Choice in Medicare is Stronger than Ever in 2012

[ProSense]

Choice in Medicare is Stronger than Ever in 2012

Nancy-Ann DeParle

At the time the Affordable Care Act was passed, Republicans in Congress said the bill would virtually end the Medicare Advantage program. “Every one of them (in Medicare Advantage) will see their benefits go down,” “provisions in there are going to allow them to kill Medicare Advantage,” “if this passes, it is the end of Medicare Advantage as we know it,” are just a few of the incendiary charges Republicans made about the Affordable Care Act. Premiums would go up, they claimed, and choice and enrollment would go down.

Those predictions turned out to be wrong. Medicare Advantage is stronger than ever – offering more seniors better benefits, higher quality care and lower costs. As reported last year, 99.7 percent of people with Medicare still have access to Medicare Advantage plans.

In fact, premiums have been consistently lower – and enrollment has been higher. Today, the Centers for Medicare & Medicaid Services announced that average premiums for Medicare Advantage enrollees in 2012 are 7 percent lower compared to last year, exceeding the 4 percent decrease that was projected in September. Since the Affordable Care Act was enacted, premiums have gone down by nearly 16 percent. In addition, enrollment increased by nearly 10 percent from 2011. That means that Medicare Advantage enrollment is up by 17 percent since enactment of the Affordable Care Act in 2010. In August of 2010, CBO projected that Medicare Advantage enrollment would be 10.2 million in 2012, down from 10.4 million in 2009. Actual enrollment is over 2 million people higher than that projection, at 12.8 million in February of this year.

And further, the Affordable Care Act strengthened consumer protections and improved plan choices for people with Medicare Advantage. The law is paring back overpayments to plans. It requires health plans to pay at least 85 percent of what they collect in payments on health care, not on overhead and profits. Plans can no longer charge higher cost sharing than a senior in traditional Medicare pays. And proven preventive services are covered for free.

And when seniors choose a Medicare Advantage plan, a new five-star rating system shows them which plans in their area are doing a better job of caring for patients. Plus, a new, value-based purchasing system is encouraging all plans to improve their quality by paying plans with excellent overall quality more, and lower-quality plans less. It’s the kind of smart reform we’ve implemented throughout Medicare since enactment of the Affordable Care Act.

This is another myth from opponents of health reform debunked by results. Under the Affordable Care Act, Medicare is stronger than ever.

http://www.whitehouse.gov/blog/2012/02/01/choice-medicare-stronger-ever-2012

[SharonAnn]

1. Maybe, but my neighbor can't find a doctor who will accept new Medicare patients.

She doesn't want Medicare Advantage, because she has to spend time with her elderly mother in another state and wants to be covered if she gets sick while she's there.

The Medicare Advantage plans around here are apparently pretty restrictive about who you can see and when, and they make it hard to get any reimbursement for "out of network" situations.

[ProSense]

3. Not

sure if this link will be of any help, but you can share it with your neighbor:

http://www.medicare.gov/find-a-doctor/provider-search.aspx?AspxAutoDetectCookieSupport=1

[Sgent]

4. Almost every primary care non-pediatrician/non-concierge physician I know is signed up for Medicare

Only ONE of them accepts new Medicare patients -- and they are in a community health center (which gets paid much better than most physicians for Medicare patients). All of them will continue to see younger patients which age into Medicare, but not new patients.

Specialists may or may not accept referrals depending on the specific needs and situation (for instance a Cardiologist will only accept a Medicare patient for stress testing, and if necessary for hospital care -- but not office patients).

[ProSense]

5. I

Almost every primary care non-pediatrician/non-concierge physician I know is signed up for Medicare

Only ONE of them accepts new Medicare patients -- and they are in a community health center (which gets paid much better than most physicians for Medicare patients). All of them will continue to see younger patients which age into Medicare, but not new patients.

...wonder how many Medicare-eligible individuals are without a doctor? Is the problem a shortage of doctors? Obviously, this isn't a new situation, but one that requires a solution.

Still, it's a separate issue from the OP.

[Sgent]

8. There's a few issues

1) There are very few physicians going into primary care due to the disparity in pay between it and other fields. Even many foreign medical graduates will turn down primary care residencies. Every year there are significant unfilled residency slots.

2) Medicare calculations for reimbursement heavily favors procedures & labs over office visits. A physician may make $70 on an office visit, and $150-$200 (profit) from doing a holter monitor, or $150 - $300 for a 10-20 minute surgery.

Most primary care testing (simple labs, EKG's, X-rays) also pay very poorly, especially given the malpractice environment which says a internal medicine / family practice doc can't even read an x-ray for pneumonia or an EKG.

They are licensed and trained to do so, but most carriers require a radiology / cardiology over-read. Only one physician can be paid per reading. They will get the technical fee charges -- but those are eaten up pretty quickly in equipment / staff time. Pay for a chest x-ray including radiology over-read is $37.10, which a primary care physician will get $27.

3) Due to the limited number of primary care doctors (see #1), they all have waiting lists for patients. Therefore they will take a private insurance patient which pays 125-200% more (depending on insurance company and procedure or lab involved). Some will pay even higher for certain items.

4) Keep in mind that a 25% increase in revenue for a primary care physician can mean a HUGE jump in revenue. If average overhead runs $250,000 / year, they make $150,000 which would be equivalent to about $120,000-$130,000 in salary. Raising the revenue by 25% means they almost double their income.

5) Most sub-specialist gerontologists (doctors who sub-specialize in the care of older people) I know don't advertise their gerontology credentials, but rather their family practice / internal medicine credentials.

6) Although the average primary care physician according to the BLS makes $170,000, I have yet to meet any of these. The ones I'm aware of make $90,000 - $120,000 (salary) with one who does a lot of dermatology making about $160,000

7) Older patients are much more complicated to manage. More medications, more co-ordination with hospitals / nursing homes / home care (much of it not reimbursed), etc. For the time it takes to manage one $100 / visit patient, they can see 3 children for wellness checkups or minor illnesses for $70 each.

[ProSense]

9. That's

a good list connecting the dots. It appears, the issues can be summed up as a shortage of doctors and flaws in the reimbursement rates. Those two issues appear to compound the other problems.

The Accountable Care Organizations (https://www.cms.gov/ACO/) were designed to address some of these issue. There is also the wrangling over the "doc fix."

Clearly, there are a number of issues with Medicare that need to be resolved, but focusing on increasing the number of primary care doctors and resolving the reimbursement-rate issue should be priorities.

The existence of ACOs will ensure quality of care and resolve some of the payment issues.

[MineralMan]

7. That may happen in some places. Here in Minnesota, all the multi-discipline clinics

accept Medicare. That's why I have Medicare and a supplement, rather than an Advantage program. All of those clinics are owned by some Hospital group or another, and they're happy to have new Medicare patients. Some doctors in individual practices may not accept Medicare, but not those clinics.

I have a regular primary care doctor at mine. If I need a specialist consultation, every specialty you can imagine is represented in that clinic or one of the others in the same group. It's never a problem, and I can get a same-day appointment with my primary care doctor any time.

Maybe that isn't the case where you live.

[Whisp]

2. K&R

[Lugnut]

6. There are two things I like about my Medicare Advantage policy.

I have eyeglass and dental coverage. If traditional Medicare included coverage for those services I'd gladly dump my Advantage plan.