Several major health systems and physician practices have cut ties with Medicare Advantage plans in the last year, citing declining reimbursements and patient care issues.
Here is why five physicians told Becker's they are dropping Medicare Advantage patients:
1. "We currently are no longer accepting Medicare Advantage. The restrictions regarding these plans have made taking care of patients extremely cumbersome. Even routine studies are denied. I had a patient I met when on call with an odontoid fracture. I fixed the fracture by fusing the first and second vertebrae together from the back. Her plan denied a follow-up CT scan, which is routine, at six months. The plan denied the scan because she 'did not have a spinal cord injury.' We appealed because: 1) The whole reason I did the surgery was so she wouldn't get a spinal cord injury; and 2) The proper study for a spinal cord injury would very likely be an MRI, except in certain situations. Either way, the denial was ridiculous. If you couple that with payment issues — late or no payment all, along with increasingly uncovering the money-making scam MA plans have turned out to be — taking these plans becomes a losing option. I feel for the members and encourage them to talk to their insurance agents, or in some cases, their human resources people to seek other options. Many hospitals have also stopped taking them altogether. The unfortunate truth is that the companies offering these plans and TV commercials mislead patients into thinking they are doing the right thing. The patients lose by giving these for-profit companies their hard-won Medicare benefits while the companies don't pay anyone who is giving care. It's a scam whose end time has come." — Brian Gantwerker, MD, neurosurgeon at the Craniospinal Center of Los Angeles.
2. "We have stopped seeing these patients due to poor and decreasing reimbursement as well as increased paperwork and administrative requirements for the plans." — Ciro Randazzo, MD, neurosurgeon at IGEA Neuro.
3. "I decided because I saw my reimbursement from Medicare for my professional fees as a neurosurgeon declining year over year and under threat year over year to where I saw approximately a 50% decrease over 10 years from 2000 to 2004 to about 2012 for my same surgeries I was doing. I also saw the Department of Justice going after physicians like a witch hunt for unintentional miscoding of services, which of course is a felony and comes with steep financial fines. I decided the risk of being a Medicare in-network neurosurgeon provider far outweighed the benefits. I signed the opt out form around 2011, and I have been very happy since then. Medicare patients pay me cash. They pay me a negotiated rate that I believe is fair and sustainable; the word 'sustainable' is important." — Ara Deukmedjian, MD, Spine Surgeon at Deuk Spine Institute in Melbourne, Fla.
4. "It's become a game of delay, deny and not pay. Providers are going to have to get out of full-risk capitation because it just doesn't work — we're the bottom of the food chain, and the food chain is not being fed." — Chris Van Gorder, president and CEO of San Diego-based Scripps Health.
5. "We recognize changing insurance options may create a temporary burden for Central Oregonians who are currently on a Medicare Advantage plan, but we ultimately believe it is the right move for patients and for our health system to be sustainable into the future to encourage patients to move away from Medicare Advantage plans as they currently exist." — Matt Swafford, CFO at Bend, Ore.-based St. Charles Health System.