Connecting the dots on Medicare Advantage plans

Let me briefly connect some dots on the Wall Street Journal’s recent coverage of private Medicare Plans known as Medicare Advantage (MA) plans.

The investigation in this 11/14 article concludes that the sickest patients eligible for Medicare are “fleeing” MA plans because of inadequate insurance coverage. At the same time, these private plans collect 20 percent more from the taxpayers for their patients because the MA plans claim they care for sicker patients. The MA plans use coding to assert that their patients are sicker.

This 10/24 WSJ article offers compelling evidence that the MA plans manipulate the coding system (rather than care for sicker patients) to receive higher taxpayer payments. To make matters worse, MA plans also pay less to doctors and hospitals for care than regular Medicare. They achieve this outcome by denying claims and paying providers lower payments. This lower payment level has caused providers to cancel contracts with MA plans because they are losing too much money on these contracts, as noted in this USA Today article.

In summary, taxpayers and Medicare are overpaying MA plans by billions of dollars, and patients and providers are being harmed by these plans. The coding system, which is ridiculously complicated and easily manipulated, makes all this abuse possible. These abuses will continue as long as healthcare utilizes coding to determine insurance and provider payments. Alternatives to coding exist for paying providers and insurers.

Visit www.thejourneys-end.org to learn more about these options. Hopefully, the new Administration will be open to these innovative solutions.

Hospital Acquired Frailty is real

This is so true, yet known by few.

Who is really cutting Medicare Advantage?

This Wall Street Journal editorial is misguided and directly conflicts with a major investigative report on Medicare Advantage (MA) plans done by the paper in August. While it is true that Medicare is making it more difficult for MA plans to overcharge Medicare, these plans are still making tremendous profits while harming providers with low payments and hurting patients by denying coverage. The best evidence of this point is the massive advertising push by MA plans during this fall's open enrollment. 

As the WSJ’s own Investigative Report clarifies, MA plans manipulate the coding system to increase their payments. This editorial describes Medicare's efforts to reduce that coding manipulation as Kamala Harris making cuts to Medicare. The real problem that all these stories have in common is that coding is exceedingly complex and, therefore, open to manipulation. The only reform that will meaningfully address these problems is to stop using coding for payment to providers or insurers. There are alternative solutions - go to www.thejourneys-end.org for information on those solutions.