Importance of a healthy nation

It is a unanimously agreed belief that for any nation to be at its highest level of performance, prosperity and wellbeing, health is crucial. Both mental and physical health play an important role if a nation wants to elevate itself economically and socially. Although, there is a clear notion that strong economy helps in improving the health of any nation, exact opposite is also true. Physically and mentally healthy people are indispensable for stable economy. In this day and age provision of health is not only socially imperative but also a necessity for long term substantial economic growth. Unable to provide the facilities of decent healthcare to its citizens, governments should not hope for outstanding productivity from its citizens. In order to raise up the economic bar and overall productivity, governments all over the world should strive formulating affordable healthcare plans for their citizens.

CMS Introduction

Centers for Medicare and Medicaid Services (CMS) is an agency within the United States which administers the healthcare programs all over the country. CMS is responsible in overseeing and managing medical healthcare programs such as Medicare, Medicaid and the state and federal health insurance market places. It also falls under the jurisdiction of CMS to investigate and eliminate fraudulent activities and abuse staining the healthcare system. CMS also analyses data and produces research work in order to elevate the overall health of the people of the US.
Now more than fifty years of its life, CMS plays a significant role in managing the healthcare facilities for most of the Americans. CMS takes upon itself to ensure that its beneficiaries receive effective, efficient and affordable healthcare.
CMS is influenced from both regulatory bodies, which are policymakers within the agency and the public representatives in Congress who are responsible for legislative decisions. CMS must evolve and keep working towards the goal of providing best healthcare to its citizens.

CMS Background

The 1965 legislation under the tenure of President Lydon B. Johnson helped establishing the healthcare system at the time termed as Health Care Finance Administration (HCFA), now known as Centers for Medicare and Medicaid Services (CMS). Before the start of 70’s, physicians were enjoying unchallenged clinical authority. The number of visits and stays at the hospitals and healthcare facilities were usually not influenced by the insurers but at the complete discretion of healthcare specialists. Such medical practice made transparency ineffective against physicians and hospitals and were unable to hold them accountable for any decisions made for patient care. This unaccountable autonomy resulted in skyrocketing of the medical expenses. Amidst burgeoning costs as well as grave concerns over fraud and abuse taking place in healthcare field, legislators finally came to a conclusion that in order to curb false practices and misuse of authorities, close inspection was needed. The first attempt in that regard was the creation of Experimental Medical Care Review Organization (EMCRO) in 1971. These organizations were established to improve the overall quality of patient care. Down the road in order to further deal with corrupt medical practices an extension of EMCRO had been founded named as Professional Standard Review Organizations (PSROs). It was proposed by the AMF that the state based medical societies would serve as PSROs in order to lessen the influence and control over medical practice within the profession.
By 80’s legislators were still not able to rein in physicians and hospitals completely. In order to deal with the rising costs in healthcare they needed to come up with the more coherent plan. In the hope of dealing with this problem legislators enacted Prospect Payment System (PPS), which sought to control hospitalization costs by determining fixed rates based on patient’s diagnosis. To discourage longer stays at the hospitals, PPS suggested strong incentives to hospitals so that they give fewer needed services to the patients during admissions
The significant paradigm shift in federal policy in healthcare began in the contract period taking place during 90’s. Taking cue from other leading industries, CMS started develop quality initiatives to improve healthcare structure. CMS had made the commitment to refine its data system and encouraged clinical researchers to do their bidding in order to improve the quality and quantity of healthcare across all the states.
CMS also introduced the effectiveness initiative to improve the quality of medical healthcare through data analysis. By pouring its resources in research, CMS was in better position to educate healthcare providers on quality and care.
Today, CMS is providing its services across all the states and playing its role in elevating the overall healthcare system.


Programs covered by CMS

Medicare: is a federal government insurance program which covers the people with permanent disabilities, individuals suffering from end-stage renal disease (ESRD) and citizens over the age of 65. Today, Medicare coverage takes care of the families with low income and pregnant women. Medicare program enables patients to pay part of costs through deductibles for hospitals and healthcare providers.
To make it easier to understand and manage, the Medicare programs have been divided into four basic parts. Each Medicare part covers different healthcare related facilities and costs.
Part A: It primarily deals with hospital insurances. It is a basic insurance plan which enables patients to receive the facilities of hospitalization and skilled nursing care. It also provides home healthcare. However, it is important to keep in mind that Medicare doesn’t usually pay the full cost of patient’s care and the patient will most likely be responsible to pay a small portion of bills.
Part B: This part of Medicare covers doctor visits, lab tests, diagnostic screenings, medical equipment, ambulance transportations and other necessary outpatient services. However, Part B of Medicare is little more costly than part A. So, if you already have an insurance plan through your job or are covered by your spouse’s health plan, it would be wise to rethink before signing up the services of Medicare Part B.
Part C: This part combines the coverage benefits of Medicare Part A and Part B and is dubbed as Medicare advantage (MA).
Following are some facilities Medicare Part C has in its arsenal.
Hospital Insurance (Part A)
Medical Insurance (Part B)
Drugs Prescription (part D)
Vision
Hearing
Dental
Health and wellness programs
Part D: It deals with coverage of prescription of the drugs. Part D often has to be bought through a private insurer. One can either sign-up for a separate plan D or buy a Medicare Advantage plan with the coverage of prescribed drugs facility already embedded in it.
After Covid19 breakout which has affected the overall wellbeing of humans throughout the world, Medicare has expanded coverage of tele-health services. Beneficiaries are able to communicate with their healthcare providers via phones, tablets and computers from the comfort of their houses without feeling the need to visit hospitals and healthcare facilities in order to protect themselves from the pandemic.
Medicaid: is a joint federal and state program which is specifically designed to serve and accommodate people with low monthly incomes. Especially, children who need healthcare but their families earn too much to qualify for Medicaid are covered through Children Health Insurance program (CHIP).
Medicaid benefits differ slightly based on the states but federal government mandates coverage for the following services:
Hospitalization
Laboratory Services
X-rays
Doctor Services
Family Planning
Nursing Services
Clinic Treatment
Home Healthcare
It is at the discretion of the states to include the options of additional healthcare benefits such as drug prescription coverage, eyeglasses, medial transportation and so on.
Medicaid often targets for fund long-term care which in most cases is not covered by Medicare or private health insurance policies. Medicaid has proved to be advantageous for those who for some reasons have depleted their savings or are not financially stable to pay for their healthcare.

Areas which need improvement

Though, CMS has made a tremendous amount of contribution in the lives of average Americans in providing healthcare facilities, there are still some aspects which are in a dire need of an improvement so that the beneficiaries of CMS can reap the benefits of quality healthcare at lower costs.
The general criticism which CMS has to face is the apparent lack of transparency and the continuous rising of the costs. Legislators and law makers need to play their effective roles in mitigating rising healthcare costs without compromising the standard of quality of the care a patient is liable to receive from his healthcare provider.
In order to increase transparency it is important that hospitals and healthcare facilities must disclose the negotiated prices that insurance companies are being charged for different procedures. One third of insured American citizens hesitate to avail the healthcare facilities they need because either the price is too high or they don’t know what exactly it would cost them.
CMS is working towards strengthening its efforts to hold hospitals and healthcare facilities accountable and making sure that the consumers will have an access to all of the prior information in order to make better decisions in choosing healthcare plan.
Another issue is the gaps in Medicare coverage which are needed to be bridged. These coverage gaps not only reduce the overall quality of care but also impose additional costs to patients which ultimately stack up for the Medicare system.
During the last decade or so more than hundred hospitals have been shut down in the rural areas. Because of this, rural communities experience higher mortality rate. Ensuring emergency treatment to the rural people is one of the biggest challenges CMS will have to overcome.
Fortunately, Congress realized this and enacted Section 125 which ensures to establish a new provider type for rural areas.
CMS has come a long way and without any doubt has an important role in shaping up the healthcare business, but still improvement in key areas is crucial.