Medicare and Medical Nutrition Therapy Essay Example

Medicare and Medical Nutrition Therapy Paper Medicare is a national social insurance program which was developed and managed by the United States in order to address the growing needs of the elderly Americans and other people who meet the requirements set by the government in order to qualify for the program. Medicare is offered to citizens of the United States who are 65 years and older and to other people with special disabilities. The Medicare program has been the biggest health insurance, single- payer, health care system in the United States. The Medicare program is enacted as a part of the Social Security Act Amendment in 1965 and was later on put into effect in 1966. The Social Security Act was enacted by the Congress and was later on signed by President Johnson. During the ceremony, President Johnson granted President Truman the privilege of being the first Medicare member and gave him the first ever Medicare card. By the end of 1966, Medicare has given aid and helped approximately 3. 9 million citizens and by 2003, studies show that Medicare has shed light to about 41 million citizens and it is precisely because of this that medicare plays a significant role in maintaining the quality of health care system in the country (Medicare, 2009). We will write a custom essay sample on Medicare and Medical Nutrition Therapy specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Medicare and Medical Nutrition Therapy specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Medicare and Medical Nutrition Therapy specifically for you FOR ONLY $16.38 $13.9/page Hire Writer The Medicare was originally under the supervision and control of the Social Security Administration but it was transferred to the Health Care Financing Administration (HCFA) in 1977. Little by little, the Medicare program was being expanded to include and allow treatment to persons with kidney problems and people below 65 years of age that have certain types of disabilities. Medicare is part of a special program similar to that of the Social Security program of the government therefore it is not based on the monetary need of a person. It is a federal program which is financed by the Federal Insurance Contributions Act (FICA) and because of this, the rules as to who would qualify as a member stays the same regardless of the place of treatment as long as it is in the United States (Medicare, 2009). The Medicare withholding tax rate is 2. 9% for both the employer and employee. Another 1. 45% of the employees’ wages and the pay matching the amount for the Medicare tax will also be withheld. The good thing about Medicare is that there is no wage base requirement for the tax so all employers and employees may continue paying the Medicare tax regardless of the amount of income (Berlin, 2009). The United States gives subsidy for citizens or residents for five years and over who are above sixty-five years of age, citizens who are physically disabled and has collected his Social Security earnings for at least two years, citizens who are candidates for kidney dialysis or transplant and individuals who have the Amyotrophic Lateral Sclerosis (ALS-Lou Gehrig’s disease). The very purpose why Medicare was enacted was to make a difference in the lives of people who have health problems and to support people who do not have the financial capacity to afford treatments (Medicare, n. d. ). Due to its continuing growing numbers, certain changes in the benefits received by the members have to be made. Now, Medicare has two different types of packages for the members. Part A of the Medicare Program covers the hospital insurance and part B covers the supplementary medical insurance. Part A, the hospital insurance, encompasses all the problems experienced in hospital services. The package allows up to a hundred-day care including hospital services in a facility filled of skilled nurses following a hospital stay. If the person is not qualified for the coverage they can still join provided they pay the monthly fee. Part B of the Medicare service is optional and it involves non-hospital services of Medicare; this is called the Supplementary Medical insurance. It covers the follow-up checkup of physicians, hospital care, laboratory services and other hospital services. Medicare also has programs for home health care services. These are some of the recent changes that Medicare implemented over the years. When Medicare first began, the services were purely inpatient hospital care which covers about two-thirds of the total program but as of today, part B of the Medicare program has greatly stretched its horizon thereby representing a little over forty percent of the budget which was about the same amount as that of the inpatient care. Medicare also puts significance in the post-acute care and home cares services for the patients which are handled by a skilled nursing facility. Enrollment in part B of the Medicare program is voluntary but there is a charge for those who choose to join. Signing up for part B is encouraged because the premium charged is only twenty five percent of the total cost of the benefit. The monthly fee for this type of program was $93. 50 in 2007 and it is more likely to rise in the future. Aside from the premium, the Medicare members are required to pay extra charges as a part of the cost- sharing expense. A kind of supplemental insurance called the â€Å"Medicap† is fast-rising. It is recommended by the employers as a component of the retirement package and it may also be bought separately by the beneficiaries. A law was passed in the late 1980’s establishing a Qualified Medicare Beneficiary Program in order to utilize Medicaid to block up the gaps. Several programs such as the Specified Low Income Medicare Beneficiary Program were established primarily to help fill-up the Medicare’s cost sharing for members with small income who are not eligible for a full Medicaid benefit (Moon, 2002). Recent developments enable the government to modify their Medicare services again including a part C of the program. Part C enables the beneficiaries to join in a private health care arrangement and obtain from an exclusive provider all the Medicare services which include both parts A and B. This type of service offered is offered with different payment options which are most suitable for the beneficiary. Medicare is continuously expanding in order to further meet and exceed the expectations of the member for the furtherance of excellence in the quality of health care. In 2006, Part D of the Medicare program is added as a voluntary insurance plan. Beneficiaries of Part D will be charged a certain amount per month in exchange for prescription medicine treatment. The additional cost per month varies depending on the type of coverage chosen. Beneficiaries are encouraged to join this program because while it is voluntary, beneficiaries, especially senior citizens, are in a continuous need for health care assistance. The price of part D increases every year for those who do not immediately sign up for this program. Medicare is specifically designed to provide medical care and not long-term care (LTC) therefore; the Medicare’s treatment is restricted for long term care. Medicare will pay the expenses for LTC as long as the following requirements are met: the seventy-two hour rule, medical necessity and the availability of the place where care can be implemented. The seventy two hour rule provides that a person must be admitted to a hospital facility for at least three full days and nights; the condition must be of such medical necessity that care must be administered in a hospital (Investopedia staff, 2009). As of 2009, the Medicare premiums and coinsurance rates have been updated. The premium for Part A Medicare is now $244 a month for people who have 30-39 quarters of Medicare-covered work. People who are not qualified for a premium-free hospital and have less than 30 quarters of their Medicare covered by their employer, the premium is $443 every month. Part B costs $ 135 every year (Medicare, 2009). Medicare Improvements for Patients and Providers Act of 2008 The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) was enacted on July 15, 2008 when the former President Bush’s veto was overridden by the Congress. This law made some changes to the Medicare program (Medicare Improvements for Patients and Providers Act, 2008). This newly enacted law made certain changes to the physician pay. In the middle of 2008, the Medicare Physician Fee (MPFS) has a reduced rate of -10. 6 percent or a grant of 1. 1% which has been retroactively substituted with the fee schedule rates which had taken effect starting from January to June. These rates are also being revised in order to increase the fee for several mental health services. The law also states that incentives will be given to doctors who will use electronic prescriptions. This Act aims to include or qualify an individual program that compensates for the Medicare premiums of people who have low-income beneficiaries (Centers for Medicare and Medicaid services, 2007). One of the reasons why Congress decided to pass the Medicare Improvements for Patients and Providers Act is to improve the quality of health care by seeing to it that access to health care services are given to all citizens. The law also enhances the amount of assets that the applicants may enjoy and still be eligible for the Medicare Savings Program which aims to help beneficiaries of low income to compensate for the costs of the Medicare benefits. This legislation also expanded the coverage for the mental health services and gave authorization to the Secretary of Health and Human Services to cover preventive services. In order to raise funds for the increase of salary for doctors and extend the assistance programs for people with low income, the Medicare Improvements for Patients and Providers Act reduces some of the funds from the Medicare Advantage program; this is a program of private health plans that accept payments from Medicare (Global Legal Information Network, 2008). Medical Nutrition Therapy Medical nutrition therapy (MNT) involves the measurement and evaluation of the nutritional level of the patients suffering from any condition or illness that puts them at risk. It includes the monitoring of a person’s nutritional status and providing him with the proper diet in order to improve his condition such as those caused by diabetes and heart disease. MNT may be classified as a medical necessity for treating, controlling and preventing diseases. This process includes reviewing and analyzing the medical and dietary background of the patient including the laboratory values and the anthropometric measurements (American Dietetic Association, 2009). A healthy eating lifestyle plays a significant role in controlling diabetes and renal ailments. Medicare pays for the medical nutrition therapy in order to lend a hand to individuals who are suffering from diabetes or renal diseases. Services include nutrition and lifestyle check, nutrition counseling and follow-up sessions (Centers for Medicare and Medicaid Services, 2005). The Center for Medicare and Medicaid Services (CMS) laid down procedures for Medicare treatment specifically medical nutrition therapy. Only registered dietitians are qualified to deal with patients. The registered dietitian must have a valid license and a good credential in order to practice the profession. It is also the job of the attending physician to refer them to Medicare in order to be covered under the Medicare Part B. The Medicare plan covers about three hours of personal counseling service during the first year and two hours for every succeeding year depending on the condition. If the diagnosis has been modified, the person with a doctor’s referral may be able to get a few more hours of treatment. Doctor’s prescription and yearly renewal of referral is a requirement for the continued availability of these services every calendar year. The individuals who are qualified with this type of Medicare plan are those who have diabetes and kidney diseases but are not on dialysis or have not experienced kidney transplant. People with an existing Medicare are required to pay twenty percent of the amount for the nutritional diet therapy subject to the deduction of Medicare part B (Medicare, 2008). For purposes of understanding and learning more about medical nutrition therapy, renal disease may be defined as certain medical condition of a person who has been discharged from the hospital within the past six months after a renal transplant. Chronic renal insufficiency involves a decrease in the renal function which is not that serious enough to require a dialysis. Diabetes is defined as an abnormal condition of the glucose metabolism (Medicare coverage of Medical Nutrition Therapy (MNT), n. d. ). A medical nutrition therapy provider may be given directly by the Medicare Advantage plan or recommended by the doctor. These registered nutrition specialist may be found in hospitals, day care and health clinics. If the provider will be given directly by the Medicare, a beneficiary should ask if they are among the participating providers, the amount of charge and whether or not they accept the assignment. This is important because if the provider declines the assignment or is not one of those qualified by Medicare, the counseling services will not be covered (Medical Nutrition Therapy, 2008). Importance of Nutritional Counseling in Medical Nutrition Therapy Nutrition counseling involves a mixture of knowledge in nutrition as well as proper psychological training which will be delivered by a highly-qualified nutrition counselor who has the ability to understand and work in a medical setting. The main priority of these sessions is to focus on the nutrition intake of a person and his feelings while eating. Studies show that a deep approach can provide excellent dietary obedience results. This is important in medical nutrition therapy because it gives a coherent framework thereby preparing the atmosphere for maximum dietary adherence always keeping in mind that the main goal of nutritional counseling should be to achieve full nutritional devotion. Nutritional counseling together with medical nutrition therapy can produce amazing effects in improving the health of a person. In medical nutrition therapy, the patient’s nutritional intake is being monitored in order to monitor, treat and prevent all possible illness which is affected with the food intake of a person (Snetselaar, n. d. , p. 3, 10). A Brief Comparison of the Nutrition Care Process for Nutrition Education and Medical Nutrition Therapy (MNT) Nutrition Education may be defined as the strengthening of the fundamental or vital nutrition-related information while Medical nutrition therapy is a more detailed application of the whole nutrition care process in any medical setting which centers mainly on the examination and management of ailments. As compared to nutrition education, Medical nutrition therapy involves a deeper assessment of the nutrition level of a certain individual. In nutrition education, interested persons often take the initiative to go to healthy nutrition classes or to consult a physician while in Medical nutrition therapy, the primary care provider sends the dietetics professional or registered dietitians (DTR or RD) written referrals for examinations of kidney related diseases or diabetes. In nutrition education, the dietetics professionals inquire about the person’s concern and any nutritional questions and sometimes they often make the person answer a certain questionnaire prior to setting up an appointment. In MNT the Dietetics professional himself gauges the nutrition level using the MNT Evident-based guidelines and the best available client information such as the medical records and then makes his diagnosis after proper analysis. In nutrition education, dietetics professional gives the client information about nutrition and taking care of the heart and body and relays information as to what he needs to most but in MNT; the good thing is that the dietetics professional himself identifies the client’s needs and sets up goals to be achieved by the client. After setting up the goals and motivating the client, the registered dietitian arranges several visits in order to monitor and check if the client is indeed doing some adjustments in his lifestyle in order to solve his nutritional problems and medical condition (The American Dietetic Association, 2006). Training is essential for a registered dietitian in order to attain a cost-efficient medical nutrition therapy program. Registered dietitians are recommended to attend seminars and special classes in order to hone and enhance their skills. Medical nutrition therapy follows a certain guideline in order to guarantee that the patient is getting the best care and treatment possible. The main purpose of evaluation in medical nutrition therapy is to find out and measure the persons’ need for therapy and to set the boundaries and generate ideas as to how to develop an effective plan that should give the best results on the individual. The medical background and history of an individual is necessary in order to administer the proper care to the individual. Prior operations, medication and maintenance should be investigated because it may affect the outcome of the therapy. A prior history of paralysis for instance, may affect the person’s capacity to eat thereby restricting his mobility and increasing the risk of complications which calls for a good nutrition intake in order to be cured. Some medicinal components may react badly and impede with the absorption of nutrients. Several dietary supplements and vitamins may also cause nutritional imbalance (Nutrition and Well-Being A to Z, 2008). Physical assessment for medical nutritional therapy includes information about the individual like the sex, body mass index, weight and height. Physical feature is also necessary because some nutritional deficiencies manifest in appearances such as iron deficiencies which appears in the hair and nails. Weight history is also important because sudden increase or loss of weight indicates a nutritional dilemma (Nutrition and Well-Being A to Z, 2008). Psychosocial assessment pertains to the profile of the person’s financial status, cultural and ethnical background, educational attainment, career or occupation, mental health and access to proper food source in order to consistently achieve good health. These factors help determine a person’s ability to follow through on his therapies. If a person is living in a house plenty of occupants or has a small income, there is a tendency of limited food access. Some exceptional situations provide for a total change in living environment in order experience development in his nutritional health. For example, a person with amputated legs has been diagnosed with diabetes and is living alone may eat only once or twice a day. There is a big possibility that his access to food may be very limited due to the difficulty of his situation. It would be best if he transferred to another facility where he can ask for assistance anytime. Reviewing the dietary history is a necessary assessment. It can be evaluated through the use of a food questionnaire or a food diary. In determining the quantity of sodium and fat in the diet, examination of the food preparation methods is necessary (Nutrition and Well-Being A to Z, 2008). Studies show that there are several public related health benefits of medical nutrition therapy. The American Diabetes Association recommended a new guideline that prioritizes nutrition intervention as an essential part of a change in lifestyle which is extremely necessary in diabetes and cardiovascular disease prevention. It is also beneficial to put attention on the totality of the dietary pattern of a person as compared to individual nutrient approach. Studies also show that there is a twelve percent decrease in the risk of heart disease if the dietary regimen of a person focuses on increasing fruit and vegetable intake and avoid eating sodium rich products. A combination of diet therapy and food consumption of garlic, low cholesterol and low fat diets would greatly lower the risk for the development of a chronic heart disease. Research provides that counseling provided by registered dietitians produce more effective results in decreasing the cholesterol level as compared to the counseling done by physicians (Health Steps, Rx, n. d. ). Medical Nutrition Therapy plays a very significant part in improving the quality of care of persons who have various complications and diseases. Most of the time, people with chronic kidney diseases do not consult a dietitian is because of the deficiency of insurance treatment for medical nutrition therapy. Undergoing this therapy can help improve their health and lifestyle. As a matter of fact, it is encouraged that even people without sickness should have their nutritional assessment just to make sure that they are getting the right amount of nutrition the body needs. When it comes to a person’s health, it pays more to be careful. Most people go through life day by day without realizing that little by little their nutritional intake is going to a dangerous level that might cause or aggravate any present disease that they have. http://www. weber. edu/WSUImages/athletictraining/Medical%20Nutrition%20Therapy%20%5BCompatibility%20Mode%5D. pdf References American Dietetic Association. 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Comparison of the American Dietetic Association (ADA) Nutrition Care Process for Nutrition Education Services and the ADA Nutrition Care Process for Medical Nutrition Therapy (MNT) Services. Retrieved April 29, 2009, from http://www. eatright. org/ada/files/chart_of_mnt_vs__nut_ed_revised_short_version_8_06. pdf