PPACA (Patient Protection and Affordable Care Act) has ramifications across the entire health insurance market. Besides the 10-15 million private insurance end of contract notices, now the Medicare beneficiaries are seeing the beginning of the 700 plus billion in cuts from the program. This real life situation is starting to play out not only across the country but right here in our back yards. Posted below is an article from the AMA about how Medicare Advantage has changed it’s lack of transparency.
Following the article is a brief commentary in response. I continue to press the issue that price-fixing by the government via Medicare is the root cause of market disruption for physician access in this country. It is my view that doctors are being compelled to come to work for whatever price CMS/the Federal government decides. The doctors are not engaged in negotiating these terms and the law regarding participation are a legal form of extortion. Besides price-fixing the program the government continues to saddle the doctors with additional expensive regulatory costs that affect the overhead of the practice and the doctors productivity. I ask the AMA to take this coercion issue to the courts.
A letter sent last week by the AMA and more than 80 other medical associations to the Centers for Medicare & Medicaid Services (CMS) calls on the agency to address the failures of some Medicare Advantage plans to provide physicians with adequate due process and patients with sufficient, reliable information regarding network changes.
Hundreds of physicians have contacted the AMA and other associations after being terminated from 2014 Medicare Advantage plan networks. The “without cause” terminations were undertaken by some of the nation’s largest insurers in an attempt to “optimize” their networks in at least 11 states, the letter explained.
The AMA and the other signatories highlighted the timing of these changes, which will disrupt long-established patient-physician relationships, interfere with existing physician referral networks and undermine emergency department coverage in many hospitals. The AMA is working with other medical associations to ascertain whether government regulations applicable to Medicare Advantage and relevant state laws have been violated.
Comment from Dr. Kordonowy:
I am a physician (Internal Medicine) in Florida. It is my understanding that due to PPACA, 2014 begins the loss of government sponsorship/subsidies of the Medicare Advantage programs. These programs should never have been initiated in the first place. The programs were given to the insurance industry during the Bush administration as an offering for the Part D prescription scheme.The loss of subsidies is the reason doctors and patients can expect the enforcement of network only arrangements. This will lead to loss of revenues for not only professional but most ancillary services customarily provided in doctors offices. This further worsens our balance sheets towards insolvency. This model will thus result in patients losing access to many established doctor relationships. I have confirmed from my own patients that most specialists that my patients had been seeing have been notified specifically by UHC that they can no longer see these patients basically because they refuse to see them at 85% of Medicare rates. I am told that the other insurance companies will drop this bombshell to the remaining customers after the New Year. This model is unacceptable to doctors in private practice. Hospital owned doctors may be able to survive this first blow due to facility fee subsidies presently enjoyed under part A provisions. I know the AMA supports doctors so this situation of favoritism can’t go unchallenged.I have personally contacted the Advantage patients in my practice and recommended they abandon Advantage plans because regardless of the specifics, the reality is they will begin to lose access to the traditionally wider network of providers. For now I recommend they go back to traditional Medicare part B insurance coverage with a part D prescription insurance (if insurance is still desired).
It is incumbent upon the AMA to make a voiced and informed recommendation to providers and patients on this issue. Advantage plans are not a disclosed or honest arrangement. Nor is Medicare for that matter. Doctors do not negotiate for payment with CMS and furthermore we are extorted to continue to participate due to the time line requirements to decide to opt in or out of Medicare in any given year. We are told to decide before January of the year yet the fee schedule isn’t posted until the end of the year or beginning of January. How the AMA can continue to allow doctors to be coerced/compelled by not only private insurers (as it the case here) but the government itself (with traditional Medicare) without arranging a Supreme court argument in defense of our profession escapes my understanding.
The parallel argument that sets some precedence in favor of a coercive judgement lies in the recent Supreme Court Case for PPACA. We learned that the states do not have to participate in the federal exchange specifically because this would be an example of the Federal Government compelling the states with undue force (using money as the weapon). This is no different than the Federal Government compelling physician participation in Medicare. If the Federal government can’t compel states, it stands to reason that it can not compel individuals (doctors). WHAT SAY YOU AMA?