Keith Washington’s Post

📢 Latest Proposed 2.8% Cut Highlights Urgent Need for Medicare Pay Reform 📢 In the ever-evolving landscape of healthcare, the latest proposed 2.8% reduction in Medicare payments underscores a critical issue that demands our immediate attention: the urgent need for comprehensive Medicare pay reform. 💡 Why This Matters: Healthcare providers are already navigating the challenges of rising operational costs, workforce shortages, and the increased demand for services. A further reduction in Medicare payments could strain resources and impact the quality of care patients receive. 🔍 Key Considerations: Sustainable Funding: Ensuring that Medicare payments are sustainable and reflective of the true costs of providing high-quality care. Provider Support: Offering adequate financial support to healthcare providers to maintain service levels and continue innovating. Patient Impact: Protecting patients from potential negative consequences of reduced funding, such as longer wait times and limited access to essential services. 📈 The Path Forward: It’s time for policymakers, healthcare leaders, and stakeholders to collaborate on creating a more equitable and sustainable Medicare payment system. This reform is not just about numbers; it’s about ensuring that every patient receives the care they deserve, and every provider is supported in delivering that care. Let's come together to advocate for meaningful changes that will strengthen our healthcare system for the future. 🏥💙 #Medicare #HealthcareReform #HealthcareLeadership #PatientCare #MedicareReform #HealthcarePolicy https://lnkd.in/gBYTXRzG

Medicare's contribution to healthcare is criticized for failing to adjust physician payments for inflation, creating financial pressure on healthcare providers. Over the last decade, Medicare reimbursement rates have declined by 10%, while physician payments have fallen 30% behind inflation since 2001. Despite some adjustments like the Cost-of-Living Adjustment for Social Security and caps on Medicare Part D out-of-pocket expenses, physician reimbursements remain stagnant. Budget constraints and the requirement for budget neutrality contribute to this issue. Consequently, many physicians limit Medicare patients or stop accepting them, reducing care accessibility. Smaller practices are especially impacted, leading to staff reductions and fewer technological investments. Some doctors increase patient volume, risking burnout. The trend may push more physicians towards concierge models, reducing availability for Medicare patients and potentially lowering overall care quality. Inflation exacerbated by expansionary monetary policies further complicates the situation, highlighting the need for a reassessment of Medicare’s financial impact on the healthcare system. Our Revenue Cycle Management (RCM) services help mitigate the financial pressures of Medicare reimbursement issues by optimizing billing processes, ensuring accurate and timely claims, and maximizing revenue. We support healthcare providers in navigating policy changes, maintaining financial stability, and improving patient care despite reimbursement challenges. We are the One! #revenuecycle #revenuecyclemanagement #priorauthorization #medicalbilling #medicalcoding #healthcare #healthcaretechnology #accountsreceivables #denialmanagement #consulting #management #implementationpartner American Institute for Economic Research - AIER

Worried about your healthcare system and current providers looking the same in the next few years? You’re Not? You Might Want to Take A Look… Things Are Changing... and Not In Your Favor... Medicare Payments to Physicians and the Effect on US Healthcare: Medicare payments to physicians have, said directly, simply not been adjusted for inflation. In fact, over the past decade, the American Medical Association estimates that rates have effectively been cut by 10%. In a period of 23 years, physician payments have fallen 30% behind the rate of inflation. This is because efforts to reduce patient costs do not usually extend to healthcare providers - and the current political environment almost ensures it will continue to be an issue with polarizing figures controlling legislation. These policymakers often prioritize controlling healthcare spending as a way to try to manage the federal budget and/or reduce deficits. Since there are far less physicians than the 65.7 million Americans on Medicare, physicians lose out in the voting block equation. However, like most times the bottom line is the main consideration, not much realization has gone into the ripple effect of what happens if doctors leave medicine or change models to concierge or Direct Primary Care – and the nearly 66m patients on Medicare, much less the rest of the population, are forced to try new approaches. If trends continue, smaller practices will merge with larger systems, reducing competition and healthcare quality. Over time, these effects will impact not only Medicare beneficiaries but all US healthcare consumers, especially Boomers and Gen-X. As the system moves from fee-for-service to value-based-care, there are not many great alternatives to consider, as most options require increased staffing to conduct this more comprehensive care – and more paperwork for already overtaxed doctors and their staffs. The margins and returns only get worse under more costs – and then you need to factor in the fines and penalties levied for not being compliant with the new value based model. If you are a hospital executive who is tired of this – and frustrated by the status quo – and want to have a strong discussion about how to work within and around this issue, please feel free to reach out. We have developed two systems that help mitigate this horrific situation – and bring better care to patients, who providing margins a hospital simply can’t create within this current environment. It is crucial that government systems either link compensation and performance with quality care provision (seemingly unlikely) – or that hospitals find services that help better results happen. We can help. Let’s talk. #PERCs #Carelync #HEG #Healthcare #Hospitals

For the last 30 years, #Medicare physician reimbursement rates have faced relentless cuts, placing enormous strain on the #healthcare system and the professionals within it. Every annual reduction creates a greater challenge for #physicians to maintain financial viability while delivering quality care—especially as costs and patient needs continue to rise.   In 1997, the Balanced Budget Act reduced Medicare spending by $115 billion over 5 years, primarily through cuts to provider reimbursements. In 2010, the #AffordableCareAct (ACA) aimed to cut Medicare spending by $716 billion over 10 years, mainly through reduced payments to healthcare providers and Medicare Advantage plans. Just one year later, Medicare faced 2% cuts annually due to the #BudgetControlAct, further affecting payments to providers. In recent years, funding cuts to Medicare Advantage plans have been proposed, but approximately 38% of Medicare beneficiaries are now enrolled in these plans.   These cuts don’t just affect physician's bottom lines; they’re reshaping #healthcareaccess for patients. As a result, many physicians are forced to make difficult choices. Some must limit the types of services they offer, while others may face the hard decision to stop accepting Medicare patients altogether. The consequences of these cuts extend directly to patients, especially as demand for care grows among an aging Medicare population.   For decades, organizations like the American Medical Association (AMA), American Academy of Dermatology (AAD), and numerous #physicianadvocacy groups have lobbied against these #reimbursementcuts, urging Congress to prioritize sustainable #healthcarefunding. However, these reductions persist, and the risk to the system only compounds. It’s clear that our #healthcaresystem cannot function effectively when reimbursement policies fail to support the providers on the front lines. Reversing or at least halting these cuts is critical for ensuring that Medicare patients can access the quality care they deserve. Addressing the funding gaps would mean investing in a healthcare future where providers are supported to continue serving their communities.   Physicians, patients, and advocates—let’s raise our voices. It’s time for meaningful reform. #MedicareCuts #HealthcarePolicy #PatientCare #PhysicianAdvocacy #HealthcareReform #Medicare   https://lnkd.in/gFcnaKDS

The Centers for Medicare & Medicaid Services (CMS) has finalized its Calendar Year (CY) 2025 Medicare Physician Fee Schedule (PFS) rule, which includes a 2.83% reduction in the payment conversion factor, lowering it to $32.35 from $33.29 in 2024. The rule also strengthens primary care, supports preventive services, and continues telehealth waivers, but it raises significant concerns for healthcare providers. Many doctors face increasing difficulty in navigating the complexities of Medicare reimbursements, with declining payment rates and rising administrative burdens. The National Association of ACOs and the American Academy of Family Physicians have voiced concerns about reduced financial targets, which are putting physician practices at risk and hindering access to care. New quality reporting requirements also necessitate costly investments in technology, but without providing actionable data, making it harder for practices to stay afloat. In this challenging landscape, Monarch MPS can help by streamlining the reimbursement process, ensuring that physicians get the reimbursements they deserve while reducing the administrative burden. Monarch MPS offers services designed to simplify billing, optimize payment collections, and help practices navigate the complexities of Medicare to improve cash flow and patient care. As CMS continues its push for an equitable healthcare system, healthcare providers need efficient solutions to thrive in a changing environment. Monarch MPS is here to help practices adapt and succeed. #Medicare #HealthcareReimbursement #PrimaryCare #Telehealth #HealthEquity #PhysicianFeeSchedule #ACO #MonarchMPS #PhysicianSupport #HealthcareSolutions

Providers Are Fed Up With Medicare Advantage More and more health systems are parting ways with big-name Medicare Advantage plans for good reason. Hassles, denying care for inpatient level of care, denying authorization for outpatient scheduled procedures, putting up roadblocks for payment according to the negotiated contract terms, requesting more medical records prepayment to slow down payment, hiring contractors to steal back monies for paid claims one to two years earlier, second-guessing physicians clinical judgment and medical decision making in diagnosing through clinical validation denials, etc. This sums it up well: "Moreover, this trend could lead to even more scrutiny and potential reforms in Medicare Advantage policies. Stakeholders, including policymakers, may need to address the concerns raised by providers to ensure that MA plans can fulfill their promise of comprehensive, accessible care without imposing undue burdens on healthcare systems." I suggest : Moreover, this trend must lead to even more scrutiny and potential reforms in Medicare Advantage policies. Stakeholders, including policymakers, must address the concerns raised by providers to ensure that MA plans can fulfill their promise of comprehensive, accessible care without imposing undue burdens on healthcare systems. Medicare Advantage is leading the innovative use of value-based care — delivering better health outcomes, through better quality care at a better cost for Medicare beneficiaries according to the trade group for Medicare Advantage plans- Better Medicare Alliance. Mission of this organization- More than 33 million beneficiaries have made the choice to enroll in Medicare Advantage. Seniors and people with disabilities deserve quality health care — and we believe Medicare Advantage provides the opportunity for a healthier future. Medicare Advantage Plans provide for a healthier future for their C suites and shareholders through healthy profits and stock dividends paid on the backs of providers and beneficiaries who are denied needed care such as SNF and rehab, services Humana has a tendency to deny or if you are UHC, use AI to determine when to stop paying for inpatient rehab/SNF. #MedicareAdvantage, #Medicaredisadvantage, #profitfirst, #reininginMAplans https://lnkd.in/exujjGN6

The American Medical Group Association (AMGA) has urged congressional leaders to prioritize provider stability by incentivizing value-based care, preventing further Medicare payment cuts, and safeguarding the Medicare Advantage program. Despite recent legislative efforts to improve Medicare Part B reimbursement and extend value-based program incentives, AMGA stresses the need for additional policy actions to support multispecialty medical groups in maintaining quality care delivery. Providers have faced significant Medicare Part B reimbursement reductions over the past four years, risking furloughs, service reductions, and delayed investments in social determinants of health. AMGA highlights the urgency to address impending Medicare program cuts triggered by the Pay-As-You-Go rules. The Value in Health Care Act aims to extend incentive payments for Advanced Alternative Payment Models and reform policies in the Medicare Shared Savings Program, recommendations supported by AMGA. Additionally, AMGA opposes changes in Medicare Advantage policies that could compromise care access and financial stability for providers. They advocate for reforms like the Pharmacy Benefit Manager Reform Act to enhance data exchange and waivers for chronic care management code coinsurance requirements for Medicare beneficiaries. Our Revenue Cycle Management (RCM) consultants assist healthcare entities by optimizing billing processes, minimizing denials, maximizing reimbursement, and ensuring compliance with evolving regulations. We provide tailored strategies to address challenges, enhance financial performance, and support sustainable healthcare delivery. We are the One! #revenuecycle #revenuecyclemanagement #priorauthorization #medicalbilling #medicalcoding #healthcare #healthcaretechnology #accountsreceivables #denialmanagement #consulting #management #implementationpartner Xtelligent Healthcare

A significant portion of healthcare spending is allocated to patients in their last year of life. Specifically, studies indicate that approximately 25% of Medicare expenditures are spent on beneficiaries during their final year. This statistic highlights the substantial financial resources directed towards end-of-life care, reflecting the intensity of medical services utilized during this period. Moreover, it has been noted that 62% of individuals in the top 5% of healthcare spenders are often those who are nearing the end of life, further emphasizing the concentration of healthcare costs in this demographic. This trend is consistent across various healthcare systems, where end-of-life care tends to consume a disproportionate share of overall health budgets.

In a recent article by Joyce Frieden, Washington Editor at MedPage Today, the Senate Finance Committee's white paper on issues with physician payment under Medicare's fee-for-service program drew praise from healthcare organizations, despite lacking clarity on some solutions. The paper, while vague on plans for addressing the problems presented, was welcomed by groups like the Medical Group Management Association (MGMA) and the National Association of ACOs (accountable care organizations). They highlighted the need for an annual physician payment update to match inflation and for modernization of outdated Medicare budget policies. The paper discussed concerns about declining physician payments, especially due to the lack of adjustment for inflation, and the impending end of payment bonuses for certain alternative payment models in 2026. The paper also scrutinized the Merit-Based Incentive Payment System (MIPS), citing administrative burdens and inconsistency in measuring quality of care, and discussed potential changes or elimination of the program. Telehealth access for Medicare beneficiaries was another focus, with the paper addressing concerns about the expiration of certain flexibilities introduced during the COVID-19 pandemic. The committee plans to engage in bipartisan efforts to preserve access to telehealth services and continues to seek input from experts, stakeholders, and committee members for future policy decisions. #Medicare #PhysicianPayment #HealthcarePolicy https://lnkd.in/gEsX8jDH

🔍 Attention Medicare Beneficiaries, Caregivers, and Healthcare Professionals! Understanding how Medicare pays physicians is crucial for making informed healthcare decisions. Forbes recently published an eye-opening article: How #Medicare Pays Physicians Is Stupid—Congress Must Change It 📈 The article sheds light on the inefficiencies of the current payment system and why it needs reform. This is particularly relevant for: Medicare Beneficiaries: Learn how payment inefficiencies could impact your care quality and financial stability. --Caregivers: Understand the potential challenges and advocate for better care for your loved ones. --Healthcare Professionals: Gain insights into policy issues that could affect your practice and patient care. 📢 Stay informed and be part of the change! For trusted, unbiased advice and guidance on your Medicare journey, contact the My Senior Health Plan team at 855-735-6705. https://lnkd.in/exRxiGJE