Brendan Williams, president and CEO of the New Hampshire Health Care Association and a former state insurance regulator, writes for McKnight’s about Medicare Advantage’s existential threat to nursing home and rehabilitation care. Our policymakers need to focus on the risks Medicare Advantage plans pose to critical health care providers and patients because of their low payments and high denial rates.
Medicare Advantage threatens the nursing home and rehab industries. These Medicare Advantage threats are on top of the threats we are all aware of: nursing and other health care worker shortages, little Medicaid support, and a low unemployment rate coupled with restraints on immigration.
Because the federal government is overpaying Medicare Advantage plans considerably, the Medicare Advantage plans have been able to offer enrollees additional benefits that are unavailable in Traditional Medicare. And, while those benefits are of questionable value–it’s unclear how many people get them and the data show widespread and persistent inappropriate delays and denials of care and coverage in Medicare Advantage–the Medicare Advantage plans can use the additional benefits to attract members away from Traditional Medicare.
People with Medicare do not appreciate the challenges they face getting costly and complex care when they are diagnosed with a serious cancer or heart problem and desperately need good care. The New York Times reported last spring, “every year, tens of thousands of people enrolled in private Medicare Advantage plans are denied necessary care that should be covered under the program, federal investigators concluded in a report…”
People needing rehabilitation services post hospitalization are also at serious risk in some Medicare Advantage plans. They are often denied critical services. According to the American Medical Rehabilitation Providers Association, Medicare Advantage plans refused to cover more than half of people admitted to rehabilitation facilities.
Williams finds it unsurprising that the Centers for Medicare and Medicaid Services, which oversees Medicare Advantage, is not going after the Medicare Advantage plans. The people working there, he says, will be looking for industry jobs when they leave. Williams suggests that people in Medicare Advantage are left unprotected.
Williams quotes the late Senator Ted Kennedy, who was reported arguing in the context of the advent of Medicare Advantage that “Congress would provide lavish subsidies to private health plans, giving them an unfair advantage in competition with the government-run Medicare program.” AARP is of no help to Medicare Advantage enrollees either, he says. It has cut a deal with UnitedHealthcare, that generates tens of millions of dollars in annual revenue for AARP.
One report by the Medicare Payment Advisory Commission or MedPAC, which oversees Medicare, quotes a survey that “Medicare’s FFS per day payments were 25% higher than MA rates.” MedPAC sums up: “[t]he payment differential between MA and FFS SNF rates indicates that facilities accept lower payments to treat MA enrollees who are not much different from FFS beneficiaries.”
Williams suggests that as Medicare Advantage takes over the Medicare market, the lower rate to nursing homes and rehabilitation facilities will mean their demise.
Here’s more from Just Care:
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