Task 2 Healthcare Ecosystems
Influence of Federal Government Programs
Introduction
Created by Congress in 1965, under President Lyndon B. Johnson, Medicare is an insurance program sponsored by the United States government. The purpose of Medicare is to guarantee access to health insurance for US citizens of age 65 and over and to people of any age with disabilities. In 2011, 48.7 million people were covered by Medicare with a total expenditure of $549.1 billion1 from which $182.7 billion was used to cover 15.3 million inpatient admissions; this represents 47.2 percent of total hospital’s admission costs in the US. Medicare falls under the category of a single-payer health care program;2 which means that a single public or semi-public agency organizes the healthcare finances; however, the delivery of care remains under private authority.
Given the staggering cost and resources utilized under Medicare, and the continuous efforts of the government to contain hospital costs and maintain the ability to manage their revenue cycle successfully.
Medicare’s Impact on Today’s Healthcare Ecosystem
By having multiple options of coverage, affordable premiums and, in some cases nonexistent costs to the members. Furthermore, Medicare is constituted by four parts (A, B, C, D). Part A (Hospital Insurance) covers the hospital’s admissions to inpatient, home-health care agencies, hospices and nursing skilled facilities. No premium cost to members; however, some co-payments and a yearly deductible are required. Part B (Medical Insurance), cover included: primary physician visits and their services, some preventive services and other outpatient care. Part B is optional; nevertheless, a monthly premium as well as an annual deductible is required. Part C refers to two types of healthcare plans (Medicare Advantage and Medigap). Medicare “Advantage” aloud members the freedom to choose parts A and B through an approved private health insurance organization. On the other hand, “Medigap” is a supplement to Medicare,
Introduction
Created by Congress in 1965, under President Lyndon B. Johnson, Medicare is an insurance program sponsored by the United States government. The purpose of Medicare is to guarantee access to health insurance for US citizens of age 65 and over and to people of any age with disabilities. In 2011, 48.7 million people were covered by Medicare with a total expenditure of $549.1 billion1 from which $182.7 billion was used to cover 15.3 million inpatient admissions; this represents 47.2 percent of total hospital’s admission costs in the US. Medicare falls under the category of a single-payer health care program;2 which means that a single public or semi-public agency organizes the healthcare finances; however, the delivery of care remains under private authority.
Given the staggering cost and resources utilized under Medicare, and the continuous efforts of the government to contain hospital costs and maintain the ability to manage their revenue cycle successfully.
Medicare’s Impact on Today’s Healthcare Ecosystem
By having multiple options of coverage, affordable premiums and, in some cases nonexistent costs to the members. Furthermore, Medicare is constituted by four parts (A, B, C, D). Part A (Hospital Insurance) covers the hospital’s admissions to inpatient, home-health care agencies, hospices and nursing skilled facilities. No premium cost to members; however, some co-payments and a yearly deductible are required. Part B (Medical Insurance), cover included: primary physician visits and their services, some preventive services and other outpatient care. Part B is optional; nevertheless, a monthly premium as well as an annual deductible is required. Part C refers to two types of healthcare plans (Medicare Advantage and Medigap). Medicare “Advantage” aloud members the freedom to choose parts A and B through an approved private health insurance organization. On the other hand, “Medigap” is a supplement to Medicare,
References: 1) How is Medicare funded? (2015, March). Retrieved March 2015, from http://www.medicare.gov/about-us/how-medicare-is-funded/medicare-funding.html 2) Torio, C. M., & Andrews, R. M. (2013, August). National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2011. (HCUP Statistical Brief #160). Retrieved March 2015, from http://www.hcup-us.ahrq.gov/reports/statbriefs/sb160.pdf 3) What Medicare covers. (2015, March 1). Retrieved March 2015, from http://www.medicare.gov/what-medicare-covers/index.html 4) Centers for Medicare & Medicaid Services (CMS). (2008, October 17). Survey & Certification - General Information. Retrieved March 2015, from http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/downloads/SCLetter09-08.pdf 5) Centers for Medicare & Medicaid Services (CMS). (2012). Medicare and Medicaid programs; reform of hospital and critial access hospital conditions of participation. Final rule. Federal Register, 77(95), 29034-76. 6) Centers for Medicare & Medicaid Services (CMS). (2013, November 27). Changes for Calendar Year 2014 Physician Quality Programs and the Value Based Payment Modifier. Retrieved March 2015, from https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2013-Fact-sheets-items/2013-11-27.html 7) Centers for Medicare & Medicaid Services (CMS). (2014). Fee Schedules - General Information. Retrieved March 2015, from http://cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FeeScheduleGenInfo/index.html 8) Budget of the United States Government, Fiscal Year 2010. Washington, DC: Government Printing Office. Retrieved March, 2015, from http://www.gpo.gov/fdsys/pkg/BUDGET-2010-PER/pdf/BUDGET-2010-PER.pdf 9) Japsen, B. (2013, August 23). U.S. Says More Doctors Accept Medicare Patients, Access 'Excellent '. Forbes.com. Retrieved March 2015, from http://www.forbes.com/sites/brucejapsen/2013/08/23/u-s-says-more-doctors-accept-medicare-patients-access-excellent/ 10) Burning Glass Technologies. (2012). A Growing Jobs Sector: Health Informatics. Boston: Jobs for the Future. Retrieved March 2015, from http://www.jff.org/sites/default/files/publications/CTW_burning_glass_publication_052912.pdf