Doctors and Medicare Are the times a-changing?

[LewB]

I live in a small town on the western slope of Colorado and only sell Medicare Supplements. Currently, there is only one MAPD available and while most doctors here accept Medicare many of them refuse to take the MAPD.

Recently I was talking with an agent that lives in Denver and he stated that things were changing in Denver. I was told that doctors in Denver are refusing to take Original Medicare but will accept certain MAPDs.

Just curious and want to know if any of the agents on the forum are seeing similar changes in their area.

Lew

 

[vic120]

I have only heard of a few groups like the villages in FL, Or Kieser in CA that have a special deal with an Insurance company and take advantage only and only from that one carrier

Apart from that, I have never heard of a doctor who only takes medicare advantage and not OG medicare

 

[Northeast Agent]

I remember reading in either Houston or Dallas there's something like this as well, where they only take MAPD (like the Villages in FL only accept UHC MAPD).

And a hospital system "tried" pulling something similar to this in WA State last year, but the people revolted, the hospital system stopped and the screaming quieted down. I posted a story about it here, I think...

 

[WCMason]

I live in a small town on the western slope of Colorado and only sell Medicare Supplements. Currently, there is only one MAPD available and while most doctors here accept Medicare many of them refuse to take the MAPD.

Recently I was talking with an agent that lives in Denver and he stated that things were changing in Denver. I was told that doctors in Denver are refusing to take Original Medicare but will accept certain MAPDs.

Just curious and want to know if any of the agents on the forum are seeing similar changes in their area.

Lew

In CO I know of only one practice of any size that takes MA plans but will not take anyone with Original Medicare who does not also have an MA plan. That group is New West Physicians, and they have about 20 offices around the metro Denver area.

Village Health Partners in north TX made that move last year, though for now they will continue to treat existing patients with Original Medicare and no MA plan, but will not accept anyone new to Medicare unless they enroll in one of the MA plans they contract with. A client sent me their letter explaining the decision. Here is a excerpt copied from that letter:

The Centers for Medicare & Medicaid Services (CMS) has made it a goal to encourage patients who are enrolled in traditional Medicare to transition to a Medicare Advantage plan. The reasons for this include: patients on such plans live on average 2.4 years longer than those on traditional Medicare; patient outcomes are greatly improved; patients’ quality of life is better; and resources of care are enhanced. In a recent study, those enrolled in a Medicare Advantage plan had 23% fewer inpatient admissions and 33% fewer visits to the emergency room along with a higher utilization of preventative care. We would like for our patients who are enrolled in a Medicare plan to be on a product that allows all of the above as our physicians believe it is a better healthcare delivery system.
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And here I had no idea that my selling med supps was shortening the lives and reducing the life quality of my clients.

 

[vic120]

In CO I know of only one practice of any size that takes MA plans but will not take anyone with Original Medicare who does not also have an MA plan. That group is New West Physicians, and they have about 20 offices around the metro Denver area.

Village Health Partners in north TX made that move last year, though for now they will continue to treat existing patients with Original Medicare and no MA plan, but will not accept anyone new to Medicare unless they enroll in one of the MA plans they contract with. A client sent me their letter explaining the decision. Here is a excerpt copied from that letter:

The Centers for Medicare & Medicaid Services (CMS) has made it a goal to encourage patients who are enrolled in traditional Medicare to transition to a Medicare Advantage plan. The reasons for this include: patients on such plans live on average 2.4 years longer than those on traditional Medicare; patient outcomes are greatly improved; patients’ quality of life is better; and resources of care are enhanced. In a recent study, those enrolled in a Medicare Advantage plan had 23% fewer inpatient admissions and 33% fewer visits to the emergency room along with a higher utilization of preventative care. We would like for our patients who are enrolled in a Medicare plan to be on a product that allows all of the above as our physicians believe it is a better healthcare delivery system.
​

And here I had no idea that my selling med supps was shortening the lives and reducing the life quality of my clients.

If you torture the data enough you can make it say anything

Special interests have been doing that a long time

 

[somarco]

n a recent study, those enrolled in a Medicare Advantage plan had 23% fewer inpatient admissions and 33% fewer visits to the emergency room along with a higher utilization of preventative care.

Sounds like you need the re-education process. No CE credit but time in the Gulag might work wonders for you.

I don't suppose the "recent study" was cited.

Did prior authorization have anything to do with fewer inpatient admits?

Does ER claim denials cause folks to opt out of going there?

My BIL has an HMO and loved it.

Past tense.

Until he got sick and had to use it.

Now the bills are racking up. He and his doc are fighting the case manager to allow him to pursue a different type of treatment.

He was also annoyed when the case manager wanted to come to his home and make sure he is following doc orders.

At least the ones that are approved by the carrier . . .

And CMS is pushing folks away from OM to MA for the same reason big companies jettison group retiree health insurance plans and replace them with the HRA.

It is a way to control costs and shift the risk to another party.

 

[somarco]

If you torture the data enough you can make it say anything

 

[axeman462]

I live in a small town on the western slope of Colorado and only sell Medicare Supplements. Currently, there is only one MAPD available and while most doctors here accept Medicare many of them refuse to take the MAPD.

Recently I was talking with an agent that lives in Denver and he stated that things were changing in Denver. I was told that doctors in Denver are refusing to take Original Medicare but will accept certain MAPDs.

Just curious and want to know if any of the agents on the forum are seeing similar changes in their area.

Lew

I been saying for a few years years now that smalls trends are starting to show in the market that doctors are leaving Original Medicare and will only accept MAPD. The reason, is that Original Medicare's payments are not keeping up with inflation.

Over time, I think you will slowly start to see this gain steam.

As I undertand, its more common in the expensive West Coast states. here is an article that talks about it a little from a few years ago. Only about 79% or Oregon doctors accept Medicare:

Medicare 2015: More doctors rejecting original Medicare - oregonlive.com

MAPD is the future of Medicare. Those that fight it will eventually go out of business.

Now que Somarco to flame me because he disagrees...

 

[Todd King]

The reasons for this include: patients on such plans live on average 2.4 years longer than those on traditional Medicare;

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And here I had no idea that my selling med supps was shortening the lives and reducing the life quality of my clients.

So, they've had 12 years or so to figure out that seniors live 2.4 years longer because they use an MA plan? I wonder who made this info up? There is no way they have that kind of accurate data in just a few short years.

 

[somarco]

So, they've had 12 years or so to figure out that seniors live 2.4 years longer because they use an MA plan? I wonder who made this info up? There is no way they have that kind of accurate data in just a few short years.

They used younger seniors in this study . . .