Medicare Program

If you want to understand a major reason medical costs are out of control, breaking the federal budget and dividing the country, look at the types of people enrolled in XLHealth's Medicare insurance plans. Most suffer from diabetes, congestive heart failure or other long-term illness. They're like the millions of chronically ill Americans who visit doctors half a dozen times a year or more and, by some measures, account for 80 percent or more of all spending by the Medicare program for senior citizens.

University of Maryland St. Joseph Medical Center will be able to recoup some of the tens of millions of dollars it lost while operating without a Medicare certification under a compromise reached with federal officials. The Towson hospital will be able to bill Medicare for treatment given to patients in the federal program since Jan. 7, about six weeks before it regained what is known as a Medicare provider agreement. St. Joseph had operated without one since the University of Maryland Medical System bought the hospital and chose not to renew its existing Medicare certification.

Arthur E. Hess, a lawyer who became the first director of the Medicare program and served as acting commissioner of the Social Security Administration in 1973, died of complications from dementia Tuesday at his Charlottesville, Va., home. He was 89. Mr. Hess, who lived in Baltimore from 1943 to 1982, was an architect of the Medicare program that provides health insurance for millions of seniors. He is widely credited with expanding federal government benefits programs during the 1960s.

University of Maryland St. Joseph Medical Center said Friday that it has received a new Medicare provider agreement, allowing it to again seek reimbursement for treating patients on the federal government's health program. The Towson hospital has not billed Medicare patients since the University of Maryland Medical System voluntarily declined to keep St. Joseph's prior federal certification when it bought the hospital Dec. 1. St. Joseph officials now hope to recoup some of those losses.

WASHINGTON -- Alarmed by runaway costs, the Clinton administration plans to cut back on health care that many elderly Medicare recipients receive at home.The administration's proposed fiscal 1998 budget, to bereleased next month, would place strict new limits on payments for home health care, the fastest-growing part of Medicare. An increasing number of elderly invalids and shut-ins seek nursing care, physical therapy, and help with dressing and bathing at home.Government costs for the care are climbing at 23 percent a year, far exceeding the 9 percent overall growth rate in the total Medicare program.

WASHINGTON -- Most seniors who lacked prescription coverage in past years now have it through the Medicare drug benefit, but a survey to be released finds that about 20 percent of enrollees said they had put off or skipped getting some medications because of the program's costs. The poll of more than 16,000 seniors, published online by the journal Health Affairs, is the closest thing to a report card on one of President Bush's major domestic policy accomplishments. The program, which began last year after being created by a Republican-led Congress, provides prescription coverage through private insurance plans, charging an average monthly premium of about $27. One reason so many beneficiaries are having difficulty paying for medications is that many low-income seniors apparently are unaware that they can get extra government subsidies to lower their costs, the survey indicated.

Like many older people, Nanna Harper depends on medication to keep her healthy. She takes pills for high blood pressure, diabetes, dizziness and other conditions. She has health insurance through the state, but it pays only part of the cost of her pills. The 71-year-old retired seamstress from Middle River spends between $200 and $300 a month on medicine - about half of her income. To save money, she often takes only half the required dose. Harper hopes that her pill-cutting days will end on Jan. 1 when the federal government begins offering drug prescription coverage for the nation's 42 million Medicare recipients.

With wrenching tales of low-income seniors being overcharged or unable to afford medication, advocates for enrollees in the new Medicare prescription drug program asked state legislators yesterday to cover some of the costs and improve the convoluted system. Advocates encouraged lawmakers to follow the lead of 25 other states and the District of Columbia, who have pledged to temporarily cover drug costs for some recipients. While the program, known as Medicare Part D, has puzzled many seniors, advocates argued that enrollees with mental illnesses and low-income beneficiaries - those covered by both Medicaid and Medicare - are the most vulnerable under the new system.

The University of Maryland St. Joseph Medical Center failed a critical federal inspection and has been unable to collect what is likely millions of dollars in Medicare reimbursements from the federal government since Dec. 1. As part of its takeover of the troubled St. Joseph that day, the University of Maryland voluntarily gave up a certification needed to bill Medicare and applied for a new one. The university health system wanted to disassociate itself...

WASHINGTON - President Bush will increase Medicare payments to health maintenance organizations and other private health plans by a record 10.6 percent in an effort to persuade them to enter the Medicare market and increase benefits for the elderly, administration officials say. Federal officials and members of Congress said they hoped the increase - five times as large as the typical annual increase in recent years - would reverse the exodus of private...

The University of Maryland St. Joseph Medical Center failed a critical federal inspection and has been unable to collect what is likely millions of dollars in Medicare reimbursements from the federal government since Dec. 1. As part of its takeover of the troubled St. Joseph that day, the University of Maryland voluntarily gave up a certification needed to bill Medicare and applied for a new one. The university health system wanted to disassociate itself...

Four doctor groups across Maryland have been chosen by the federal Department of Health and Human Services for a program that aims to cut health costs and better coordinate care for Medicare recipients. The program named 89 new groups in 40 states to become Accountable Care Organizations under the federal health care reform law. That brings the total already signed up for the voluntary program to 154, according to federal health officials. The groups share in savings realized through the more coordinated care.

If you want to understand a major reason medical costs are out of control, breaking the federal budget and dividing the country, look at the types of people enrolled in XLHealth's Medicare insurance plans. Most suffer from diabetes, congestive heart failure or other long-term illness. They're like the millions of chronically ill Americans who visit doctors half a dozen times a year or more and, by some measures, account for 80 percent or more of all spending by the Medicare program for senior citizens.

Our national experience with the Medicare program can provide guidance to the choices our legislators must make regarding health care reform. If one favors more or less government in health care, positive and negative lessons emerge from the nearly 50-year Medicare experience of providing universal health care coverage for all those age 65 and older. Medicare eliminated the fragmented, episodic and often dehumanizing care that many retired seniors were forced to seek through emergency departments or charitable sources because they no longer had coverage from an employer.

Medicare cuts push doctors to the brink On behalf of the more than 2,000 members of the Maryland chapter of the American College of Physicians, I want Sun readers to know how much our members share the concerns and dismay expressed by Dr. Ronald Sroka in the article "Where the money isn't" (June 29). We are major providers of care for Maryland's elderly and disabled citizens through Medicare, and we are shocked and angry that we face a huge cut in our reimbursement rates. Internal medicine physicians run lean practices with high overhead costs that have been rising much more quickly than our very meager to nonexistent payment increases in the last few years.

WASHINGTON -- Most seniors who lacked prescription coverage in past years now have it through the Medicare drug benefit, but a survey to be released finds that about 20 percent of enrollees said they had put off or skipped getting some medications because of the program's costs. The poll of more than 16,000 seniors, published online by the journal Health Affairs, is the closest thing to a report card on one of President Bush's major domestic policy accomplishments. The program, which began last year after being created by a Republican-led Congress, provides prescription coverage through private insurance plans, charging an average monthly premium of about $27. One reason so many beneficiaries are having difficulty paying for medications is that many low-income seniors apparently are unaware that they can get extra government subsidies to lower their costs, the survey indicated.

WASHINGTON - Although he won't officially roll it out until Tuesday, President Bush's ambitious proposal to offer senior citizens subsidized prescription drugs is already drawing heavy fire from within his own party and from Democrats. The proposal, which administration officials say is still being fine-tuned for the president's State of the Union address Tuesday night, would provide prescription drug benefits only to seniors who leave the traditional fee-for-service Medicare program and enroll with private health insurers.

University of Maryland St. Joseph Medical Center said Friday that it has received a new Medicare provider agreement, allowing it to again seek reimbursement for treating patients on the federal government's health program. The Towson hospital has not billed Medicare patients since the University of Maryland Medical System voluntarily declined to keep St. Joseph's prior federal certification when it bought the hospital Dec. 1. St. Joseph officials now hope to recoup some of those losses.

WASHINGTON -- Insurance companies have used improper hard-sell tactics to persuade Medicare recipients to sign up for private health plans that cost the government far more than the traditional Medicare program, federal and state officials and consumer advocates say. Insurance agents, spurred in some cases by incentives such as trips to Las Vegas, have aggressively marketed the private plans, known as Medicare Advantage plans. Enrollment has skyrocketed in the past year, and Medicare officials foresee continued rapid growth in the next decade.

The day before Gov. Robert L. Ehrlich Jr. is expected to stamp his signature on scores of pieces of legislation, immigrant advocates, poor families and medical experts urged the governor to adopt a measure to restore health insurance benefits to thousands of women and children. "We want to send a message that Maryland welcomes new Americans," said Del. Victor R. Ramirez, a Prince George's County Democrat who organized a news conference in Adelphi yesterday calling for the bill to be signed into law. "This is an exceptional group that has a particular need."