Trump is Improving Medicare – Part I


Republicans have gotten a bad rap on healthcare reform. Democrats would have you believe that only they can be trusted with your healthcare. Since ObamaCare has more than doubled your healthcare premiums and deductibles, and it was passed without a single Republican vote, it’s hard to understand why Democrats aren’t blushing.

To be sure, Republicans failed to deliver on their 2016 promises to repeal and replace ObamaCare. With zero support from Democrats and just enough Republican defectors, the Trump administration was unable to get passed the legislation they wanted. This probably accounts for the impression that Republicans “have no plan for healthcare reform.”

But the Trump administration is certainly not remaining idle. They have already implemented some significant improvements in ObamaCare (see Winning the Healthcare Debate) and now they are finding ways to improve Medicare.

John C. Goodman, writing in The Wall street Journal, says the Trump administration has taken great strides toward making Medicare better – while saving billions of dollars of taxpayers and patients’ money. It’s all detailed in a 124-page document from the Department of Health and Human Services called Reforming America’s Healthcare System Through Choice and Competition. Unlike the last 50 years of health policy thinking that believed the flaws were in the private sector, this document believes most problems arise because of government failure.

This new Trump policy is based on the idea of promoting choice, competition, and market prices.It seeks to do that in Medicare by:

  • Liberating telemedicine
  • Liberating Accountable Care Organizations (ACOs)
  • Ending payment incentives to hospital-based physicians
  • Promoting hospital price transparency
  • Deregulating paperwork
  • Increasing transparency in the market for prescription drugs

Today I’ll begin this discussion and then we’ll continue next week.

Liberating telemedicine

You may not realize that the world of medicine is changing fast. What was unthinkable just a few years ago is now happening.

For example, in my specialty of orthopedic surgery, it was not long ago when a total hip or knee replacement was a 5-7 day hospitalization. Now these procedures are often only an overnight stay – and in some cases are done as an outpatient in an ambulatory surgery facility. Many of these patients are then transported to a rehab facility, nursing home, or even their private home. Nurses can often observe them by video cameras and check on them when needed.

It can be even more remote. A nurse at Mercy Virtual Hospital in St. Louis may monitor a patient by camera in a hospital room in North Carolina. If the IV bag needs changing, she can notify the nurse in North Carolina to make the necessary change. Telemedicine cameras make this possible and microphones can even pick up patient coughs, gasps, and groans.

There’s just one problem for these advances in telemedicine. Medicare won’t pay for this service. Since private insurance tends to follow Medicare’s example, most of them will also deny coverage. Even though this service could save Medicare billions, the current system denies these claims.

Current Medicare policy is that doctors can examine, consult with and treat patients remotely only in rural areas and even there, patients cannot be treated in their own homes. Just as irrational is the policy that home nursing and physical therapy won’t be paid unless the patient is hospitalized for three days first.

As of January 1 this year, doctors in Medicare Advantage and Accountable Care Organizations (ACOs) can now bill Medicare if they use the phone, email, Skype and other technologies to consult with patients remotely to determine if they need an in-office visit. Doctors can also bill Medicare to review and analyze medial images patients send them, and they can bill for telemedical consultations with other doctors.

(In Part II we’ll continue this discussion.)