Your Medicare Benefits Are Changing
As the 16th century English poet Edmund Spenser once observed, "times
do change and move continually." That observation is as true today as it
was in Spenser’s time, and it certainly applies to health care and the
policies that govern it. That’s why we make a special effort at Lourdes to
keep our community aware of the changes which affect us and the patients
we serve.
With that point in mind, we think you should know that as of August 1
the Medicare program has changed the way it pays for hospital outpatient
services. These changes mean patients eligible for Medicare will notice
their Medicare Explanation of Benefits notice and Medicare Summary notice
will look different.
When you receive services on an outpatient basis, you are typically
responsible for a fee that the Medicare program does not cover. This fee
is called coinsurance or co-payment.
The Centers for Medicare & Medicaid Services (CMS) says that
"overtime" Medicare’s new system will ultimately lower the overall
coinsurance for outpatient services. However, at the outset, your
coinsurance is likely to increase because CMS based the new Medicare
rates on national averages, and New York hospital’s outpatient charges
have been below national averages.
If you have a Medigap policy or another supplemental insurance such as
Medicaid, your private insurance probably already pays your co-payment or
deductible. As a result, changes in your co-payments may not affect you
directly. If you do not have this insurance, you may notice that your
co-payments have changed.
The government has drastically reduced payments to hospitals for the
key health care services you depend on. Initially, while some patients may
pay a slightly higher coinsurance for certain outpatient services, the
government still pays hospitals less than the cost of providing your care.
Our constant Mission at Lourdes is to serve our patients to the best of
our ability and to continue providing the essential services our community
needs. We assure you these changes will not affect the quality of care you
expect from us.
If you have questions about your bill or the new
system, please call CMS’ Medicare Helpline at 1-800-MEDICARE
(1-800-633-4227), or call our Community Relations Department at (607) 772-1302.
Please remember that this is an enormous change for all of us, and it
is to be a work in progress. That means we all will be searching for
answers to complex questions regarding policy changes that are still
taking shape.
At the outset, however, here are some key points to keep in mind:
- In 1997, Congress mandated a new payment for Medicare hospital
outpatient services.
- It has taken this much time to covert that mandate into something
close to detailed policy, and some key details are still being
developed.
- Reimbursement under the the new payment system is based on national,
rather than hospital-specific charges.
- Despite the transition to a new system, no change will occur in the
way hospitals, including Lourdes, deliver care. The mission of
physicians, nurses, and other care givers in the hospital is to put
patients' needs first.
- The Centers for Medicare & Medicaid Services (CMS) will set the
payment rates of outpatient services hospitals provide to Medicare
beneficiaries. Because of this, hospitals will have no control over
whether a senior's coinsurance will increase or decrease at the onset.
- However, CMS says overall coinsurance is supposed to decrease
nationally, and "over time" seniors should ultimately pay less for
outpatient services under the new system. That's why the senior group
AARP fully supported this move.
- Medicare beneficiaries who have Medigap coverage do not have to pay
out-of-pocket expenses for hospital outpatient services.
- Many hospitals are not financially able to voluntarily reduce a
beneficiary's coinsurance. Hospitals have historically been paid less
than their costs for Medicare outpatient services. This is due in large
part to the federal government's continual ratcheting down of Medicare
payments. As it is, hospitals are walking a tightrope ---having to
provide the same high quality services with fewer resources. Many are
struggling to make ends meet so they can continue providing the same
services to their parents. Some hospitals, including Lourdes, have
already had to cut services to their patients.
- But Lourdes will not compromise on our Mission to provide the best
care we possibly can to the Medicare beneficiaries and all the patients
we serve.
Questions? Please call the Lourdes Physician Referral
Number at (607) 797-0006.