All of healthcare has struggled with declining reimbursements, patient care issues and administrative burdens associated with Medicare Advantage plans.
Here's what five leaders have to say about Medicare Advantage, pulled from prior coverage or quotes from Becker's 30th Annual Business and Operations of ASCs Meeting in Chicago Nov. 1:
Harel Deutsch, MD. Co-Director of the Rush Spine Center (Chicago): The drastic increase in patients with Medicare Advantage plans has been a nightmare. Getting authorization with Medicare is simple, but Medicare Advantage plans will basically deny everything, including things such as routine CT scan to assess for fusion.
Andrew Lovewell, CEO of Columbia (Mo.) Orthopedic Group: I hate Medicare Advantage. It is the biggest scam in our country. It's terrible for not only providers but patients too. I would come up with education in your practices to give to people, especially around enrollment time. We exclusively have started down this path of getting rid of MA plans in our practice, and just going completely out-of-network with them because it's such a hassle factor. All of the prior authorizations that go into it, the denied care, the retroactive denials, just everything that comes along with an MA plan. It is just scammy. We don't believe in providing bad care and bad medicine to patients. And I think anytime we take a plan like that, people think that they have something covered. It's just not, and people are not informed at all about their insurance benefits. We all deal with that challenge.
Vishal Mehta, MD. President and Managing Partner at Fox Valley Orthopedics (Geneva, Ill.): I think it's one of the best kept secrets in this country, how profitable these Medicare Advantage plans are to some of these payers and how much of their business is coming from Medicare Advantage. For some payers, it's just a minority coming from traditional insurance plans, and their growth industry is coming from Medicare Advantage. It is troubling the trends in the wrong direction. For us, the biggest issue we have is the denials and the amount of time and energy it takes to explain that to patients and convince them, it's not our fault.
John Prunskis, MD. Co-Medical Director of the Illinois Pain & Spine Institute (Barrington): Maybe you should call them 'Medicare Disadvantage' plans. f you want to take control of yourself, invite your Congressman to your surgery center and show them the cost savings, they'll probably know about that, but then explain to them the Medicare Disadvantage plan is actually profiting off our taxpayer dollars to not provide care to seniors that they're supposed to.
Philip Schneider, MD. The Centers for Advanced Orthopaedics (Bethesda, Md.): Pay cuts continue to get worse each year. Last year, we had a 2 percent pay cut, and this year we are looking at an additional 3.4 percent. Rising inflation and decreasing reimbursements are exacerbating stress on providers. Medicare Advantage programs are also implementing a lot of onerous prior authorization requirements, which limit patients' ability to get treatment. They are also slashing reimbursements for certain examinations and injections. There is a bill in Congress right now to tie Medicare rates to the Medicare Economic Index as introduced in bipartisan legislation. I'm hopeful this will alleviate challenges providers are facing, so we can continue to provide needed care to Medicare patients — which is of course why we got into practicing medicine in the first place.