How Does Your Hospital Rate? Medicare is Watching!

Choosing the right hospital is an important decision for all families . Since funds are tight most everywhere these days, Medicare is evaluating the quality of hospitals across the country. The evaluations are part of Medicare’s broad move from paying hospitals a set amount for each procedure. That change was directed by last year’s health care law, which set up a new “value-based purchasing program” that will begin in October 2012. Over time, hospitals with the lowest quality— judged by a variety of factors, not just the new patient safety measures—will be at risk to lose up to 2 percent of their regular Medicare reimbursements under the health law.

The new data on patient safety moves Medicare further along toward its ultimate goal, which is to base payments on the actual medical outcomes for patients. To rate hospitals, Medicare is comparing them to the national rates for medical complications and hospital acquired conditions. By looking at how a hospital compares to the national average, Medicare has come up with overall evaluations of how good hospitals are at avoiding complications and hospital-acquired conditions. Medicare is aiming to incorporate the new patient safety data into payments in the second year of the program.

If you’re still unsure about Medicare and it’s four different types of plans, take a look at our earlier entry for some background . Also, if you’re like many Californians and are confused about  the difference between Medicare and Medi-Cal, take a look at the information we have provided regarding Medi-Cal  and remember, although Medi-Cal has a variety of programs, its long term care program is the one most people talk about and, typically, it only covers skilled nursing facilities (SNF).  , SNF is a high level of care beyond convalescent care/assisted living.  Medicare, on the other hand is available to anyone over the age of 65 and can benefit enrollees for many different types of care, but does not cover SNF (except for a very limited amount of time) or convelescent care/assisted living.

If you are 65 years or older you should already be enrolled in Medicare even if you’re not planning on using it right away as there are penalties for late enrollment. If you or a loved one is interested in receiving Medi-Cal benefits the person attempting to qualify for eligibility must meet certain income and net worth requirements . In many cases pre-planning is needed in order to qualify and there are penalties associated with making transfers in order to become eligible.  Currently there is a 30 month look back rule on transfers, which may go up to 60 months in the near future depending on when California completes the implementing regulations.

In other words, plan while you can and avoid having to burn through all of your assets before you’re eligible. Lastly, don’t forget, Medi-Cal is a loan not a gift, so if you don’t plan properly the government can take back a great deal of your assets.  Obviously, this is not child’s play and the advice of a skilled individual is essential.

And if you’re in a planning mood, remember the Veterans Aid & Attendance Non Service Connected Pension is available to most war time veterans and spouses for in home care, assisted living, or skilled nursing.