Posted on 11/24/2023 10:47:42 AM PST by buckalfa
Medicare Advantage provides health coverage to more than half of the nation's seniors, but a growing number of hospitals and health systems nationwide are pushing back and dropping some or all contracts with the private plans altogether.
Among the most commonly cited reasons are excessive prior authorization denial rates and slow payments from insurers. Some systems have noted that most MA carriers have faced allegations of billing fraud from the federal government and are being probed by lawmakers over their high denial rates.
"It's become a game of delay, deny and not pay,'' Chris Van Gorder, president and CEO of San Diego-based Scripps Health, told Becker's. "Providers are going to have to get out of full-risk capitation because it just doesn't work — we're the bottom of the food chain, and the food chain is not being fed."
In late September, Scripps began notifying patients that it is terminating Medicare Advantage contracts for its integrated medical groups, a move that will affect more than 30,000 seniors in the region. The medical groups, Scripps Clinic and Scripps Coastal, employ more than 1,000 physicians, including advanced practitioners.
Mr. Van Gorder said the health system is facing a loss of $75 million this year on the MA contracts, which will end Dec. 31 for patients covered by UnitedHealthcare, Anthem Blue Cross, Blue Shield of California, Centene's Health Net and a few more smaller carriers. The system will remain in network for about 13,000 MA enrollees who receive care through Scripps' individual physician associations.
"If other organizations are experiencing what we are, it's going to be a short period of time before they start floundering or they get out of Medicare Advantage," he said. "I think we will see this trend continue and accelerate unless something changes."
Bend, Ore.-based St. Charles Health System took it a step further and was not only considering dropping all Medicare Advantage plans, but also encouraged its older patients not to enroll in the private plans during the upcoming enrollment period in October. The health system's president and CEO, CFO and chief clinical officer cited high rates of denials, longer hospital stays and overall administrative burden for clinicians. Ultimately, the health system has decided to remain in network with four MA carriers and will not renew contracts with three.
"We recognize changing insurance options may create a temporary burden for Central Oregonians who are currently on a Medicare Advantage plan, but we ultimately believe it is the right move for patients and for our health system to be sustainable into the future to encourage patients to move away from Medicare Advantage plans as they currently exist," St. Charles Health CFO Matt Swafford said.
"I feel terrible for the patients in this situation; it's the last thing we wanted to do, but it's just not sustainable with these kinds of losses," Mr. Van Gorder added. "Patients need to be aware of how this system works. Traditional Medicare is not an issue. With these other models, seniors need to be wary and savvy buyers."
Here are 13 more recent instances of hospitals dropping Medicare Advantage contracts:
In October, the Nebraska Hospital Association issued a report detailing how Medicare Advantage is "failing patients and jeopardizing Nebraska hospitals," 33% of which do not accept MA patients. The report cited negative patient experiences, post-acute placement delays, and administrative and financial burdens on hospitals that accept MA patients.
York, Pa.-based WellSpan Health will no longer accept Humana Medicare Advantage and UnitedHealthcare-AARP Medicare Advantage plans starting Jan. 1. UnitedHealthcare group MA PPO and Humana employer PPO MA plans will still be accepted.
Greenville, N.C.-based ECU Health said it anticipates it will no longer be in network with Humana's Medicare Advantage plans starting Jan. 1.
Raleigh, N.C.-based WakeMed went out of network with Humana Medicare Advantage plans in October. According to CBS affiliate WNCN, the plan provides coverage to about 175,000 retired state employees. WakeMed cited a claims denial rate that is "3 to 4 times higher" with Humana compared to its other contracted MA plans.
Zanesville, Ohio-based Genesis Healthcare System is dropping Anthem BCBS and Humana Medicare Advantage plans in 2024.
Brunswick-based Southeast Georgia Health System will terminate its contract with Centene's WellCare Medicare Advantage plan on Dec. 8. The system said it started negotiations with the carrier after years of "inappropriate payment claims and unreasonable denials."
Nashville, Tenn.-based Vanderbilt Health went out of network with Humana's HMO Medicare Advantage plan in April.
Fayetteville, N.C.-based Cape Fear Valley Health dropped UnitedHealthcare Medicare Advantage plans in July.
Corvallis, Ore.-based Samaritan Health Services ended its commercial and Medicare Advantage contracts with UnitedHealthcare. The five-hospital, nonprofit health system cited slow "processing of requests and claims" that have made it difficult to provide appropriate care to UnitedHealth's members, which will be out of network with Samaritan's hospitals on Jan. 9. Samaritan's physicians and provider services will be out of network on Nov. 1, 2024.
Cameron (Mo.) Regional Medical Center stopped accepting Cigna's MA plans in 2023 and plans to drop Aetna and Humana in 2024. It plans to continue Medicare Advantage contracts with UnitedHealthcare and BCBS, the St. Joseph News-Press reported. Cameron Regional CEO Joe Abrutz previously told the newspaper the decision stemmed from delayed reimbursements.
Stillwater (Okla.) Medical Center has ended all in-network contracts with Medicare Advantage plans amid financial challenges at the 117-bed hospital. The hospital said it made the decision after facing rising operating costs and a 22% prior authorization denial rate for Medicare Advantage plans, compared to a 1% denial rate for traditional Medicare.
Brookings (S.D.) Health System will no longer be in network with nearly all Medicare Advantage plans in 2024, with the exception of Medica. The 49-bed, municipally owned hospital said the decision was made to protect the financial sustainability of the organization.
Louisville, Ky.-based Baptist Health Medical Group went out of network with Humana's Medicare Advantage plans in September, Fox affiliate WDRB reported. The system will also go out of network with UnitedHealthcare and Centene's WellCare on Jan. 1 without a new agreement in place
I did think healthcare wouldn't cost me anything when I hit Medicare, but I pay about $1950 for part B, about $120 for part D and $2800 for the supplemental for a total of $4870. Not free but (1) less than my cr@ppy high deductible plan and (2) Actually covers just about anything. The only issue I've had is with the Part D, which includes a $500 deductible, and I've hit the “donut hole,” and had to shell out another $300 this week for that, for a total of about $800-900 or so this year.
Man, medical expenses for us senior citizens start piling up in a hurry, even if we don't have major problems!
I keep getting hit on for C & D. No comprende.
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Take it now or get penalized later. Its a recurring penalty, not a one shot. The longer you wait the steeper the penalty.
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I’m on Medicare A & B. Provider is Kaiser. Isn’t everything taken care of
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No
It is for me...So is the VA...Means testing is increasingly the future. I expect TRICARE for Life to be the next target of the collectivists.
This stuff is ridiculously confusing—with Medicare Parts A,B,C, D and more (!) with different rules to follow....
not exactly senior friendly.
What I have read lately the MA’s are competing with each other to see how many give-aways they can promise that have no connection to sickness/health. One was even giving groceries.
That's not a bug, it's a feature.
I think that was the point.
If people haven't yet figured out that seniors and the elderly/infirm are on the Nazi death lists, I can't help you. See exhibit A: COVID vaccination.
Obamacare was designed to destroy the health care insurance business so people will demand a government takeover. Since its passage, health care has become more expensive and less available. When you can see a doctor (an actual doctor and not a PA) they spend all their time looking at the computer and checking off options via drop down menus. They then tell you what they are allowed to prescribe or recommend based on the computer’s diagnosis and the insurance/government’s permissions.
I go to the doctor as little as possible. Not a one has assisted me with a medical problem in the past 20 years. For almost every single visit lately, the PA’s recommendation has been the drug Neurontin — no matter what the problem may be. I’ve seen what that drug can do. My late sister was on so much of that drug that I swear it destroyed her brain.
Physicians are good for setting bones (most of the time) or stitching up a large cut. These days, that’s about all they are good for.
BKMRK.
not exactly senior friendly.
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Bureaucrat friendly is all that matters.
Just get them all, even if it is redundant with other private insurance. After you retire, they will hit you up for penalties which will lower your SS payment; any increases in Medicare will be reflected in an increased monthly penalty.
Yeah..
The feds are pushing advantage plans on people...
I got standard Medicare with a medigap plan...
Costs more money, but you get what you pay for...
My insurance specialist said she could make 6 times the commission by selling me the advantage plan, but she would not do that to me...
Take a part G plan...
They don’t tell you about that
I know there is a penalty associated with Medicare Part B—not sure if that applies to the rest of the alphabet.
I was in a medical facility recently. They had a poster on the wall saying DON’T BE FOOLED BY MEDICARE ADVANTAGE . It listed the disadvantage of Medicare Advantage and the advantages of Medicare Supplements.
My financial advisor had strongly recommended we stay away from Advantage plans and go with Medicare Supplement plans.
I took a picture of the poster. I’d like to post it somewhere so I can show it on FR.
EXACTLY what OBAMA wanted to happen-
Major step in destroying the USA.
“Only covers 80% at best, with a lot of gaps. You could easily get struck with Hospital bills of $100K after standard Medicare.”
That’s why you should always have a supplement if you go with original Medicare.
That's for sure. I would have cheerfully paid a completely impartial adviser to help me through the signup process as I was turning 65. Unfortunately, all of the so-called advice seems to come from insurance salesmen, who are only interested in helping you make the choice that nets them the most money.
I wonder if there would be a business opportunity for someone who really understands the whole system to charge an hourly rate for advice that is aimed strictly at helping the client. Probably not; people would want the heavily-advertised advice that's available for "free".
Hmmm...I haven’t had any problems
Good for you, congratulations.
Systemically, however, MA programs are causing catastrophic harm and they should be discontinued soon.
Of course, every tweak to Federal and State health programs which envision public-private partnerships flooding Congress with bribes makes things worse, Medicare Advantage is no exception
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how much pressure do you think the illegal migrants are putting on the health care system costs? & normal insurance premiums?
“stay away from “Advantage Plans” like the plague... get the supplemental”
Our supplemental is with Mutual Of Omaha, and we’ve been pleased with the service. The cost, though ... OMG!
For a few years I had been in a craft group with several older ladies when it came time for me to sign up. The ones in Advantage Plans had some horror stories, so I paid attention and went a different route.
“someone who really understands the whole system”
These people actually exist?
;-)
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