A major provision in the healthcare reform law, the restrictions of formerly unregulated payments to private carriers in Medicare Advantage programs, seems to be taking hold without a hitch. Although somewhat early in the game — the new rules of MA reimbursements, ushered in during the first GWB administration in 2003 as part of the Medicare Modernization Act — have not brought fears of decreased access to market-based care, as Republicans had long argued. Instead, the opposite has happened.
Beginning in 2012, Medicare will begin lowering payment to Medicare Advantage providers to even the playing field between original Medicare and Advantage plans. But plans generally aren’t leaving because of healthcare reform, experts say. The Centers for Medicare & Medicaid Services is offering bonuses to plans that perform well, which should soften the cuts and keep good providers in the marketplace.
Beneficiaries still have ample choice of programs in many communities and are enrolling steadily. Still, the jury is out on this reform work-in-progress. Leading insurance lobbies still predict an overall decline in MA plan participation by the mid ’10s, and the drop-dead date for much of reforms unfettered provisions (2014) will bring the first substantial signs of just how far the federal government’s reach in private penetration of FFS Medicare will affect premium levels (and, by extention, access to care) for millions of Boomers crossing that magic threshold for the first time. | LINK
On Monday, Medicare (and Medicaid) turn 45. And to celebrate, the government will be touting its annual open enrollment. Well, okay, the feds will also be throwing in a plug for government’s role in health reform and what benefits are in store for those who were spring chickens when Medicare became law. Who better to message than the avuncular Andy Griffith?
Clearly targeted at those seniors who still think “death panels” are an essential creation of the Obama plan for reform, the ad — which begins airing in some markets today — will mostly focus on the benefits for seniors inherent in standalone or the program’s supplemental plans under reform. There will be no mention, however, of the major way the new reform law will maintain Medicare solvency well into the next couple of decades: trimming the fat from Medicare Advantage payouts from plans which originally saw benefit under the George W. Bush administration’s 2003 Medicare Modernization Act. | LINK
Medicare Advantage flourished in the second George W Bush administration, creating new siphons of revenue for third parties in a rampantly robust healthcare marketplace. Although choices for plans presented to potential beneficiaries were touted as beneficial and desirable, confusion over eligibility and extent of coverage made participation mildly risky for seniors who felt traditional coverage was inadequate for certain services even Medigap plans couldn’t provide. Within the scope of the Obama reform law, MA plans will have to increase quality assurance parameters to remain viable.
Are the majority of MA beneficiaries getting that quality currently?
According to a recent survey commissioned by a public policy group, about one-quarter of beneficiaries were enrolled in plans that received either four- or five-star quality indicators. Metrics were very broad and covered everything from telephone customer service to follow up on beneficiary preventive medical services those plans explicitly underwrote. As payment to private insurers begins a new era tied to quality, numbers like these are sure to improve. | LINK
A healthcare imprimatur of sorts for the outgoing Bush Administration? The current lame-duck president’s ‘Patients’ Right of Conscience’ regulation, which proposes that healthcare providers may withhold services based upon their moral beliefs, would probably do more to hurt patients than help — even those religious conservative patients who are the regulation’s intended targets. Unsurprisingly, the major medical associations have swiftly come out against such proposed actions, citing patient safety — especially in emergency cases.
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Originating from Saint Paul, Minnesota, [doctorpundit.com] is a weblog about the policy of healthcare and where it intersects with politics and public opinion; it is edited by Michael Douglas, MD, MBA. Welcome, and please consider my take on what is Healthcare 2.0, complemented by a few of my thoughts on my personal avocations and guilty pleasures: music, prose, and writing. Follow Doctor Pundit via RSS above.
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DOCTOR PUNDIT @ ONE YEAR | An occasional DP series from 2010 highlighting healthcare policy trends over the period from 2009-2010 in a compare/contrast format.
