Medicare Advantage has gone through a lot of controversy since it was first introduced. The newest situation is that Lawmakers are considering options to change the structure of Medicare Advantage payents starting in 2011 or 2012. They are considering modifying benchmark rates or using the competetive bid method where companies who want to be able to offer the plans offer the most competetive and fair rates and payments.
“It’s clear every one of these [MA pay options] would be a revenue reduction from where we’re at, and it appears [that] administrative burdens would also go up, possibly dramatically,” Pat Dunks, a principal and consulting actuary with the Milwaukee office of Milliman, Inc., said. Mr. Dunks is worried theat the estimates are not correct because they are partially based on scheduled cuts to physicians which will not really take place, which skews the formula the pay options are being based on.
The aim is to actually try to reduce cost and at the same time improve quality in the health care system, especially when it comes to health care delivery. Senator Bacus And Senator Grassley of the Senate Finance Committee discussed the proposals and asked for feedback, also stating that they would hep in an way they could to help create a fair and comprehensive plan. In fact, they included 48 pages in two more policy option papers trying to describe how the committee could consider promoting quality, efficiency and care management among MA plans.
They suggested linking payment to quality. There could be a 5 star ranking system and CMS’s current system could be a prototype with a few changes. The higher the consumer satisfaction, the higher increase in pay vs. lower-ranked plans. There are still numerous details that would need to be worked out including better inpatient and outpatient plans plus issues with home health care and physician and skilled nursing services. “If MA plans have to create a quality program for each service they offer, that all adds a lot of administrative burden to plans,” he contends. And if such programs aren’t also put in FFS Medicare cost estimates, that worsens the competitive situation.”
Then comes a more effficient payment system which would have to include changing the current benchmarks.
Since there are differences in payment rates in different parts of the country, for instance, New Yor and Los Angeles vs. small town Ohio or North Dakota, there needs to be a way to equal the inequeties in some way. Figuring out a formula to do this fairly will take time.
Another idea that was included was possible bonuses. If bidding doesn’t work, bonuses for the plans that work the best could be an incentive. At any rate, at least lawmakers and others are working to try to make it all come together and work for everyone. For more information on reform options go to www.finance.senate.gov.
Related Articles
No user responded in this post
Leave A Reply
Please Note: Comment moderation maybe active so there is no need to resubmit your comments