Medicare Advantage plans have garnered animosity from providers due to the restrictive approval processes for needed services.
Congress is investigating insurer practices, but the Medicare Advantage plans likely aren't going anywhere.
"Politically, getting rid of the Medicare Advantage program is probably not going to happen," said Adam Bruggeman, MD, a spine surgeon at San Antonio-based Texas Spine Care Center and chief medical officer of MPOWERHealth, during a June 21 panel at the 21st Annual Spine, Orthopedic & Pain Management-Driven ASC + The Future of Spine Conference in Chicago. "It's baked into the Affordable Care Act, and that is a difficult piece of legislation to attack. Any of the issues that arose within that legislative piece are very difficult because clearly there's a lot of animosity around it, and the parties will line up against each other and we'll get nothing done when it comes to repealing those parts of it."
But that doesn't mean there won't be change.
Dr. Bruggeman testified in front of the House of Representatives budget committee on consolidation and its impact on the healthcare environment. Jodey Arrington, a Republican congressman from Texas, chairs the committee and was receptive to the message.
"There was strong bipartisan agreement that we have a problem on our hands, and the problem involves Medicare Advantage," said Dr. Bruggeman. "The problem involves consolidation within healthcare systems and honestly even somewhat within physician groups as well, whether we're talking about being bought up by insurance companies or bought up by large health systems. I think there's a growing desire to attack the Medicare Advantage problem."
Congress is still mulling the best way to solve issues related to consolidation and Medicare Advantage to ensure competition in healthcare. MedPAC, the group advising Congress on Medicare policy, released a report showing the country spends an additional $80 billion a year on Medicare Advantage plans that are cherry-picking the best patients for them financially.
"Hopefully what we'll see is legislation that comes out and looks at chipping away at that," said Dr. Bruggeman. "Why would I say that? Because everybody's looking for some money to be able to spend somewhere. Certainly as physicians, we want to see inflationary updates on our Medicare payments and that $80 billion a year would pay for that."
Congress has other pet projects as well vying for additional funding in the healthcare space.
"I think we're going to see some changes to [the payers'] disadvantage, and we might partner with site neutral payment reform, which will be to their advantage," said Dr. Bruggeman. "So there's a give and take, but I hope that we get some changes made."