Article - July 10, 2008 - Shreveport Times

Time to cure what ails Medicare

By Pete Sepp

Medicare's fiscal woes are well known, and the demise of the program's hospital insurance component is looming ever closer. The so-called Trust Fund for "Part A" — consisting of government IOUs — will begin the slide toward bankruptcy in three years and reach total insolvency in 2019.

A lesser known fact, however, is Congress can take several cost-controlling measures to alleviate coming budget disruptions that won't require tax hikes, price controls and government bailouts. Louisiana's own Rep. Jim McCrery, R-Shreveport, holds a key position on the House Ways and Means Committee, which likely will undertake many of these proposals. Although solutions to preventing Medicare's collapse vary, the first step toward reform may begin with something as simple as dialysis — starting at the door of Fresenius Medical Care, which has 78 clinics and more than 4,600 patients in Louisiana.

Medicare currently serves as the secondary payer for a patient undergoing dialysis for end stage renal disease for the first 30 months of treatment, during which the beneficiary's own private insurance plan provides primary payment. Patients are forced to switch to Medicare as their primary payer after 30 months of treatment — regardless of their age or preferences.

Extending private coverage from 30 to 42 months, as proposed in the otherwise ill-advised Children's Health and Medicare Protection Act of 2007, would save $1.2 billion over 10 years, according to a Congressional Budget Office estimate. Given its tax and spending hikes, the CHAMP Act deserved to be buried by Presidential veto, but the bill's Patient Coverage Extension is worth salvaging.

In addition to common-sense changes such as the Patient Coverage Extension, Congress could save tens of billions of dollars annually lost to waste, fraud and abuse in federal health programs by expanding the use of private-sector Recovery Audit Contractors. RACs corrected nearly $443 million in improper Medicare payments in fiscal years 2006 and 2007, according to the Department of Health and Human Services. Every dollar paid to RACs has resulted in $15 of identified improper payments. Among the dubious cases RACs uncovered: seven appendectomies in one day for the same patient.

Lawmakers also should preserve another important accountability measure for Medicare: an "alarm bell" requiring Medicare Trustees to issue a warning (and Congress to respond) if overall funding from general federal revenues exceeds a 45 percent share in two consecutive annual reports.

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