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Medicare News
Congress, AMA, Advocates All Targeting Medicare
Advantage Private Fee-for-Service Plans
AMA says most members report their patients were
denied coverage
May 24, 2007 The spotlight in Congress and in
Medicare advocacy circles is increasing the focus on problems in the
Medicare Advantage Private Fee-for-Service Plans. A powerful House
member says he wants to cut the questionable high fees paid to these
plans and the American Medical Association released a survey saying most
of the physicians report that their patients in a Medicare Advantage HMO
or PPO plan were denied coverage of services typically covered in the
traditional Medicare.
(Read AMA statement below news report.)
Rep. Stark Says Private Medicare Advantage
Fee-for-Service Plans at 'Top' of His List for Reductions in Medicare
Reimbursements (May 23, 2007)
The House Ways and Means
Health Subcommittee
on Tuesday held a hearing on private Medicare Advantage fee-for-service
plans, and subcommittee Chair Pete Stark (D-Calif.) said that the plans
top his list for proposed reductions in Medicare reimbursements to fund
an expansion of SCHIP,
CQ HealthBeat
reports.
Stark said, "Given that half of the projected Medicare
Advantage growth" is in the area of private fee-for-service plans, "we
need to immediately evaluate its value before it gets unmanageable"
(Reichard, CQ HealthBeat, 5/22).
"As I've said all year, as we look to improve and
protect Medicare, all provider payments must be reviewed and are subject
to change," Stark said, adding, "Given what we know about PFFS at this
time, they're at the top of my list." Medicare reimbursements for MA
fee-for-service plans on average are 19% higher than those for
traditional Medicare for equivalent benefits, and critics have said that
sales agents often misrepresent the plans to enroll beneficiaries
(Edney, CongressDaily, 5/23).
Testimony
At the hearing, Stark released a letter from
California Medical
Association President Anmol Mahal that said the group has
received "hundreds of phone calls from physicians complaining that their
long-standing Medicare patients had enrolled" in MA fee-for-service
plans. In the letter, Mahal said that the plans "deem" physicians
contracted when they agree to treat one beneficiary, although the plans
do not have to inform physicians when they revise reimbursement rates.
Mahal added that Medicare beneficiaries enrolled in the plans who
receive treatment from "deemed" physicians pay higher copayments and
that physicians who actively agree to contract with the plans might
receive lower reimbursements than those provided by traditional
Medicare. Mahal said that the plans are "unwarranted profit centers for
the insurance industry at the expense of patients, physicians and the
taxpayers."
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Read
Testimony |
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Testimony at Subcommittee on Health
Hearing on Medicare Advantage Private Fee-For-Service Plans
Tuesday, May 22, 2007
Click on names for links to
testimony
Hearing Advisory
Chairman Stark
Announces a Hearing on Medicare Advantage Private Fee-For-Service Plans
Witness List and
Testimony (Printer Friendly)
Witnesses
Abby L. Block,
Center for Beneficiary Choice, Centers for Medicare and
Medicaid Services
Mark Miller, Ph.D,
Executive Director, Medicare Payment Advisory Commission
Sean Dilweg,
Commissioner of Insurance, State of Wisconsin, Madison, Wisconsin
Patricia Neuman,
Sc.D., Vice President, Henry J. Kaiser Family Foundation,
Director, Medicare Policy Project
David Lipschutz,
California Health Advocates, Los Angeles, California
Brock Slabach,
Administrator, Field Memorial Community Hospital,
Centereville, Mississippi, on behalf of the National Rural Health
Association
Catherine Schmitt,
Vice President, Federal Government Programs, Blue Cross Blue
Shield of Michigan, Detroit, Michigan
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David Lipschutz, a staff attorney with
California Health
Advocates, said, "In the one-on-one marketing pitch,
prospective enrollees are told, 'You can see any doctor you want,' or
'You can see any doctor that accepts Medicare.' The reality is quite
different" because many beneficiaries "have had problems finding
providers who are willing to accept" the conditions of and
reimbursements provided by the plans.
Patricia Neuman, vice president and director of the
Medicare Policy
Project at the
Kaiser Family
Foundation, said that, although the plans cover many
out-of-pocket costs not covered by traditional Medicare, some of the
plans "impose daily hospital copayments, daily copayments for home
health visits and daily copayments for the first several days in a
skilled nursing facility." Wisconsin Insurance Commissioner Sean Dilweg
said that insurance regulators in 39 states have received complaints
about sales agents who misrepresent the plans to enroll Medicare
beneficiaries.
Blue Cross Blue
Shield of Michigan Vice President Catherine Schmitt
recommended against "vilifying" the plans.
CMS Testimony
Abby Block, director of the
Center for
Beneficiary Choices at
CMS,
said that MA fee-for-service plans "often locate in areas where Medicare
Advantage plans have not traditionally been available," adding that the
plans are the only MA plans available in some states.
Block said that the plans "also are attractive to employers and unions
throughout the country because they can readily provide coverage
nationwide, including coverage that is adaptable to seasonal changes in
residence" (CQ HealthBeat, 5/22). Block added, "It might be a wise idea
to look at performance measures, quality performance and certainly it
might be a good idea to let CMS review those plans the same way we
review other plans" (CongressDaily, 5/23).
AMA Survey
In related news, the
American Medical
Association on Tuesday released a survey in which physicians
said that more than 50% of their patients who enrolled in MA plans were
denied coverage for services covered by traditional Medicare. In
addition, physicians said that 84% of their patients who enrolled in MA
plans did not understand the plans.
According to the survey, 51% of physicians said that reimbursements
provided by MA plans are lower than those provided by traditional
Medicare. AMA Chair Cecil Wilson in a statement said, "The private
health plans were supposed to inject competition into the Medicare
program, but instead we've ended up with a federal handout to the
insurance industry." Wilson said, "Eliminating the overpayments to the
insurance companies will save Medicare $65 billion over five years,
according to the government's own estimate," adding, "Congress has to
make a choice -- preserve access to care for all seniors by stopping
next year's Medicare cut to doctors or continue to help insurance
companies line investors' pockets" (CQ HealthBeat, 5/22).
AMA calls for financial neutrality in Medicare
Advantage
New survey, congressional statement Highlight
Medicare Advantage problems
WASHINGTON A new American Medical Association
(AMA) survey, released Tuesday, paints a bleak picture of physicians'
experiences with Medicare Advantage plans. In a statement provided today
to the House Ways and Means Subcommittee on Health, the AMA highlighted
physicians' concerns with Medicare Advantage, based on the survey
findings.
The results of our new survey of physician
experience with Medicare Advantage plans are troubling, said AMA Board
Chair
Cecil Wilson, MD.
More than half of the physicians report that their patients in a
Medicare Advantage HMO or PPO plan were denied coverage of services
typically covered in the traditional Medicare plan, and 84 percent
reported patients have had difficulty understanding how the plan works.
Also, 51 percent of physicians report that Medicare
Advantage payments are below the traditional Medicare rate. Of the
physicians with patients in a Medicare Advantage private fee-for-service
plan, 45 percent have experienced denial of services typically covered
in traditional Medicare and 80 percent report patient members have had
difficulty understanding how the private fee-for-service plan works.
The private health plans were supposed to inject
competition into the Medicare program, but instead we've ended up with a
federal handout to the insurance industry, said Dr. Wilson.
Eliminating the overpayments to the insurance companies will save
Medicare $65 billion over five years, according to the government's own
estimate.
In a written statement to the House Ways and Means
Subcommittee on Health today, the AMA expressed its staunch support of
fiscal neutrality between the regular Medicare program and the Medicare
Advantage program.
The government now pays Medicare Advantage managed
care plans on average 12 percent more than it spends on patients
enrolled in traditional Medicare. The overpayments jump to 19 percent on
average for Medicare private fee-for-service programs, the subject of
today's congressional hearing.
It's shameful that under current law Medicare will
slash payments to doctors well below the cost of caring for seniors,
while increasing payments to highly profitable managed care companies.
Congress has to make a choice preserve access to care for all seniors
by stopping next year's Medicare cut to doctors, or continue to help
insurance companies line investors' pockets.
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