Packerland
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Spin how you may..
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Packerland
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Few poloticians these days dare to attack entitlement’s these days, but Nikki Haley dared to do so in the recent debate on Medicare. A new study shows her pitch to expand the Medicare Advantage program could lower costs and improve care.
Medicare Advantage plans are growing rapidly and cover about half of the entitlement’s beneficiaries. Private insurers administer the plans and are paid by Medicare per beneficiary. Insurers compete for patients by offering benefits, including vision and dental care that aren’t available in traditional fee-for-service Medicare.
Lower premiums have made Advantage plans popular in particular among low-income seniors. Plans are able to offer more benefits at lower cost in part by reducing unnecessary care and expensive hospital stays.
Avalere, a healthcare consulting firm, analyzed utilization rates in traditional Medicare versus Advantage plans. After adjusting for disease and demographics, Avalere found that fee-for-service utilization was 12% higher for skilled nursing homes and 37% higher for hospital inpatient care in 2019.
Hospitals are the biggest driver of Medicare spending. The Centers for Medicare and Medicaid Services (CMS) has tried to use performance-based payment models such as accountable care organizations (ACOs) to improve preventative care and reduce hospital admissions. But these haven’t moved the dial as much as Medicare Advantage plans.
The Avalere study doesn’t dissect why healthcare utilization is so much lower in Medicare Advantage. Democrats who oppose private competition accuse insurers of putting up bureaucratic hurdles to treatments. That may be true in some cases, but it doesn’t explain why inpatient hospital utilization is so much lower among Advantage patients.
One reason is private insurers have a financial incentive to keep patients out of the hospital by improving adherence to treatments and coordination of care. CMS also scores plans based on quality metrics, including diabetes control, medication adherence and post-emergency room visits. Higher-rated plans receive bonuses.
As Ms. Haley noted at the GOP debate, the Medicare Board of Trustees estimated this year that the program’s hospital trust fund—financed by payroll taxes—would run dry by 2031. If fee-for-service utilization rates were similar to those in the Advantage program, Avalere projects that the hospital trust fund would remain solvent until 2048.
But instead of expanding Medicare Advantage, the Biden Administration is trying to limit the program’s growth by restricting plan marketing and reducing payments for treating higher-risk patients under the guise of rooting out waste, fraud and abuse. The reason is purely ideological: Progressives loathe private medicine and want the government to control all healthcare.
As an alternative to competition, the Administration is resorting to brute government force to curb Medicare spending: restricting access to new Alzheimer’s treatments, imposing price controls on other medicines, and reducing reimbursements to doctors. CMS recently finalized a rule cutting physician fees by 3.4% next year, which it purported to offset partly by increasing payments to ACOs that treat more minorities.
Medicare’s low reimbursement rates are driving doctors to leave private practice for hospitals, which reduces provider competition and increases healthcare spending. Ms. Haley’s idea of unleashing private competition isn’t a panacea to runaway entitlement spending, but it’s less painful than the price and reimbursement controls that Democrats want.
Medicare Advantage plans are growing rapidly and cover about half of the entitlement’s beneficiaries. Private insurers administer the plans and are paid by Medicare per beneficiary. Insurers compete for patients by offering benefits, including vision and dental care that aren’t available in traditional fee-for-service Medicare.
Lower premiums have made Advantage plans popular in particular among low-income seniors. Plans are able to offer more benefits at lower cost in part by reducing unnecessary care and expensive hospital stays.
Avalere, a healthcare consulting firm, analyzed utilization rates in traditional Medicare versus Advantage plans. After adjusting for disease and demographics, Avalere found that fee-for-service utilization was 12% higher for skilled nursing homes and 37% higher for hospital inpatient care in 2019.
Hospitals are the biggest driver of Medicare spending. The Centers for Medicare and Medicaid Services (CMS) has tried to use performance-based payment models such as accountable care organizations (ACOs) to improve preventative care and reduce hospital admissions. But these haven’t moved the dial as much as Medicare Advantage plans.
The Avalere study doesn’t dissect why healthcare utilization is so much lower in Medicare Advantage. Democrats who oppose private competition accuse insurers of putting up bureaucratic hurdles to treatments. That may be true in some cases, but it doesn’t explain why inpatient hospital utilization is so much lower among Advantage patients.
One reason is private insurers have a financial incentive to keep patients out of the hospital by improving adherence to treatments and coordination of care. CMS also scores plans based on quality metrics, including diabetes control, medication adherence and post-emergency room visits. Higher-rated plans receive bonuses.
As Ms. Haley noted at the GOP debate, the Medicare Board of Trustees estimated this year that the program’s hospital trust fund—financed by payroll taxes—would run dry by 2031. If fee-for-service utilization rates were similar to those in the Advantage program, Avalere projects that the hospital trust fund would remain solvent until 2048.
But instead of expanding Medicare Advantage, the Biden Administration is trying to limit the program’s growth by restricting plan marketing and reducing payments for treating higher-risk patients under the guise of rooting out waste, fraud and abuse. The reason is purely ideological: Progressives loathe private medicine and want the government to control all healthcare.
As an alternative to competition, the Administration is resorting to brute government force to curb Medicare spending: restricting access to new Alzheimer’s treatments, imposing price controls on other medicines, and reducing reimbursements to doctors. CMS recently finalized a rule cutting physician fees by 3.4% next year, which it purported to offset partly by increasing payments to ACOs that treat more minorities.
Medicare’s low reimbursement rates are driving doctors to leave private practice for hospitals, which reduces provider competition and increases healthcare spending. Ms. Haley’s idea of unleashing private competition isn’t a panacea to runaway entitlement spending, but it’s less painful than the price and reimbursement controls that Democrats want.
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What about Congress and a certain former President who expanded MAPD subsidies by billions of dollars?
there's no need to make this political now.
We're just talking about violent genocide of tens of millions of seniors in the united states that no one except a few medsupp only heroes are talking about.
God bless those brave souls for the work they do!
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Packerland
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And God Bless The USA
And, no one has ever said any of the malarkey you are spewing.
I am glad to see you are acknologing you are lying with your exagerations.
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