04/10/2024    

RESPONSES/COMMMENTS (MEDICARE ADVANTAGE)

RE: Medicare Advantage in the Headlines

From: Paul Kesselman, DPM

 

A recent Becker's Payer Issues has many stories on Medicare Advantage. One such story states the following:

 

"The Medicare Payment and Advisory Commission called for a "major overhaul" of Medicare Advantage policies in its annual report to Congress. The commission estimated that in 2024, the government will spend $83 billion dollars more on Medicare Advantage beneficiaries than if they were enrolled in fee-for-service Medicare." In addition, Becker's cited 7 other problematic issues with these replacement plans.

 

As both a taxpayer and provider, I have no words to reflect my exact outrage! These companies have bilked the system, given their CEO 8 figure annual salaries, and paid providers often less than 50% of what Traditional Fee for Service Medicare would pay...all at increased costs to the government. It's time to shut this system down! It's now not only non-advantageous to providers and patients alike, it's also disadvantageous to the government and the taxpayers!

 

Paul Kesselman, DPM, Oceanside, NY

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04/11/2024    

RESPONSES/COMMMENTS (MEDICARE ADVANTAGE)

RE: Medicare Advantage in the Headlines (Paul Kesselman, DPM)

From: Richard Rettig, DPM

 

Medicare Advantage (Part C) plans were initiated in order to save money for the Medicare (MC) system. Many people believe that the "Government" is inherently wasteful, and so private industry can accomplish the same tasks more efficiently for less money and still make a profit. The plan was to start them off with a capitation rate above the cost of traditional Medicare, in order to get them on their feet. They could offer more services than MC, such as gym memberships and rides to the doctor as an incentive to join. Then they would eventually lower the capitation to a small amount below traditional MC costs and capture the cost savings. But thanks to lobbying, that never happened.  

 

The Advantage plans proposed to save money by keeping people healthier, utilizing preventive care. But in reality, they capture the healthier patients, who then switch to traditional MC when they really get sick. I see patients in long-term care who are admitted with a managed care plan. Most of them eventually get switched over to traditional MC. It is rare to find a retired doctor who has not chosen traditional Medicare as his/her coverage. 

 

In addition, corporate greed kicked in. They get paid a higher capitation rate for managing sicker patients. It is estimated there are 8.5 million people in the U.S. with "PVD". 62 million seniors in the U.S. (13%). If you analyzed charts of podiatrists, you would probably come up with a statistic well over 50%. So they pay us large sums to "mine" our charts to establish documentation of that diagnosis. This is just one of many examples of theoretically good ideas that go bad once money comes into play. 

 

Richard Rettig, DPM, Philadelphia, PA