Link: Medicare is Good

Evidence:
Amends title XVIII (Medicare) of the Social Security Act (SSAct) to: (1) remove sustainable growth rate
(SGR) methodology from the determination of annual conversion factors in the formula for payment for
physicians' services, and (2) revise the update in rates for 2015 and subsequent years. Directs the
Medicare Payment Advisory Commission (MEDPAC) to report to Congress on the relationship between:
(1) physician and other health professional utilization and expenditures (and their rate of increase) of
items and services for which Medicare payment is made; and (2) total utilization and expenditures (and their rate
of increase) under Medicare parts A (Hospital Insurance), B (Supplementary Medical Insurance), and D (Voluntary Prescription Drug Benefit Program). Requires a separate report on the 20152019 update to physicians' services under Medicare. Directs the Secretary of Health and Human Services to consolidate components of the three specified existing performance incentive
programs into a new Merit-based Incentive Payment (MIP) system under which eligible professionals (including physicians, physician assistants, nurse practitioners, clinical nurse specialists, and
certified registered nurse anesthetists, but excluding most APM participants) shall receive annual payment increases or decreases based on their performance as measured by standards the
Secretary shall establish according to specified criteria.

Republicans Hate Medicare:

The issue over Medicare funding is made more complicated by disagreements between the two main
political ideologies over how the deficit should be corrected. Republicans tend to favor cutting
government spending, which could result in less federal monetary support for Medicare. Democrats, on
the other hand, favor an increase in taxes. This alternative places a heavier burden on the taxpayer during
an economic period that still finds many people recovering from the recent economic downfall.
Impact:
But what if all hell broke loose and no Medicare were available. What would our healthcare world look
like?
First and foremost, existing entities dependent on Medicare payments would scurry to assure their
viability and potential for profitability any way possible. For most, rationing of healthcare benefits would
rapidly accelerate. High risk individuals would be denied insurance coverage or face exorbitant
premiums. Competition for low-risk patients would accelerate between insurers. Hospitals would shift
billing from their largest insurer to the patients themselves. Patients would have an eye-opening
experience when the reality of their price markup reveals the perversity of health care prices.

Medicare coverage is limited to items and services that are reasonable and necessary for the diagnosis or
treatment of an illness or injury (and within the scope of a Medicare benefit category). National coverage
determinations (NCDs) are made through an evidence-based process, with opportunities for public
participation. In some cases, CMS' own research is supplemented by an outside technology assessment
and/or consultation with the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC). In
the absence of a national coverage policy, an item or service may be covered at the discretion of the Medicare
contractors based on a local coverage determination (LCD).
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 amended several portions of the
NCD development process with an effective date of January 1, 2004.
Current
On Wednesday, August 7, 2013, the Centers for Medicare & Medicaid Services (CMS) published a Federal
Register notice, (78 FR 48164-69), updating the process used for opening, deciding or reconsidering national
coverage determinations (NCDs) under the Social Security Act (the Act). The notice replaces the September
26, 2003 Federal Register notice (68 FR 55634) and further outlines an expedited administrative process, using
specific criteria, to remove certain NCDs older than 10 years since their most recent review, thereby enabling
local Medicare contractors to determine coverage under the Act.
This notice does not alter or amend our regulations that establish rules related to the administrative review of
NCDs.
Historical
On and after January 1, 2004, the following changes to the NCD process will be effective:

For NCD requests not requiring an external technology assessment (TA) or Medicare

Evidence Development & Coverage Advisory Committee (MEDCAC) review, the decision on the
request shall be made not later than 6 months after the date the completed request is received;
(731(a)(2)(A))

For those NCD requests requiring either an external TA and/or MEDCAC review, and
in which a clinical trial is not requested, the decision on the request shall be made not later than 9
months after the date the completed request is received; (731(a)(2)(B))

Not later than the end of the 6 or 9 month period described above, the proposed
decision shall be made available on the CMS website (or other appropriate means) for public
comment. This comment period shall last 30 days, and comments will be reviewed and a final
decision issued not later than 60 days after the conclusion of the comment period. A summary of
the public comments received and responses to the comments will continue to be included in the
final NCD. (731(a)(3)(A))

An Annual Report shall be issued listing the national coverage determinations made
in the previous year and explaining how to get more information on those determinations. (953(b))

How often is it covered?

Medicare Part B (Medical Insurance) covers a lung cancer screening with Low Dose Computed
Tomography (LDCT) once per year.
Who's eligible?
People with Part B who meet all of these conditions:

They're 55-77.
They're asymptomatic (they dont have signs or symptoms of lung cancer).
They're either a current smoker or have quit smoking within the last 15 years.
They have a tobacco smoking history of at least 30 pack years (an average of one

pack a day for 30 years).

They get a written order from their physician or qualified non-physician practitioner.
Note

Before your first lung cancer screening, youll need to schedule an appointment with your doctor to
discuss the benefits and risks of lung cancer screening. You and your doctor can decide whether
lung cancer screening is right for you.
Your costs in Original Medicare
You pay nothing for this service if the primary care doctor or other qualified primary care practitioner
accepts assignment.

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