MEDICARE: Payment Caps For Nursing Homes Take Effect
Medicare payments to nursing homes will be capped starting today, a move that could put small and rural facilities out of business. Daily caps will be set at about $260 per Medicare patient, and annual caps of $1,500 will be applied to "ancillary" services such as physical therapy, USA Today reports. The payment caps come after government audits found as much as 15% of Medicare's $22.7 billion in yearly payments to nursing home are fraudulent or wasted. While larger nursing homes "are expected to weather the shift to payment caps by cutting costs and consolidating," smaller facilities could be forced to close their doors or turn away patients. "There are patients in nursing facilities today who essentially will be a loss to the facility tomorrow," said American Health Care Association Executive Vice President Paul Willging. Industry observers gave the payment caps mixed reviews. "The old system incented (nursing home operators) to spend more and increase utilization," said Joseph Lubarsky, director of long-term care services at Milwaukee's BDO Seidman. "The new system does the exact opposite: It promotes efficiency and effective care," he said. But Atlanta health care consultant Harriet Gill said "[s]ome nursing home operators must now choose between people and profits" (Smith, 7/1).
Medicare beneficiaries with diabetes or those at risk for osteoporosis have access to two new covered services today, the St. Petersburg Times reports. Under provisions in last year's balanced budget agreement, the federal program will cover bone-density screening for patients at risk for the bone-thinning disease and will provide diabetics with test strips, lancets and blood glucose monitors to keep track of their condition (Landry, 7/1). The biannual bone-density exams "will be covered for women considered by their doctors to be at risk of osteoporosis because of a decline in estrogen, and men or women who have vertebral abnormalities, an overactive thyroid gland, or who have been taking steroid drugs," the Ft. Lauderdale Sun-Sentinel reports (McVicar, 7/1). The new coverage for diabetes services replaces earlier Medicare regulations that allowed for coverage of supplies only for diabetics who required insulin injections. "By encouraging people to keep their blood sugar in control through blood-glucose testing, we hope to help prevent or delay serious complications like blindness, amputations and kidney failure," said American Diabetes Association spokesperson Christine Beebe (St. Petersburg Times, 7/1).