• December 22, 2014

Doctors, patients adjust to Medicare changes

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Posted: Sunday, February 10, 2013 4:30 am

Thousands of Bell County residents were impacted by changes to Medicare coverage this year.

As of Jan. 1, Medicare offers expanded coverage for preventive care consultations, such as obesity screening and smoking cessation. States now pay primary care physicians no less than 100 percent of Medicare payment rates for primary care services. And a national pilot program to encourage hospitals, doctors and other providers to work together to improve coordination and quality of patient care kicked in.

The changes to the federal program, which provides health insurance to millions of people age 65 and older, people younger than 65 with certain disabilities and people of all ages with end-stage renal disease, were a direct result of the Affordable Health Care Act.

“For primary care, the ‘good side’ (of the legislation) is that preventive services are now covered,” said Dr. J. Kyle Morsch, who runs a family practice at Wellstone Health Partners in Harker Heights. “For instance, you are now allowed an annual wellness visit. In the past, we’d bill Medicare, they would reject it and the patients would get the bill.”

Morsch said he thinks the changes that went into effect in January will benefit patients and his practice in the short term, but he said there is no way to gauge how the changes will impact the economy over the long term.

The uncertainty is not necessarily related to the Affordable Health Care Act. Morsch said Congress’ inability to pass a budget creates more annual anxiety for health care professionals than the recent legislation.

50 million and growing

Numbers explain why Medicare is such an important part of the current debate about health care and the economy. Statehealthfacts.org, a website published by the nonprofit, privately run Kaiser Family Foundation, which focuses on U.S. health care issues, reports there were a little more than 50 million Americans covered by Medicare in 2012. And experts said the number of those covered will climb rapidly as “baby boomers” continue to hit 65 over the next several years.

“The number of people with Medicare will steadily climb, year by year, largely because of our aging population,” said Bob Moos, Southwest public affairs officer for the Centers for Medicare & Medicaid Services.

More than 3 million Texans are enrolled in Medicare, including 32,390 in Bell County, according to the Centers for Medicare & Medicaid Services. So far, local enrollees seem to be taking the changes in stride.

Cathy Shibley, benefits counselor for the Area Agency on Aging in Belton, credits an empowered generation of seniors for the smooth transition.

“The majority of people are not in a state of panic,” Shibley said. “Most people contact our agency well before they become eligible for Medicare. Our benefit counselors explain the health and prescription benefits and options available for people who are eligible for Medicare or are 60 years of age or older.”

Drug coverage

Moos said another important change in 2013 is to Medicare’s prescription drug coverage.

He said the goal is to close the gap in Medicare drug coverage known as the “doughnut hole” by 2020.

“This year, for instance, you get a 52.5 percent discount on your brand-name drugs and a 21 percent discount on your generics while you’re in the doughnut hole,” Moos said. “Those savings have added up to $197 million for almost 300,000 Texans with Medicare over the last year. That’s an average savings of $661 per person.

“In 2012, people with Medicare received a 50 percent discount on their brand-name drugs and a 14 percent discount on their generics while in the doughnut hole,” he added. “So, as you see, the discounts are gradually growing, year by year.”

At the end of the day, Morsch said the local impact of health care legislation depends on a lot more than the Affordable Health Care Act and changes to Medicare.

Morsch said no matter how much coverage any Medicare changes offer to enrollees, the big picture will remain alarmingly fuzzy until Congress gets its act together.

“I am confident people will get better care,” Morsch said. “But Obamacare is not what is causing the anxiety for physicians. It is part of a 10-year-old problem related to Medicare spending, inflation and the GDP. Medicare is the 800-pound gorilla in the room, and Congress keeps kicking the can.”

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