November 9, 2024 • 14 mins
Whether you're taking part in Medicare Open Enrollment for the first time or reviewing your current plan, there are plenty of changes that can be difficult to navigate. Renee McInnes, CEO of NVNA and Hospice in Norwell, is here on the show share valuable insights on how to maximize your benefits, avoid common pitfalls, and make informed decisions on coverage for the upcoming year.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:07):
From WBZ News Radio in Boston. This is New England Weekend.
Each and every week right here, we come together and
talk about all the topics important to you and the
place where you live. As always, it's so good to
be back with you this week. I'm Nicole Davis. I
don't know if you can call it the most wonderful
time of the year, but here we are getting into
the holiday season and Medicare open enrollment. This is the
(00:31):
time when you can join, drop or switch your plans,
but sometimes doing so can get a bit overwhelming, so
I brought in an expert to help us out. Renee
mckinness has been here before. She is the CEO of
NVNA and Hospice in Norwell. She is back with us
now to talk all about this. Renee, thank you for
being here. Before we dig into all this with Medicare again,
(00:51):
there's a lot to go over quickly. Remind us what
you do at NVNA and Hospice.
Speaker 2 (00:56):
We are a home health and hospice organization. We also
have the pat Roach Hospice Home in Hangham, which is
a twelve bed residential home. So we have an average
daily census of twelve hundred patients comprehensively for all our
minds of business and cover twenty seven towns from Quincy
to Plymouth. And home health services can range from anything
(01:18):
from physical therapy at home after a knee or hip
replacement or you know potentially ivy therapy or wound care.
We have a very robust palliative program as well, which
is led by nurse practitioners and medical director doctor John Stephenson,
and that program is a serious owness program, chronic disease
(01:43):
program for patients. Palliative is sometimes for people to understand,
but I'd like to clarify that group of people that
we service so that they can have a better quality
of life and stay out of the hospital. And then
we have a hospice program which is home hospice and
as I said, twelve beds at the pet Roach Hospice
(02:05):
home in our hospice program is about two hundred and
twenty five average daily census.
Speaker 1 (02:10):
Okay, you, I hope you're sleeping. There's a lot going
on here. I'm getting rest. I mean, being the one
who's kind of in charge of all this stuff, I mean,
that's a lot for you to juggle. But it seems
like you've got a great team behind you too.
Speaker 2 (02:22):
Great team, amazing team. Actually, we just found out we
got our patient satisfaction scores have been five for quite
some time, but we're the only VNA in the region
that has five star patient satisfaction. And to me, the
patient's rating us because that's a survey sent out by Medicare,
so it's not us sending a survey out and so
(02:47):
that's really makes the biggest difference. Right, So, how are
the patients experiencing us? You know, how are they experiencing
the care? And you know, did we service them in
the way that they met their expectations? And so we're
really proud of that.
Speaker 1 (03:04):
Well, then let's talk about something that a lot of
your patients are dealing with and a lot of people
in general who might be listening or dealing with Medicare
open enrollment. Now, I am not on Medicare. I cannot
speak to this. I am not a Medicare expert by
any means, and I know that there are a lot
of moving parts when it comes to Medicare as well.
(03:24):
So let's talk really quickly about the basics here. Why
do we have to do open enrollment every year and
why is it right now?
Speaker 2 (03:31):
For next year, so Medicare right, which everybody pays into Medicare.
So Medicare give your dollars over to a managed care company,
insurance company. Okay, So there's many and the intent from
Medicare was that they would manage that money more tightly
(03:52):
and maybe have more oversight. It's like an HMO managed Medicare.
If you think of Medicare advantage, it's like having an HMO.
So there is authorizations and so on. I'll get a
little bit into that, so that money is now over
in their hands. Right, So every year you have to
make a decision if you want to go with straight Medicare,
(04:15):
which means at age sixty five, you enroll in Medicare A.
Whether you're working or not working. You enroll in Medicare A,
which covers hospital costs, and it covers home health actually
and hospice. Then there's Medicare B, which you sign up
for when you potentially when you're not working, and that
(04:37):
covers outpatient and copays. And then if you don't have
another insurance plan when you're not working or your suppose
isn't working, you sign up for a supplement for Medicare right.
But that's not Medicare advantage, so a supplement to Medicare,
which is another insurance company for medications, and so that
(05:00):
can be your plan, or you can sign up for
a Medicare advantage plan which is offered through several different
insurance companies. And a Medicare advantage plan is you know,
they are like an HMO where you do have someone
managing your care right in terms of authorizations and where
(05:22):
you can go and not go, where you're going to
have choice for your physicians or your hospital or who
actually takes that insurance, and what happens when you travel.
So there's other pieces that I really what I really
want to do is to educate the consumer to really
look into what are you purchasing, what are you buying,
because for Medicare advantage, you will your monthly premium will
(05:47):
look less, right, so your monthly premium is less, but
there's other costs that might come about when you get
sick but you want to go to a particular rehab
and it's out of network or they don't take that insurance.
So with Medicare and a supplement, you're guiding your own care.
(06:07):
So no matter where you are, you don't need authorization.
You have. You know, you have your Medicare and you
don't need prior authorization, and authorizations can becomebersome. People wait
in the hospital sometimes for the authorization to get processed
so that they can go to the subacute level of care,
(06:28):
which is you know, a rehab or a skilled nursing
facility or home care, so which costs money. And so
it's really complicated, and I think people aren't always aware
of what they're buying. So I'm not telling you one
way or the other what you should do as the consumer.
(06:48):
But what I'm saying is talk with your physician, because
they witness their concerns with Medicare advantage plans, So you know,
talk with your physician who you trust, Talk with your family,
talk with your friends, talk with people who do have
Medicare advantage plans, and really understand what you're buying for us.
I'll be honest with you, and this is you know,
(07:12):
everybody knows this, so I'm not saying anything anyone doesn't know.
For home health care, the Medicare advantage plans which are
FIFA service plans, meaning each visit is paid for us separately,
and the authorizations they pay us about fifty to sixty
percent below our direct cost. So there's a VNA up
in New Hampshire who boldly in the Valley News up there,
(07:36):
son of p DNA, the CEO, came out and said
we cannot take this particular insurance anymore, and he wanted
all the consumers in the region to know, because we
won't be in business if we do. You know, we
just can't do it anymore. So I think people are
starting to question. You know, we get phone calls often,
(07:59):
I'm not able to go to this rehab. Can you
help us? Because we have a program where we help
people navigate through the healthcare system. It's so complicated and
we you know, we're like, we can't because you can't
change your insurance until next year during open enrollment. So
there's a window of time that you can change, which
is now.
Speaker 1 (08:19):
Yeah. Yeah, And if you think that you're going to
but I mean, we never really know when we're going
to get into an accident and need to go to rehab,
so on and so forth. But if you think that
you're at the place where palliative care or home healthcare
might be in your near future, this might be an
important conversation to have to make sure you have the
right plan in place.
Speaker 2 (08:36):
Right.
Speaker 1 (08:37):
You have some time too, because open enrollment is under
right now, but you have until the start of December,
December seventh, so you have a few weeks to have
these conversations.
Speaker 2 (08:46):
Exactly. Yes, it's complicated and it's hard. So I totally
understand where people are confused. Yeah, because it is. It's
very confusing.
Speaker 1 (08:56):
You want to make sure that everything's covered because you know,
if you're at the stage in your life, don't want
to have to think about it. I mean, health care
is hard enough, and billing in Medicare and all this stuff,
I mean, not being on Medicare healthcare is hard enough.
But when you get to your retirement years, your golden years,
the last thing you want to think about is going
through bills and paying stuff and this, and that you've
worked hard. You want to make sure that the system
(09:17):
you've paid into is working for you.
Speaker 2 (09:19):
Exactly.
Speaker 1 (09:21):
Yep, there are changes coming to Medicare this year, as
I believe that there are pretty much every year. What
are the big changes people should know about?
Speaker 2 (09:29):
The changes are significant for the providers of care. Okay, okay,
so there's you know, and I won't give Medicare Medicare
is pretty innovative. I know people think it's you know,
we're always talking about Medicare not in a good way,
and they're actually pretty innovative in their payment structure. But
(09:53):
and now we're in value based purchasing. It's called value
based care, and they're they're they're scoring us on our
quality and they've come up with some really good ways
to score you. And then you can get bonus points
if you do well, which isn't a bad thing. But
they are cutting I mean, they have to balance their budget,
(10:15):
which I know it's not good, so they are cutting
in different areas. Might be some you know, in terms
of surgeries and different things, different processes and different tests
you have to go through before being approved. I mean,
there might be some of that, but I don't think
there's going to be a huge change from their perspective
(10:35):
in terms of what kind of care they can receive.
There is big changes coming with Medicare advantage plans because
Medicare has noted that it's not saving the government money.
You have given the money over to Medicare advantage plans.
Speaker 1 (10:51):
Interesting, Okay, I'm seeing here though a few companies are
actually leaving Medicare advantage or cutting back. So that's a
really good point.
Speaker 2 (10:58):
Right, yeah, because the margins aren't there for them anymore.
And you know, it's tough out there. I mean, the
margins in healthcare are blimmed to none or negative, so
you know, and I think for all of us, really,
all the healthcare leaders I speak to, everybody gets up
and wants to do a good job in the one
sure in this because we want to do a good job.
(11:21):
But man, it's tough when you have increased salaries and benefits,
you know, for our employees, it's it's tough. You know,
the health care benefits keep going up what you're paying
for health care, and the revenue isn't increasing, right, and
they keep cutting in other areas. So it's a struggle
(11:41):
in health care. But we're all trying to work it
out together as a community, as a region. How do
we service everybody? And with denicure advantage, the concern is
with less and less providers taking those plans because they
are such a loss. What about access to care? For instance,
when I told you about in Hampshire, there is regions
(12:03):
up there where that VNA only covers those rural areas,
so what happens there. You know, for these people with
particular insurance, they won't have the access to care. So
that's the other piece that you have to look into,
like what is my access to care going to be?
Can I go to this rehab, Can I go to
this physician or this specialist or.
Speaker 1 (12:25):
And in network, out of network? What are my options?
I mean, I've spent many years of my life in
the White Mountains. I know that options are few and
far between when you're living in rural areas like that.
So you got to make sure that your plans align
with whatever's around, so you don't have to get an
ambulance and be driven ninety minutes away to the first
medical facility that may not even take your insurance.
Speaker 2 (12:47):
That's exactly right, No, you're right, yes, it's true. I mean,
is this some difficulty up in those rural areas of
Maine and Vermont. You know, Vermont several of their agencies
have clothes because of this issue, because the penetration of
Medicare advantage was so high up there that. Yeah, so
(13:08):
it's really is a big concern, and I just want
people to be educated because you know, it's I think
it's difficult when the provider has to say no to
a patient, right, we can't take you, because you know,
no one really wants to do that. But it's it's
at that point now where it's really kind of become
a crisis.
Speaker 1 (13:29):
So it sounds like a lot of work, but a
lot of work right now for the next few weeks
will make your life infinitely easier for the next eleven months.
Speaker 2 (13:38):
It's important because trying to to, you know, advocate for
yourself when you're looking at a bill that someone tells
you you owe and you say, how do I owe this?
We've all been down that road before, right, like, this
doesn't make sense. I thought I had everything aligned and
you went to the you went to a place that
(13:58):
I was out a network didn't know or you didn't
get an authorisation and what have you. So you know,
it's just we all know that that's tough to navigate
right after the facts.
Speaker 1 (14:09):
So well, Renee mckinnis, it's always great to have you
on the show. Thank you for your insight and your expertise,
and uh, happy open enrollment period to you.
Speaker 2 (14:18):
Yes, happy open enrollment.
Speaker 1 (14:21):
Please have a safe and healthy and happy weekend. Join
me again next week for another edition of the show.
I'm Nicole Davis from WBZ News Radio on iHeartRadio
From WBZ News Radio in Boston. This is New England Weekend.
Each and every week right here, we come together and
talk about all the topics important to you and the
place where you live. As always, it's so good to
be back with you this week. I'm Nicole Davis. I
don't know if you can call it the most wonderful
time of the year, but here we are getting into
the holiday season and Medicare open enrollment. This is the
(00:31):
time when you can join, drop or switch your plans,
but sometimes doing so can get a bit overwhelming, so
I brought in an expert to help us out. Renee
mckinness has been here before. She is the CEO of
NVNA and Hospice in Norwell. She is back with us
now to talk all about this. Renee, thank you for
being here. Before we dig into all this with Medicare again,
(00:51):
there's a lot to go over quickly. Remind us what
you do at NVNA and Hospice.
Speaker 2 (00:56):
We are a home health and hospice organization. We also
have the pat Roach Hospice Home in Hangham, which is
a twelve bed residential home. So we have an average
daily census of twelve hundred patients comprehensively for all our
minds of business and cover twenty seven towns from Quincy
to Plymouth. And home health services can range from anything
(01:18):
from physical therapy at home after a knee or hip
replacement or you know potentially ivy therapy or wound care.
We have a very robust palliative program as well, which
is led by nurse practitioners and medical director doctor John Stephenson,
and that program is a serious owness program, chronic disease
(01:43):
program for patients. Palliative is sometimes for people to understand,
but I'd like to clarify that group of people that
we service so that they can have a better quality
of life and stay out of the hospital. And then
we have a hospice program which is home hospice and
as I said, twelve beds at the pet Roach Hospice
(02:05):
home in our hospice program is about two hundred and
twenty five average daily census.
Speaker 1 (02:10):
Okay, you, I hope you're sleeping. There's a lot going
on here. I'm getting rest. I mean, being the one
who's kind of in charge of all this stuff, I mean,
that's a lot for you to juggle. But it seems
like you've got a great team behind you too.
Speaker 2 (02:22):
Great team, amazing team. Actually, we just found out we
got our patient satisfaction scores have been five for quite
some time, but we're the only VNA in the region
that has five star patient satisfaction. And to me, the
patient's rating us because that's a survey sent out by Medicare,
so it's not us sending a survey out and so
(02:47):
that's really makes the biggest difference. Right, So, how are
the patients experiencing us? You know, how are they experiencing
the care? And you know, did we service them in
the way that they met their expectations? And so we're
really proud of that.
Speaker 1 (03:04):
Well, then let's talk about something that a lot of
your patients are dealing with and a lot of people
in general who might be listening or dealing with Medicare
open enrollment. Now, I am not on Medicare. I cannot
speak to this. I am not a Medicare expert by
any means, and I know that there are a lot
of moving parts when it comes to Medicare as well.
(03:24):
So let's talk really quickly about the basics here. Why
do we have to do open enrollment every year and
why is it right now?
Speaker 2 (03:31):
For next year, so Medicare right, which everybody pays into Medicare.
So Medicare give your dollars over to a managed care company,
insurance company. Okay, So there's many and the intent from
Medicare was that they would manage that money more tightly
(03:52):
and maybe have more oversight. It's like an HMO managed Medicare.
If you think of Medicare advantage, it's like having an HMO.
So there is authorizations and so on. I'll get a
little bit into that, so that money is now over
in their hands. Right, So every year you have to
make a decision if you want to go with straight Medicare,
(04:15):
which means at age sixty five, you enroll in Medicare A.
Whether you're working or not working. You enroll in Medicare A,
which covers hospital costs, and it covers home health actually
and hospice. Then there's Medicare B, which you sign up
for when you potentially when you're not working, and that
(04:37):
covers outpatient and copays. And then if you don't have
another insurance plan when you're not working or your suppose
isn't working, you sign up for a supplement for Medicare right.
But that's not Medicare advantage, so a supplement to Medicare,
which is another insurance company for medications, and so that
(05:00):
can be your plan, or you can sign up for
a Medicare advantage plan which is offered through several different
insurance companies. And a Medicare advantage plan is you know,
they are like an HMO where you do have someone
managing your care right in terms of authorizations and where
(05:22):
you can go and not go, where you're going to
have choice for your physicians or your hospital or who
actually takes that insurance, and what happens when you travel.
So there's other pieces that I really what I really
want to do is to educate the consumer to really
look into what are you purchasing, what are you buying,
because for Medicare advantage, you will your monthly premium will
(05:47):
look less, right, so your monthly premium is less, but
there's other costs that might come about when you get
sick but you want to go to a particular rehab
and it's out of network or they don't take that insurance.
So with Medicare and a supplement, you're guiding your own care.
(06:07):
So no matter where you are, you don't need authorization.
You have. You know, you have your Medicare and you
don't need prior authorization, and authorizations can becomebersome. People wait
in the hospital sometimes for the authorization to get processed
so that they can go to the subacute level of care,
(06:28):
which is you know, a rehab or a skilled nursing
facility or home care, so which costs money. And so
it's really complicated, and I think people aren't always aware
of what they're buying. So I'm not telling you one
way or the other what you should do as the consumer.
(06:48):
But what I'm saying is talk with your physician, because
they witness their concerns with Medicare advantage plans, So you know,
talk with your physician who you trust, Talk with your family,
talk with your friends, talk with people who do have
Medicare advantage plans, and really understand what you're buying for us.
I'll be honest with you, and this is you know,
(07:12):
everybody knows this, so I'm not saying anything anyone doesn't know.
For home health care, the Medicare advantage plans which are
FIFA service plans, meaning each visit is paid for us separately,
and the authorizations they pay us about fifty to sixty
percent below our direct cost. So there's a VNA up
in New Hampshire who boldly in the Valley News up there,
(07:36):
son of p DNA, the CEO, came out and said
we cannot take this particular insurance anymore, and he wanted
all the consumers in the region to know, because we
won't be in business if we do. You know, we
just can't do it anymore. So I think people are
starting to question. You know, we get phone calls often,
(07:59):
I'm not able to go to this rehab. Can you
help us? Because we have a program where we help
people navigate through the healthcare system. It's so complicated and
we you know, we're like, we can't because you can't
change your insurance until next year during open enrollment. So
there's a window of time that you can change, which
is now.
Speaker 1 (08:19):
Yeah. Yeah, And if you think that you're going to
but I mean, we never really know when we're going
to get into an accident and need to go to rehab,
so on and so forth. But if you think that
you're at the place where palliative care or home healthcare
might be in your near future, this might be an
important conversation to have to make sure you have the
right plan in place.
Speaker 2 (08:36):
Right.
Speaker 1 (08:37):
You have some time too, because open enrollment is under
right now, but you have until the start of December,
December seventh, so you have a few weeks to have
these conversations.
Speaker 2 (08:46):
Exactly. Yes, it's complicated and it's hard. So I totally
understand where people are confused. Yeah, because it is. It's
very confusing.
Speaker 1 (08:56):
You want to make sure that everything's covered because you know,
if you're at the stage in your life, don't want
to have to think about it. I mean, health care
is hard enough, and billing in Medicare and all this stuff,
I mean, not being on Medicare healthcare is hard enough.
But when you get to your retirement years, your golden years,
the last thing you want to think about is going
through bills and paying stuff and this, and that you've
worked hard. You want to make sure that the system
(09:17):
you've paid into is working for you.
Speaker 2 (09:19):
Exactly.
Speaker 1 (09:21):
Yep, there are changes coming to Medicare this year, as
I believe that there are pretty much every year. What
are the big changes people should know about?
Speaker 2 (09:29):
The changes are significant for the providers of care. Okay, okay,
so there's you know, and I won't give Medicare Medicare
is pretty innovative. I know people think it's you know,
we're always talking about Medicare not in a good way,
and they're actually pretty innovative in their payment structure. But
(09:53):
and now we're in value based purchasing. It's called value
based care, and they're they're they're scoring us on our
quality and they've come up with some really good ways
to score you. And then you can get bonus points
if you do well, which isn't a bad thing. But
they are cutting I mean, they have to balance their budget,
(10:15):
which I know it's not good, so they are cutting
in different areas. Might be some you know, in terms
of surgeries and different things, different processes and different tests
you have to go through before being approved. I mean,
there might be some of that, but I don't think
there's going to be a huge change from their perspective
(10:35):
in terms of what kind of care they can receive.
There is big changes coming with Medicare advantage plans because
Medicare has noted that it's not saving the government money.
You have given the money over to Medicare advantage plans.
Speaker 1 (10:51):
Interesting, Okay, I'm seeing here though a few companies are
actually leaving Medicare advantage or cutting back. So that's a
really good point.
Speaker 2 (10:58):
Right, yeah, because the margins aren't there for them anymore.
And you know, it's tough out there. I mean, the
margins in healthcare are blimmed to none or negative, so
you know, and I think for all of us, really,
all the healthcare leaders I speak to, everybody gets up
and wants to do a good job in the one
sure in this because we want to do a good job.
(11:21):
But man, it's tough when you have increased salaries and benefits,
you know, for our employees, it's it's tough. You know,
the health care benefits keep going up what you're paying
for health care, and the revenue isn't increasing, right, and
they keep cutting in other areas. So it's a struggle
(11:41):
in health care. But we're all trying to work it
out together as a community, as a region. How do
we service everybody? And with denicure advantage, the concern is
with less and less providers taking those plans because they
are such a loss. What about access to care? For instance,
when I told you about in Hampshire, there is regions
(12:03):
up there where that VNA only covers those rural areas,
so what happens there. You know, for these people with
particular insurance, they won't have the access to care. So
that's the other piece that you have to look into,
like what is my access to care going to be?
Can I go to this rehab, Can I go to
this physician or this specialist or.
Speaker 1 (12:25):
And in network, out of network? What are my options?
I mean, I've spent many years of my life in
the White Mountains. I know that options are few and
far between when you're living in rural areas like that.
So you got to make sure that your plans align
with whatever's around, so you don't have to get an
ambulance and be driven ninety minutes away to the first
medical facility that may not even take your insurance.
Speaker 2 (12:47):
That's exactly right, No, you're right, yes, it's true. I mean,
is this some difficulty up in those rural areas of
Maine and Vermont. You know, Vermont several of their agencies
have clothes because of this issue, because the penetration of
Medicare advantage was so high up there that. Yeah, so
(13:08):
it's really is a big concern, and I just want
people to be educated because you know, it's I think
it's difficult when the provider has to say no to
a patient, right, we can't take you, because you know,
no one really wants to do that. But it's it's
at that point now where it's really kind of become
a crisis.
Speaker 1 (13:29):
So it sounds like a lot of work, but a
lot of work right now for the next few weeks
will make your life infinitely easier for the next eleven months.
Speaker 2 (13:38):
It's important because trying to to, you know, advocate for
yourself when you're looking at a bill that someone tells
you you owe and you say, how do I owe this?
We've all been down that road before, right, like, this
doesn't make sense. I thought I had everything aligned and
you went to the you went to a place that
(13:58):
I was out a network didn't know or you didn't
get an authorisation and what have you. So you know,
it's just we all know that that's tough to navigate
right after the facts.
Speaker 1 (14:09):
So well, Renee mckinnis, it's always great to have you
on the show. Thank you for your insight and your expertise,
and uh, happy open enrollment period to you.
Speaker 2 (14:18):
Yes, happy open enrollment.
Speaker 1 (14:21):
Please have a safe and healthy and happy weekend. Join
me again next week for another edition of the show.
I'm Nicole Davis from WBZ News Radio on iHeartRadio
Popular Podcasts
True Crime Tonight
If you eat, sleep, and breathe true crime, TRUE CRIME TONIGHT is serving up your nightly fix. Five nights a week, KT STUDIOS & iHEART RADIO invite listeners to pull up a seat for an unfiltered look at the biggest cases making headlines, celebrity scandals, and the trials everyone is watching. With a mix of expert analysis, hot takes, and listener call-ins, TRUE CRIME TONIGHT goes beyond the headlines to uncover the twists, turns, and unanswered questions that keep us all obsessed—because, at TRUE CRIME TONIGHT, there’s a seat for everyone. Whether breaking down crime scene forensics, scrutinizing serial killers, or debating the most binge-worthy true crime docs, True Crime Tonight is the fresh, fast-paced, and slightly addictive home for true crime lovers.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.