It’s that time of year when annual updates are made to Medicare payment rules and there’s one that’s garnering a lot of attention.
A nearly 1,900-page document detailing proposed new Medicare payment rules appeared April 24 in the Federal Register. Chief among its proposals, the document calls for a new level of price transparency that could help both Medicare recipient and people who aren’t on Medicare comparison shop for health care.
Check out these new potential developments with Medicare
If you’re on Medicare, you’re going to want to know about this…
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Hospitals will be required to post prices online
Under the proposed rules, hospitals would have to post standard prices online.
This is info that hospitals already have and must disclose publicly by law. But there’s no mandate that they do it in a machine-readable form that can be processed by computers.
This requirement would change that, thereby helping close the loop on the question of cost between a given health care provider and a potential health care recipient.
And even though this provision is aimed at Medicare recipients, it will help any consumer who wants to price shop for health care — regardless of how they get their insurance.
So it’s a big step in the right direction toward price transparency. But as PBS News Hour observed, there would still be one key piece of info missing: Those standard rates don’t show what insurers and government programs pay toward those costs.
So to determine your true out-of-pocket (OOP) cost, you would still need to check with your insurer. Fortunately, your OOP cost is capped by an annual limit under most insurance plans — not so with traditional Medicare.
For years, money expert Clark Howard has called for price transparency in what we pay for health care.
He’s advocated looking at health care as a business — rather than as a partisan issue or through any particular ideological prism.
“With everything else we do in our lives, price is a signal we use to decide what and where to buy. Health care should be the same. We’re talking about something that’s virtually one-fifth of our economy!” the consumer champ says.
“People say you can’t look at medicine in terms of dollars and cents. But everywhere else in the world else they do. There’s only so much money to go around. The only tool to control costs is clear pricing signals.” – Clark Howard
Get Clark’s full take on the health care debate here.
Electronic records will be more readily available
Some health care providers already offer you access to your e-records. But for those that don’t, these new proposed rules would hit them where it hurts if they don’t start doing just that over the next three years — right in the wallet.
By 2021, hospitals who don’t comply with the e-records rule would find their Medicare payments reduced.
With major players like Apple turning your phone into a one-stop shop that allows medical providers to quickly and easily see a patient’s allergies, conditions, immunizations, lab results and other vitals, easy e-record access is a goal that’s front of mind for a lot of people.
New strategies to pay for costly immunotherapies could be coming
New treatments like chimeric antigen receptor therapy (CAR-T) are rapidly advancing for the treatment of blood cancers like leukemia and lymphoma. Such strategies work by empowering a patient’s immune system to attack renegade cancer cells.
But with the new scientific advance, Medicare is reeling from the costs. These expensive immunotherapy drugs can cost up to $370,000 for a single patient!
That’s forcing Medicare to review how it comes up with money to pay for that. Seema Verma, head of the Centers for Medicare and Medicaid Services, says a comprehensive review of the payment protocol is set to begin.
“It’s a new area for the agency,” Verma says. “We haven’t seen drugs priced at this level and we’re having to think about our strategy.”
The new Medicare cards have finally begun arriving
Separate from the proposed new payment rules, residents of Alaska, Delaware, District of Columbia, Hawaii, Maryland, Oregon, Pennsylvania, Virginia and West Virginia started receiving new Medicare cards this month.
And here’s the biggest improvement in the new cards: They don’t display your Social Security number like the old ones did!
Instead, the new Medicare cards have an 11-character Medicare Beneficiary Identifier made up of random numbers and uppercase letters. That makes them a more secure replacement for the SSN-based Health Insurance Claim Number (HICN) you’re used to right now.
To see when you’ll get your card based on your state of residence, click here.