Medicaid and Medicare

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(MedPage Today) -- Wide-scale disclosure of clinical errors seems intuitively to be the ethical choice for hospitals and physicians, but researchers from the University of Washington suggest that disclosure should be decided on a case-by-case basis rather than a one-size-fits-all solution

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You may be thinking that June gloom is an expression to describe the weather in otherwise sunny Southern California. However, in the not-so-sunny world of Medicare it might be used to describe how Medicare physicians are feeling since Congress has once again averted a 21% pay cut to physicians by implementing a six-month fix.

 

Even though the Senate finally passed a bill rescinding the 21% cut and adding a 2.2% increase for Medicare payments, the action came too late to stop the first reduced Medicare payments to doctors from the scheduled 21.3% cut that went into effect June 1. Plus now the bill has to go back to the House for final approval.

 

“What this does,” says Alan Weinstock, an insurance broker at www.MedicareSupplementPlans.com, “is put a temporary hold on physician payments.”  In this case there was both a temporary hold, and then a reduced payment.

 

Physicians React to the Medicare Cut

 

While there has not been the threatened mass exodus of physicians opting out of Medicare, many are making some changes.

 

A May online survey of more than 9,000 physicians conducted by the American Medical Association (AMA) found that about 17% of all physicians who accept Medicare patients are restricting the number of Medicare beneficiaries they see. More than 30% of respondents who were identified as primary care physicians said they limit their Medicare patient load. For both sets of physicians, the top two reasons they cited were that Medicare rates were too low and that the constant threat of cuts made Medicare an unreliable payer.

 

Medicare Beneficiaries are Impacted by the Medicare Cut, Too

 

This ping-ponging between cutting and raising physician Medicare payments can make for uncertainty for seniors. The AMA likened it to playing Russian roulette with seniors’ health care.

 

In fact, a December 2007 Medicare Payment Advisory Commission reported that:

 

30% of Medicare patients indicated trouble in finding a new primary care physician;

25% indicated trouble getting timely appointments for preventive care and chronic conditions;

Nearly 20% indicated trouble getting timely appointments for illness or injury.

 

And this information is nearly three years old. “So, of course, the concern is that things aren’t getting any better for seniors,” notes Alan, “especially those who are just nearing the age of 65 and looking to sign up for Medicare for the first time.”

 

That is why it is important for those new to Medicare to begin the process early. There is a seven-month period in which to sign up for Medicare. It spans from three months before the month in which you turn 65 to three months after the month in which you turn 65.

 

And for current or soon-to-be Medicare patients who are looking for the best place to shop and compare Medicare supplement insurance plans, it is easy to get all the information they need just by visiting http://www.MedicareSupplementPlans.com.

CVS Caremark Corp (CVS.N) said it won an extension on its contract with the Teacher Retirement System of Texas (TRS), worth about $1 billion, to provide pharmacy benefits for two years.

CVS shares closed up more than 2 percent on Friday.

The contract, which begins Sept. 1, 2010 is valued at $480 million in 2011 and $518 million in 2012. It allows for as many as four optional one-year renewals, TRS spokeswoman Juliana Fernandez Helton said in a statement.

CVS said last month that its pharmacy benefits management (PBM) business lost $4.8 billion in contracts heading into next year. Investors sold off shares and began to question its 2007 acquisition of Caremark. [ID:nN05502370].

Texas is also investigating CVS alleged underpayments in its Medicaid program and other government agency claims. [ID:nN05129729]

TRS said it selected CVS Caremark as the pharmacy benefit manager from among five bidders, based on what was determined “to best serve TRS members.”

More than 202,000 retirees and their dependents participate in the TRS-Care plan or the group retiree health benefits program administered by TRS. While Aetna takes care of the medical benefits, CVS administers the pharmacy benefits.

CVS was selected following “a thorough due diligence process,” Fernandez Helton said.

Wells Fargo Securities analyst Matt Perry said the contract is “good news” for CVS Caremark in the light of the current investigation and as it has lost a significant number of PBM contracts recently.

Although Perry sees good long-term value in the drugstore chain’s shares, he does not expect the stock to regain its prior valuation until CVS shows some success in the next PBM selling season. Perry rates CVS at “outperform”.

CVS shares, which shed as much as 21 percent when it disclosed its PBM losses on Nov. 5, closed up 72 cents at $32.22 Friday on the New York Stock Exchange

(MedPage Today) -- Children with a dry cough at night or wheezing during exercise are at elevated risk of respiratory adverse events during and after general anesthesia, researchers reported.

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We have been seeing a lot of enquiries from clients wanting to know if a Self Invested Personal Pension (SIPP) would be appropriate for them.

Let’s look at an example to illustrate this.

Let’s say you have several personal pensions, some separate share investments and an investment property. How can you use a SIPP to invest in the shares and the property?

A SIPP allows greater control of pension investments and a wider range of options. This means that, subject to what legislation will allow, you can decide when, where and how to invest your pension contributions.

By using a SIPP, you are able to access investment funds which are managed by the full range of fund managers. You will also be able to invest your fund directly in stocks and shares, commercial property and other assets.

To assist with this, the fund will be able to borrow up to a maximum of 50 per cent of the net assets of the scheme. However, it should be noted that when borrowing to help fund a property purchase, the SIPP will also need to cover all associated costs such as stamp duty and legal fees.

As well as buying a new property, the ban on connected party transactions that was lifted by HM Revenue & Customs on April 6, 2006 means that if you already own a commercial property, you can either sell the property to your SIPP or pass the property to your SIPP as an in specie contribution.

Technically speaking, it is not possible for property, shares or other allowable assets to be passed to a scheme as a contribution. However, the Revenue has confirmed that it is possible to say: “I am going to contribute £100,000 to my SIPP and to discharge this obligation I give my SIPP this property or these shares.”

Where the allowable asset is passed to a scheme, the contribution will benefit from tax relief limited to the higher of earnings or £3,600 gross, rather than the full value of the asset.

When passing a property to a pension scheme as a contribution, any outstanding mortgage will need to be paid off before the property can be moved into the pension scheme.

But where you own an existing property, what is the best option?

The in specie transfer might appear to be the more attractive of the two because tax relief is available on the contribution. However, the major drawback with this method is that the mortgage must be paid off before the transfer can proceed.

Investors wishing to benefit from tax relief on the full value of the property will need to have earnings that are at least equal to the value of the property. It would therefore appear that the most practical method of moving property into a pension is likely to be to build up a fund first and then buy the property.

In relation to share ownership within a SIPP, the following points should be noted:

- The SIPP or connected parties cannot own over 50 per cent of the shares of the company

- Shares acquired under savings-related share option schemes or share incentive plans are allowed by the Finance Act 2004 to be transferred to a pension scheme and these will automatically qualify for tax relief as contributions if they are rolled over into the pension scheme / arrangement within 90 days of the member becoming the owner

- The purpose of the investment must not be for the SIPP member or a connected party to use the company’s assets

- The company’s main activity must be trading

The transfer is in effect a contribution, so it is entitled to tax relief in the normal way. If the contributions would normally get tax relief at source, basic rate tax relief on the value contributed will be paid by HMRC into the plan, with any higher rate relief being claimed through self-assessment.

The person transferring the ownership of the asset will be liable for any capital gains tax on any gain in the asset since he/she acquired it. They may also be liable for stamp duty.

The simplest way of making a contribution to a pension scheme equal to the value of assets held would be to sell those assets and pay the proceeds into the pension plan.

This avoids the potential problems with an in specie contribution and allows someone who does not initially have the cash to make a substantial contribution to their pension scheme. Tax relief will be given on the contribution as normal, assuming the gross contribution does not exceed their UK earnings. Capital gains tax and stamp duty may be payable on the sale of assets.

The disadvantages are that the assets do not end up in the pension scheme, unless the pension scheme subsequently buys the assets. This could involve delay and values may have moved in the meantime. If the asset was a property, of course, it might not be available for sale.

The Financial Tips Bottom Line

If you are considering the SIPP route, make sure you do your research in advance as this area can be a minefield!

Also, there are a number of SIPP providers so make sure you look at what type of SIPP you need, as well as checking the small print before you sign on the dotted line.