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New Changes in the Medicare system are here! Get up to date now.

By 29th March, 2016 Medical Assistance, Medicare Comments Off


The “Bundle” health care system is in effect now in many states across the U.S and is affecting the lives of millions of the elderly.  This program is now in Arizona and will effect everyone’s care going forward.  So what is it?  It is known as the BPCI (Bundled Payments for Care Improvement) initiative.  It’s goal?  To reduce Medicare expenditures while preserving and possibly enhancing the quality of care for the beneficiary.   In the past Medicare made separate payments to providers for individual services provided for a single illness or course of treatment.  This meant every provider was paid based on the quantity (days) versus quality of care they provided for the Medicare beneficiary.  Unfortunately some providers took advantage of the system and extended the stay of the beneficiary to maximize their payment even when it was not truly in the best interest of the beneficiary.  In order to combat this misuse of funds Medicare has introduced their new bundle program.  The way the bundle program works is it will allow one single payment (the amount is based on a predicting cost for that particular illness or procedure) that will be shared among the hospital, the rehabilitation center, home health, medical equipment company and any other provider that provides care to the beneficiary and receives payment from Medicare. The hospital will be graded and held accountable for how the funds are used as well as for the end result for the beneficiary.  If the beneficiary returns to the hospital within 30 days of hospitalization this will be graded poorly and over time the hospital would be penalized.   Hospitals will be given a high quality performance when discharging to a rehabilitation center or home which results in no re-hospitalization and everyone working together efficiently to reduce costs. Hospitals that perform well over time will be rewarded for helping Medicare reduce their costs.

So saving money is a good thing right? So who loses? Well at times the beneficiary!  Here is how.   The hospital now becomes the manager of your Medicare money. Since they are given a lump sum based on the beneficiary’s health issue it is now in their best interest to actually use as little of those funds as possible as long as it does not result in the beneficiary being re-hospitalized within 30 days. As stated before these funds are to cover all of the services that the beneficiary would require which again is why it’s called the bundle program. Hospitals will now be grading the other service providers on their efficiency and cost effectiveness since there will be a limited amount of funds to work with.  This could lead hospitals to make choices of which service providers to use based on saving money rather than the quality of care given.  This will also lead to earlier discharges in order to again save money even if it is not truly in the best interest of the beneficiary.

How do you protect yourself? First off become more educated about the options that are out there.  Check the reviews on all the service providers in your area as well as asking your friends and family what experiences they have had. It is kind of sad but more people will check reviews on restaurants they may want to eat at more often than hospitals or rehabilitation centers they may someday have to rely on to save their lives. Once you make a decision on which providers you will want to use in the case of an emergency write it down and share it with all your loved ones. Hospitals must abide by your request if there are certain service providers you would rather use than another even it is not one of their preferred providers. Also know all your options for being discharged from both a hospital and a rehabilitation center. If you do not feel that you or your loved one is ready to go home ask for a longer stay. Remember not everyone is the same and sometimes it may take longer than normal to get back on your feet don’t let the hospital decide what is best for you. If you are denied the longer stay due to Medicare restrictions remember you can always opt to pay privately for the remainder of your stay although this can be a very expensive option at around $500 per day or more. Also, be aware due to these changes new alternatives are now becoming available. One such alternative is called “Transitional Respite Care”. This is a short term stay program usually offered by Assisted Living Facilities that allow you or your loved one to stay at the assisted living for a short stay while you prepare to transition back home. One of the major complaints about rehabilitation centers especially regarding the elderly is that when they get home they are still too weak to get around and do the basic tasks. This is usually due to the limited tasks rehabilitation centers allow their patients to perform for safety reasons. So many times you will work with a physical therapist once a day for a short period of time and the rest of the time you will lay in your bed which can make you weaker. In the Assisted Living Facility you can have the best of both worlds. You can have PT come to you (as long as your doctor recommends it) at the facility while the rest of the time you will be assisted with your everyday tasks such as going to the restroom, going to the table to eat, going to your room to sleep and in most cases in a short time you will find that your strength will return and you will then be able to return home. You will still need to pay privately for these services but at usually half of what it would cost you at the rehabilitation center with more benefits.

I hope you have found this article to be informative and please check back for more articles in the future.