Sarah Jane Tribble reports for Kaiser Health News that small rural hospitals have been hit hard by Medicare Advantage.
The CEO of Battle Mountain General Hospital, in a Nevada gold mining town, turned away Medicare Advantage plans for the last few years. The Medicare Advantage plans weren’t willing to pay his hospital as much as traditional Medicare pays. And, the Medicare Advantage plans have yet to come forward with a fair offer.
Consequently, people in the town of Battle Mountain can’t sign up for Medicare Advantage unless they are prepared to drive three hours to Reno or four hours to Salt Lake City to go to the hospital or they are willing to pay out of pocket for their local hospital care.
Hospitals across the country, small and large, say that at times the insurers don’t pay them or don’t pay them promptly, putting them at financial risk. More than 150 rural hospitals have closed. The largest number of hospital closures have been in Texas, Tennessee and Georgia. Even though Medicare calls these rural hospitals “critical access,” the government has not ensured their ability to continue or protected them against the threat of Medicare Advantage payment denials.
Dozens of hospital systems are cancelling their Medicare Advantage contracts because of patient safety concerns as well as inappropriate delays and denials of payment, forcing their patients to find new health care providers. Still, in rural America, enrollment in Medicare Advantage continues to grow at a rapid pace since 2010.
What’s noteworthy is that the government pays these hospitals more in traditional Medicare because they are designated as “critical access.” Since government payments to Medicare Advantage plans are based on payments to providers in traditional Medicare, it appears that Medicare Advantage plans are the ones benefiting from these additional payments. They are pocketing the extra money, not willing to pay the hospitals the same rates as traditional Medicare pays.
But, some rural hospitals have no choice but to accept the terms the Medicare Advantage plans offer them. Too high a percentage of their patients are enrolled in Medicare Advantage. Mesa View in Nevada, for example, has 21 Medicare Advantage contracts. But, the hospital can’t get the MA plans to pay for the care they provide enrollees. Mesa View is now owed more than $800,000 for care it has provided.
Not only are the insurers that offer Medicare Advantage plans hurting the rural hospitals with which they are contracting, they are hurting the patients who most need care. These patients have to travel long distances to get their nursing care and rehab care covered. The local providers won’t take Medicare Advantage because they are not paid appropriately to treat them. They only take Traditional Medicare patients.
Some Medicare Advantage plans appear to pride themselves on saving money and maximizing profits by hurting provider finances and keeping people from getting easy access to care. Meanwhile, according to Kaiser Health News, ‘Centers for Medicare & Medicaid Services press secretary Sara Lonardo said CMS has acted to ensure ‘that private insurance companies are held accountable for providing quality coverage and care.’” I have been trying to determine what CMS is doing to ensure accountability from the corporate health insurers offering Medicare Advantage for years now; if CMS is doing anything meaningful, it is far from evident.
In response to a bi-partisan Senate letter to CMS about ensuring MA pays health systems appropriately, the CMS administrator claimed a final rule issued in April addresses concerns about MA coverage rules. She makes no mention about inappropriate MA payment delays and denials.
Here’s more from Just Care:
- Medicare Advantage endangers rural hospitals
- Rural hospital closures mean poor health outcomes for rural Americans
- Need a shrink? Your Medicare Advantage plan might not think so
- Medicare Advantage plans use AI to deny care
- 2023: Five things to think about when choosing between traditional Medicare and a Medicare Advantage plan
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