Trump administration attempts to privatize traditional Medicare

The Trump administration is deep into rolling out a pilot plan that, over time, could privatize the public fee-f0r-service Medicare program unless the Biden administration hits the pause button on its implementation. Several open issues with this payment and care delivery or “Geo” model–a capitated payment system–highlight its ability to undermine access to care for millions of older and disabled Americans who might be forced into it.

1. How can CMS ensure that capitated corporate plans regulating access to care for people in traditional Medicare won’t undermine quality of care or increase costs? Government audits indicate that capitated corporate Medicare Advantage plans systematically engage in widespread inappropriate delays and denials of care. They also overcharge the government for their services to the tune of billions of dollars a year. And, MedPac continues to report that taxpayers are paying more for them on a per capita basis than for people in traditional Medicare. Moreover, Medicare Advantage plans have not released accurate and complete encounter data, as required by law, which would allow a meaningful assessment of each of them.
2. How will CMS effectively assess quality based on consumer surveys and “measuring outcomes?” Information from people who are relatively healthy is of little relevance as they don’t use the health care system much. The 20 percent of people with Medicare who are very ill or who need complex care will likely be unable to assess and report the quality of care they receive.
3. How will the government know whether the GEO model improves quality without increasing costs over the short and long-term? How will CMS uncover fraud, detect inappropriate care, or identify practices that harm patients without this data?The model does not provide for a meaningful way for CMS to oversee the direct contracting entities (DCEs) that will be assuming full financial risk for all medical and hospital services people receive. It does not call for the DCEs to turn over encounter or claims data. 
4. What protections will be available to people in Medicare who are forced into the GEO model if they are unable to get the care they need? The model does not allow them to opt out. Their out-of-pocket costs should not increase, but how will CMS know if they do?
5. CMS suggests that the DCEs, corporations assuming full financial risk, can use “value-based” payments to providers. How will DCEs determine value-based payments? Will these payments lead physicians to delay and deny people needed care?
6. Some people with Medicare need a substantial amount of care during the course of the year.  How will CMS know whether people with complex and costly conditions are getting the care they need rather than low-quality ineffective care or no care at all?
7. Given that Medicare rates are already significantly lower than commercial rates, does CMS believe that high-quality providers will accept lower rates from DCEs? 
8. How will CMS know whether DCEs are fostering health inequities, rationing care based on ability to pay and ability to navigate their complex system?
9. What assurances are there that DCEs wouldn’t end up behaving like chain nursing home owners, pocketing the vast share of their government payments and leaving our nation’s most vulnerable people without access to care? How will they be held accountable if they do? Even if CMS were able to analyze every aspect of DCEs, DCEs can change their methodologies as they please when they please. 

Everyone wants a healthcare system that improves quality and reduces costs. But, conducting this large scale costly social experiment with vulnerable older adults and people with disabilities seems imprudent and misguided at best.

Here’s more from Just Care:

• Ten ways Medicare Advantage plans differ from traditional Medicare
• New study finds Medicare Advantage plan enrollees end up in lower quality nursing homes than people in traditional Medicare
• PACE helps older adults stay in their community
• Could you pay more in Medicare Advantage than traditional Medicare?
• To save money on your care, consider using a free health clinic