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DOGE Has a Plan for Medicare, Medicaid. Will it Work?
Politico / By Ben Leonard and Chelsea Cirruzzo
Presented by the Coalition to Strengthen America’s Healthcare
UNPACKING DOGE CLAIMS — Biotech entrepreneur Vivek Ramaswamy, co-leader of President-elect Donald Trump’s Department of Government Efficiency, is eyeing Medicare and Medicaid as potential sources to cut federal spending by trillions, Ben reports.
The goal of DOGE — an outside group that will recommend spending and regulation cuts — is a tall task that would likely involve cutting entitlement programs to extract significant savings. Ramaswamy said last week on CNBC that “hundreds of billions of dollars in savings” could come from just “basic program integrity measures” in Medicare, Medicaid and Social Security.
He’s generally in the right ballpark for the numbers. HHS estimated that, in fiscal year 2024, Medicare and Medicaid accounted for about $86 billion in improper payments, and other estimates peg fraud and waste higher annually.
But the devil’s in the details.
Jessica Farb, managing director of the Government Accountability Office’s health care team, noted that most of the improper payments in HHS’ estimates are due to insufficient documentation.
“If these documentation errors were corrected, it is very possible that these payments would no longer be considered improper and therefore there would not be any ‘savings’ to the programs,” Farb said, adding that she doesn’t know what estimates Ramaswamy was using. “Improper payment rate is not an estimate of fraud or waste.”
Controlling fraud might be more difficult than Ramaswamy suggests because many before him have pointed to curbing fraud, waste and abuse as a way to control government spending. Experts on health care fraud say there are ways to reduce it.
“Internal controls are extremely important in trying to deter fraudulent activity from occurring, and to be honest, the government has the worst system of any organization,” Patrick Malloy, program coordinator at the University of New Haven’s health care fraud, waste and abuse program, told Pulse.
He suggested the government could follow the private sector by auditing its waste control processes annually and reporting on their findings. Fraud in private organizations is generally about 5 percent of revenues, he said, compared with up to 15 percent in government.
Still, others are more skeptical that Ramaswamy’s vision could be achieved…
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Home-Based Care Providers, Advocates React To Passage Of Elizabeth Dole Act
Home Health Care News / By Audrie Martin
On Dec. 13, the U.S. Senate unanimously approved an amended version of the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act. This landmark legislation includes various measures to make home care more accessible to veterans. The bill is now awaiting President Biden’s signature to become law.
For almost two years, the Elizabeth Dole Foundation has worked with a coalition of organizations to promote this bipartisan package of legislation.
“Our leaders in Congress have shown that America can still come together to support those who have served our nation and their families,” Elizabeth Dole Foundation CEO Steve Schwab said in a statement. “This bill was not only passed with broad bipartisan support, but it is also the most comprehensive veterans’ legislation this Congress has passed. It includes significant, far-reaching benefits and reforms that will be transformative for the wider veterans’ community and essential in helping our nation’s military and veteran caregivers succeed.”
The Foundation ensured that caregivers and their families were prioritized in the legislation, which includes more than 90 sections addressing issues such as long-term care, mental health resources, education, job training and modernization of the Department of Veteran’s Affairs (VA). The Elizabeth Dole Home Care Act, a bill within the larger package, will allow severely ill and aging veterans to recover at home by increasing their caregivers’ access to support services…
…In addition to comprehensive updates focusing on mental and behavioral health support, education and training programs, and benefit reforms, the act includes essential long-term care provisions that would establish a pilot program through the VA to offer assisted living options for aging and disabled veterans.
Currently, the VA can only allocate 65% of the cost of providing nursing home care to a veteran on home- and community-based care. This bill permits the VA to increase spending on this type of care.
The bill would require the Undersecretary of Health to review each program administered by the Office of Geriatric and Extended Care and the Caregiver Support Program Office to ensure consistency in program management, eliminate service gaps at medical centers and ensure proper coordination…
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Do Families Want Hospice Present During the Death?
By Barbara Karnes
Recently I have been hearing discussion of why families and significant others do not want hospice or EOL Doulas with them during the final moments of life. Families often do not want anyone with them as their special person is actively dying. That is alone, private time. Anyone else present is an intrusion, an invasion of privacy.
My two cents: Yes, some may think it is a very private moment and do not want to share it with "strangers." HOWEVER, most people don’t understand how death happens. They don’t understand how people die. Movies tend to be today’s role model and that is not how death comes. So, most people don’t know what they are getting into when they say they want to be alone.
Education about what dying is going to look like is paramount for us end of life workers. This is the most important thing we give to families and significant others. We need to explain the way most people die — especially the not-so-pretty parts. This includes the sounds, movements, pees, poops, frowns, grimaces, and the struggles that accompany approaching death.
After the "talk," offer to be a presence with them -- at that point it is their choice. Explain how you can guide and support everyone during this special time. You can be quiet & unseen, or have more of a presence if that is wanted. You can be a quiet "conductor."
If after you have explained what will occur and your offer is not accepted, know you have done your job. You have educated and offered support.
Don’t just assume a family wants to be alone. Most families welcome the support and guidance of a professional being with them.
Part of end of life work is to develop a relationship with the patient and family. Work with the dying is more about the emotional connection from which trust can develop than just meeting the physical needs of the patient. When hospice sends a different nurse, home health aide, social worker, or chaplain on every visit, a bond and trust is not established. A huge part of end of life work is creating a connection and trust during a very emotional time in the family's and patient's lives.
A side note: when my husband was dying last year, my hospice nurse was present. She was invisible but present. She was a great "security blanket" for us even though I knew everything that was going to happen. I had no fear and I had the knowledge. BUT my husband was dying and Stephanie’s presence was a great comfort.
I believe that most families, when death has come, appreciate the knowing presence that end of life workers bring. |
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How Trump Could Roll Back Biden-Era Healthcare Regulations
Fierce Healthcare /By Noah Tong Dec 6, 2024 3:40pm
President-elect Donald Trump and his allies make no secret of their disdain toward federal agencies and their desire to fundamentally disrupt the regulatory state.
The new administration plans to rely on unorthodox health official picks Robert F. Kennedy Jr. and Dr. Mehmet Oz to shape, and remake, healthcare in Trump’s second term, but administrative law experts and health policy analysts expect Trump’s disdain for the prior Oval Office-holder will mirror his first term.
Although many question marks remain as to what healthcare priorities will ultimately catch on, it’s expected Trump will try to reverse Biden-era regulations, as he did during his first term.
That’s where the possibilities unfold.
One avenue for quick recissions of federal rules is through the Congressional Review Act (CRA). The lesser-known federal law enacted during President Bill Clinton’s term allows Congress a short window to overturn final rules with the support of the president.
Lawmakers introduce resolutions of disapproval frequently, but the law is typically a nonfactor except under unique circumstances. After an election when one party is in control of Congress and the White House, the new president has a short time frame to reverse individual rules under the “lookback” period. In 2017, Trump repealed 16 rules, by far the most of any president. Biden followed suit with a few revoked regulations when he took office.
Now, with the executive and legislative branch under Republican rule, Trump will have the opportunity to utilize the CRA once again. He could, theoretically, reverse any rule finalized after Aug. 1, though that date is yet to be determined and certain restrictions may disincentive this behavior…
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Notice of Retraction: Final OASIS E-1 Manual and Change Table
The Final OASIS E-1 Manual and Change Table was posted on the HH QRP Spotlight and Announcement Page last week and removed shortly afterward. CMS reports that the materials are being temporarily removed and will be reposted at a later date. They will provide an updated announcement once the resources are available. |
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