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Medicare: The Impact for You and Your Patients

Medicare: The Impact for You and Your Patients

Access to healthcare is a hot-button issue in America. Each election cycle, we hear arguments on all sides of the healthcare debate, and 2018’s mid-term election was no different.

Your organization’s programs hinge on continuous regulation changes. These changes can have a big impact, even more so for facilities with older or lower-income patient populations. For rural hospitals, Medicare and Medicaid make up about 60 percent of revenue, versus 45 percent of revenue for urban hospitals.

Medicare spending is expected to grow 7.4 percent each year through 2026, says the Centers for Medicare & Medicaid Services (CMS). Compare that to private insurance spending, which is expected to grow by 4.7 percent each year. Any way you slice it, that’s a huge chunk of your revenue to take into consideration.

Growing Medicare Reliance

Today, more than 59 million people who are over the age of 65 or living with disabilities rely on Medicare to cover healthcare services ranging from preventative care to hospitalizations to nursing home care. Of Medicare beneficiaries, 1 in 3 have more than five chronic conditions and a quarter say they are in fair or poor health.

America’s population is growing older – 1 in 5 Americans is older than 65, and 10,000 Americans will turn 65 each day over the next 15 years. That means increased demand for healthcare services and a shift in cost to Medicare. Healthcare spending is up, according to CMS, and an aging population is one of the drivers behind that spending.

Medicare Advantage enrollment is expected to surge over the coming years; more than 4 in 10 beneficiaries are expected to be in the program by 2028 because people are more attracted to the extra benefits MA offers. 

The Ongoing Battle of Readmission Rates

Reducing readmissions is at the top of every healthcare executive’s wish list. Medicare’s Hospital Readmissions Reduction Program seems to be working in its goal; in recent years there’s been a decline in national readmission rates for both Medicare patients and those patients who are covered under Medicaid or privately insured.

But hospitals that serve in low-income communities are up against additional challenges. Patients who don’t have regular checkups or proper follow up are more likely to end up back in the hospital. Recently, CMS has decided to evaluate safety-net hospitals in their own class, which should reduce penalties for those facilities.

Maintaining Medicare Compliance

Hospitals in rural areas or in communities with older populations are most impacted by compliance shortcomings.

The Emergency Department is one area that’s become particularly challenging to many hospitals’ Medicare designations. For some facilities, physician shortages have left them without enough providers to adequately screen and stabilize ER patients. Two Maine hospitals were cited this year for “patient dumping” and actively diverting mental health patients away from the hospital.

Sources: Fierce Healthcare, Healthcare Finance News, Healthcare Leaders Media, Henry J Kaiser Family Foundation, Clarion Ledger

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