In 2016, the first year health care providers were allowed to bill for the service, nearly 575,000 Medicare beneficiaries took part in the conversations, new federal data obtained by Kaiser Health News show. Nearly 23,000 providers submitted about $93 million in charges, including more than $43 million covered by the federal program for seniors and the disabled. Use was much higher than expected, nearly double the 300,000 people the American Medical Association projected would receive the service in the first year. That’s good news to proponents of the sessions, which focus on understanding and documenting treatment preferences for people nearing the end of their lives. Patients and, often, their families discuss with a doctor or other provider what kind of care they want if they’re unable to make decisions themselves. Still, only a fraction of eligible Medicare providers — and patients — have used the benefit, which pays about $86 for the first 30-minute office visit and about $75 for additional sessions. Nationwide, slightly more than 1 percent of the more than 56 million Medicare beneficiaries enrolled at the end of 2016 received advance-care planning talks, according to calculations by health policy analysts at Duke University. But use varied widely among states, from 0.2 percent of Alaska Medicare recipients to 2.49 percent of those enrolled in the program in Hawaii. In part, that’s because many providers, especially primary care doctors, aren’t aware that the Medicare reimbursement agreement, approved in 2015, has taken effect.
Donald Trump has signed an emergency spending bill that will pump more than $2 billion into a program that allows veterans to receive private medical care at government expense. Trump, who made improving veterans care a central campaign promise, signed the VA Choice and Quality Employment Act while at his New Jersey golf club on Saturday. The bill, which addresses a budget shortfall at the Department of Veteran Affairs that threatened medical care for thousands of veterans, provides $2.1 billion to continue funding the Veterans Choice Program, which allows veterans to seek private care. Another $1.8 billion will go to core VA health programs, including 28 leases for new VA medical facilities. The Choice program was put in place after a 2014 wait-time scandal that was discovered at the Phoenix VA hospital and spread throughout the country. Veterans waited weeks or months for appointments while phony records covered up the lengthy waits. The program allows veterans to receive care from outside doctors if they must wait at least 30 days for an appointment or drive more than 40 miles to a VA facility. VA Secretary David Shulkin has warned that without legislative action, the Choice program would run out of money by mid-August, causing delays in health care for thousands of veterans. The bill will extend the program for six months. Costs will be paid for by trimming pensions for some Medicaid-eligible veterans and collecting fees for housing loans.
Medicare projects that the 2018 base premium for its Part D drug benefit will be 61 cents cheaper than this year, despite the rising cost of drugs, particularly specialty drugs. It is the first decrease in five years. The base premium will drop from $35.63 to $35.02 as of Jan. 1, the Centers for Medicare & Medicaid Services announced last week. The agency also calculated the average basic premium in 2018. This methodology, unlike that used for the base premiums, includes all plan types, adding in special needs plans and private fee-for-service plans, that are left out of the base premium calculation. It’s weighted by projected enrollment and accounts for the likelihood that a portion of enrollees will switch to lower cost plans. The result for this calculation was even more impressive. The average basic monthly premium is projected to drop by an estimated $1.20, from $34.70 in 2017 to $33.50 in 2018.
In a sign that the Democratic Party is embracing more progressive health care ideas, eight Democratic senators announced last week that they were co-sponsoring legislation that would allow people 55 and older to buy in to Medicare. Sen. Debbie Stabenow (D-MI) introduced the Medicare at 55 Act with the immediate support of Democratic Sens. Tammy Baldwin (WI), Sheldon Whitehouse (RI), Sherrod Brown (OH), Jeff Merkley (OR), Patrick Leahy (VT), Jack Reed (RI), and Al Franken (MN). The bill, which would allow Americans aged 55 to 64 to purchase Medicare coverage, reflects the growing influence of progressive activists who are pushing for a single-payer health care system they dub “Medicare for all.” Although the bill stops short of making Medicare universal, its embrace of expanded public health insurance, rather than the private model at the heart of the Affordable Care Act, or Obamacare, marks a distinct leftward shift for the party. “People between the ages of 55 and 64 often have more health problems and face higher health care costs but aren’t yet eligible for Medicare,” Stabenow said in a statement. “If you live in Michigan, are 58 years old, and are having a hard time finding coverage that works for you, this bill will let you buy into Medicare before you turn 65.”
Even though advance directives have been promoted for nearly 50 years, only about a third of U.S. adults have them, according to a recent study. People with chronic illnesses were only slightly more likely than healthy individuals to document their wishes. For the analysis, published in the July issue of Health Affairs, researchers reviewed 150 studies published from 2011 to 2016 that reported on the proportion of adults who completed advance directives, focusing on living wills and health care power-of-attorney documents. Of nearly 800,000 people on whom the studies reported, 36.7 percent completed some kind of advance directive. Of those, 29.3 percent completed living wills, 33.4 percent health care proxies and 32.2 percent were “undefined,” meaning the type of advance directive wasn’t specified or combined the two. People older than 65 were significantly more likely to complete any type of advance directive than younger ones, 45.6 percent vs. 31.6 percent. But the difference between people who were healthy and those who were sick was much smaller, 32.7 percent compared with 38.2 percent. The Medicare program began reimbursing physicians in January 2016 for counseling beneficiaries about advance-care planning. This study doesn’t incorporate any data from those changes. Rather, it can serve as a benchmark to gauge improvement, said Dr. Katherine Courtright, an instructor of medicine in pulmonary and critical care at the University of Pennsylvania.