 4,500 organizations, including over 2,000 hospitals that have officially committed to improving patient safety by joining the initiative! In fact, HHS is thrilled to recognize the 100% participation rate by Iowa hospitals to promote innovations to improve hospital care and reduce wasteful spending.

Are you a partner? If so, you can add the badge below to your website. All you need to do is click here or on the image below and grab the code provided on the right side of the page where it says “show code.”

Building off the extraordinary work many local hospitals and health systems around the country have already been doing – from Denver Colorado to Richmond Virginia – the Partnership for Patients aims to improve the quality, safety and affordability of health care for all Americans.

One Denver hospital in particular is setting the bar for Patient Safety. Last month, HHS Secretary, Kathleen Sebelius, visited Denver Health along with Dr. Don Berwick, Administrator of the Centers for Medicare and Medicaid Services. Denver Health, along with other hospitals and organizations across the country are committed to providing better health care.

Check out this PBS NewsHour program to learn why improving health outcomes and lowering costs go hand in hand. Seven years ago, Denver Health took a structured approach to improving quality and safety. By focusing on high opportunity clinical circumstances, Denver Health ranks first, with the lowest ratio of deaths according to the 2010 University Health System Consortiums Quality and Aggregate Score. While this success is encouraging, too many Americans go without quality healthcare: which is where the Partnership for Patients comes in.

CMS Administrator Don Berwick meets with VCU medical students.

This partnership is connecting health care providers all across the nation. At a recent visit to Regions Hospital in St. Paul, Secretary Sebelius learned about the “time-out” towel. This towel is used to cover surgical instruments at Regions Hospital to help ensure operations don’t being until safety protocol has been observed. This partnership is fostering innovation and encouraging health care providers to share their own success stories.

HHS Secretary Kathleen Sebelius visiting Regions Hospital in St. Paul.

To kick off this unprecedented partnership, two goals have been identified:

•Reduce preventable injuries in hospitals by 40 percent
•Cut hospital re-admissions by 20 percent

By achieving these goals and providing better care, countless Americans will have more healthy years to spend with their loved ones. Together we can build a stronger, safer health care system and he Partnership for Patients helps us do just that, one hospital at a time.

First EHR Incentive Program Payments are In

If you’re an eligible professional, you can get up to $44,000 by participating in the Medicare Electronic Health Record (EHR) Incentive Program, and up to $63,750 by participating in the Medicaid EHR Incentive Program. Depending on certain factors, your hospital or critical access hospital may be eligible for a base payment of $2 million dollars.

Eligible professionals and eligible hospitals like you have already gotten more than $75 million in first payments from the Medicare EHR Incentive Program. Including the $83.3 million in Medicaid EHR Incentive Program payments, the Federal government has given out more than $158 million since the two programs opened in January.

You’re not getting rewarded just for adopting EHR technology for the sake of more technology—EHR systems support our nation’s effort to bring higher quality care and improved patient safety to all Americans. EHRs help ensure you and your patients have the right information at the point of care.

Bring EHR Incentives to Your Practice
Join the more than 42,600 eligible providers who have already signed up. Register now.
Not sure which program to join? Get a side-by-side comparison.

Protecting Physicians and People with Medicare: Fixing the Sustainable Growth Rate

By Don Berwick, Administrator, Centers for Medicare & Medicaid Services. Cross-post from

One of the most important relationships people have is with their doctor. They rely on them for treatment when they are sick, counseling on ways to stay well, and for help navigating our complex health care system. But, unfortunately, a problem in Medicare’s payment system for doctors threatens that relationship and seniors and people with disabilities’ regular access to their doctor.

In 1997, Congress passed a law that was intended to slow the growth in Medicare spending so that the program would remain financially solvent. There were many good things in that law but one piece of it has proved to be problematic. A new formula – known as the Sustainable Growth Rate or SGR – was supposed to make sure we didn’t overpay for doctors’ services. Instead, it has resulted in the potential for huge cuts in Medicare fees that would not be good for doctors or patients.

For nine years in a row, Congress has enacted legislation to override large payment cuts to physicians. But lawmakers haven’t acted to get rid of the SGR and replace it with a formula that works. Since he took office, President Obama has called for a “permanent fix” to the SGR that would avoid this annual exercise. While we stopped the cuts scheduled for 2010 and 2011, we are now faced with the prospect of a 29.5 percent cut in 2012.

Today, the Centers for Medicare & Medicaid Services (CMS) issued proposed rules that spell out how this cut is calculated and warned that if Congress does not act in time, doctor fees will be slashed come January 1. We cannot – and will not – let this happen.

In his proposed budget for fiscal 2012, the President again called for getting rid of the SGR and he identified savings to pay for that change for the next two years. In his fiscal framework, the President identified additional savings that would pay for a 10-year fix.

For too long, we’ve been putting a Band-Aid on a wound that needs a permanent fix to heal. And we are committed to fixing this problem, once and for all.

At CMS, we are working every day to make Medicare a system focused on three major aims – better care, better health, and lower costs through improvement. To achieve this, physicians need to know what Medicare will pay and patients need to know that they can continue to see their doctors. This is the system 48 million people with Medicare need and the system we want to preserve for years to come.

Today happens to be the 45th anniversary of the implementation of Medicare. There couldn’t be a better time to begin renewing our commitment to the people it serves and the physicians who care for them.

Read the press release here.

To view the proposed rules, go here.

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