Rural Americans with Medicare are in a bind. Too often, they cannot afford the high cost of supplemental coverage that limits out-of-pocket costs in traditional Medicare. And Medicare Advantage HMOs don’t meet their needs, reports Kelly Hooper for Politico Pro. Rural hospitals often won’t agree to be in a Medicare HMO network because the insurers don’t pay them adequately and endanger patient safety. What will Republicans in Congress do?
Some rural Americans in Medicare HMOs must drive as much as four hours to get the medical care they need. It’s hard enough to get care in rural America. People in Medicare HMOs struggle all the more. The insurers don’t pay the rural hospitals as much as traditional Medicare and impose all kinds of costly administrative hoops.
Traditional Medicare pays rural hospitals extra to ensure they are there for rural communities. But, even though the government pays that money to insurers serving rural communities supposedly to pass on to the rural hospitals, the insurers tend to pocket that extra money. The harder it is for their enrollees to get care, the more they profit.
Congress needs to change the payment system to rural hospitals. It could take the extra money that goes to the insurers and give it to the hospitals directly. It could also constrain insurers’ ability to impose administrative obstacles to care. But, will it?
Jerry Moran, a Republican Congressman from Kansas knows how dire the financial situation is for rural hospitals as a result of the Medicare HMOs. But, he is not proposing a fix. Nonetheless, hospitals are hopeful Congress and the administration will address insurer misuse of prior authorization to delay and deny care inappropriately.
The truth is that CMS lacks real power to prevent the insurers from inappropriate delays and denials of care. The laws and regulations have no teeth. CMS cannot punish violators in meaningful ways. And, now, with massive staffing cuts, CMS has even less ability to undertake oversight and enforcement.
A spokeswoman at CMS stated that staff would continue to do use its statutory authority to oversee Medicare HMO insurers. But, CMS lacks the resources and the tools to protect Americans in Medicare HMOs, and CMS continues to allow the insurers to overcharge Medicare for their services.
Over the last ten years, more than 100 rural hospitals have closed their doors. More than 400 more are at “high financial risk,” says a report of the American Hospital Association. Yes, more rural Americans might be enrolling in Medicare HMOs, but HMO enrollment does not mean satisfaction, nor does it help the bottom lines of the rural hospitals.
Today, almost half of all health systems across the country are either dropping or thinking about dropping their Medicare HMO contracts because of inappropriate denials of care and underpayments, reports the Healthcare Financial Management Association and Eliciting Insights.
Here’s more from Just Care:
- Medicare Advantage insurers are killing rural hospitals and communities
- Rural hospitals accept Medicare Advantage at their peril
- People living in rural communities disenroll from Medicare Advantage at a high rate
- Rural hospital closures mean poor health outcomes for rural Americans
- Hospitals find a lot wrong with Medicare Advantage
