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Medicare Changes for 2018 - USA Patients

Discussion in 'Knee Replacement Pre-Op Area' started by Jamie, May 4, 2015.

  1. Jamie

    Jamie Administrator

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    Changes are scheduled for 2018 in the way Medicare provides coverage for surgical procedures including joint replacement surgery.

    Currently surgery covered under Medicare provides a "bundled" payment for the entire procedure to the surgeon. The bundle includes visits by the surgeon while in the hospital, discharge, and post-op visits. For example, a knee replacement pays for 3 in-hospital visits, the discharge and 3 visits after surgery within the 90 day period from surgery forward (called the 90-day global period).

    Beginning in 2018, the global period will change to zero (0), meaning that payments will not cover any post-op visits in the surgery payment package, essentially unbundling the payment process for Medicare patients. The reason for this change is the government auditors determined that the number of post operative visits to doctors was consistently below the three visits paid for in the bundling process.

    So what might this mean for patients contemplating joint replacement surgery and the surgeons performing the procedures? For patients, there probably will be no direct impact as their needed post-op visits should be covered as an individual cost. But most certainly the surgeons will receive smaller payments for the surgery overall from Medicare. Assuming that 1 or 2 post-op visits are needed for an average case instead of the three now allowed under the bundled payment program, there will be less money going to your doctor.

    It remains to be seen if this reduction in payments will impact how surgeons handle post-op care or if the reduction will impact the number of surgeons who perform joint replacement and other surgeries. So far there has not been much discussion of this issue, but as the deadline nears it should become more of a topic for discussion in the medical community.

    Article link: http://orthobuzz.jbjs.org/2015/04/3...RG&l=7404097_HTML&u=476059589&mid=186947&jb=0
     
    • Informative Informative x 1
    • ucsbgal1971

      ucsbgal1971 Senior

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      Thanks for sharing Medicare changes. I am always interested and concerned.
       
      • Informative Informative x 1
      • nomoreski

        nomoreski Junior Member

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        Thanks Jamie. Our VNA has been working with a local hospital on their bundling plan, but this is new information we hadn't heard yet! You are on top of it!
        thx!
         
      • old goat

        old goat Senior

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        Thank you so much for Medicare info. I will begin this in Jan. and will have 2 knee surgeries one in Feb and one about 3 months later if all goes well. I think I am preset with Medicare. ugh
         
      • Jamie

        Jamie Administrator

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        I think you'll find Medicare to provide pretty good coverage. Some of it depends on what plan you've chosen. Did you decide to go with traditional Medicare and a supplemental policy or one of the Advantage plans?
         
      • Grandma new knee

        Grandma new knee New Member

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        Thanks for the information ! Glad I'll be finished with my replacements before I go on Medicare on Oct. The whole thing sounds very daunting!
         
      • old goat

        old goat Senior

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        Now that I gave been on medicare advantage I am not sure I have made the right decision. I think I will end up with lots of out of pocket expenses. However if I had kept the regular medicare and the standard insurance my monthly payments would have been maybe even more than out of pocket. It is crazy. I do have Champ VA but I am not sure a if everyone is coding everything right. ICD10 is the new system everyone should be on by LAST October. OF COURSE in the UK they have been on it since the 90s! My daughter is an insurance coordinator at one of hospitals. I was opening some bills today and just took a big sigh between my husband and myself. Somehow I need to be a better record keeper, organizer, bill payer, etc. etc. for all of this. I am always open to suggestions and would love to hear from others.

        Sent from my SAMSUNG-SM-G900A using Tapatalk
         
      • ucsbgal1971

        ucsbgal1971 Senior

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        Thanks so much for keeping us updated on Medicare changes. I have been very afraid to go through another surgery to have my knee replacement redone. It causes me a great deal of pain and I can barely bend my knee now. Apparently, I have patellar clunk syndrome. It is life limiting but I am afraid another surgery may end up in the same or worse result. I have Sjogren's Disease and part of the problem may be due to that. Maybe I should have the surgery before Medicare decides not to give adequate coverage.
         
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        • newlybionic

          newlybionic Forum Advisor

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          @old goat I have traditional Medicare a a supplemental policy. I pay a premium for the supplemental plan of 150 per month ( the best coverage) and I had 0 $ copay for my knee revision surgery for which bills added up to approximately $185,000. I also have to pay a small premium for a part D Medicare plan for prescriptions. This way I know what my bills will be and I have no paperwork to file.
           
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          • newlybionic

            newlybionic Forum Advisor

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            @ucsbgal1971 I had a revision only 8 months after my TKR. I was very frightened going into the second surgery with thoughts that I could wind up even worse than I was. I was able to find a revision specialist and it was the best thing that I could have done. My flexion was only 95 before the revision and at 15 weeks out it was 127 and improving. I worked a 10 hour shift today with no pain. Good luck with whatever you decide.
             
          • ucsbgal1971

            ucsbgal1971 Senior

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            Marian, That sounds wonderful! I truly wish I could get my life back. The idea of being able to bend my knee is so appealing. It really is life limiting when a person can't bend her knee. I fell in the hospital parking lot today and hit my knee replacement really hard on the asphalt. They xrayed it and I guess it is OK but it hurts really badly. I think that I will contact another surgeon if it keeps hurting. Maybe this will be the nudge I need to go through with another surgery. My concern is that if the Sjogren's Disease is what is the problem, then another surgery probably won't help. : (
             
          • ucsbgal1971

            ucsbgal1971 Senior

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            Is it normal to experience pain in the knee after a TKR when a person is sitting with the knee bent? The TKR was three years ago.
             
          • Jamie

            Jamie Administrator

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            No, one does not normally have pain in the knee when sitting 3 years after a TKR. I really think you need to have this checked by a quality revision surgeon. Let me do some checking and see if i can find some names for you.
             
          • ucsbgal1971

            ucsbgal1971 Senior

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            Thanks Jamie. That would be great. I fell yesterday in the hospital parking lot and hit my knee replacement hard. They xrayed it and there isn't a fracture but it is hurting like no tomorrow. I think I should have it checked out by an OS but I would rather go to whomever may be a good revisionist.

            I am really concerned about this site. Has anyone considered sending out an email blast again? Sometimes people overlook emails. I wish that there was something more that I could do. I hope everyone recognizes how important this site is and does their best to help it continue by contributing. I wonder if some physicians would help? This site was way more help to me than my own doctor. I actually didn't have to call him because of the information I found on this site so that reduced his workload.
             
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            • ucsbgal1971

              ucsbgal1971 Senior

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              What about contacting the Hilton Foundation or even Bill Gates? There must be other people who are big donors to good causes. Maybe they might be interested in contributing. This site helps thousands of people. It is well worth a donation to keep it up and running.
               
            • ucsbgal1971

              ucsbgal1971 Senior

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              I don't know if it is even possible, but I just contacted the Bill Gates Foundation about a grant for Bonesmart. If you are so inclined, say a prayer. Maybe they will help fund the site for now.
               
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              • BBCG

                BBCG Senior

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                Thanks, Jamie, for your good detective work. I probably need my right knee done too, someday, so perhaps this will mean I consider doing it in 2017 before the new rules take effect. My surgery bills are only now beginning to appear so I'm not sure what my out-of-pocket will amount to, as I have a Medicare advantage plan. Is there any information in what you're seeing to let us know How many PT visits will be included? They aren't part of the bundle, obviously, but my OS' center does PT, too, but I chose to stay with the PT I have a long history with...
                 
              • Jamie

                Jamie Administrator

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                I have not seen anything new on this topic and unfortunately with our financial constraints, I've not been able to attend a medical convention in a couple of years to see if it is being discussed there. Even in the initial discussions, I heard no mention of changes to the number of therapy visits. The discussion was centered around doctor and hospital billings.
                 
              • birdwatchr

                birdwatchr Graduate

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                For those of us who like outpatient surgery better than inpatient through a surgery center, I've read that medicare is considering including it in a year or two for tkr's. Hopefully my other knee won't need it though!
                 
              • BBCG

                BBCG Senior

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                Hi UCSBGal and all,
                I wonder if we can do a GoFundMe for Bonesmart?! Especially so the moderators and administrators can get good up to date info. from conferences, and such? I keep seeing colleagues and friends use these self-funding sites to benefit of various causes; why not Bonesmart! Surely we each know a dozen of so folks who could find it and go "yes!"?
                 

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