Medicare Advantage is Destroying Geriatric Care
In the old days, say…five or six years ago, taking care of Medicare patients was relatively easier than you might expect. If you needed a CT scan or MRI, you could order one. If the diagnosis code was appropriate, the test was approved. This was a significant advantage compared to those under age 65, where insurance requires extensive prior authorization for every procedure. Yes, for those over 65, if you did not have the appropriate reason to get a scan, it would not be covered, but there was rarely such a thing as prior authorization.
Medicare Advantage has changed everything. Every test needs a prior authorization now. Worse, every six months, Medicare Advantage demands the records of every single patient in their plan so they can re-code them as higher levels of illness to get more money from the government. No, that does not mean you, the doctor, will get more money.
Worse, Medicare Advantage has become a weird inconsistent patchwork across our state. We have two hospitals in our area. One brand of Aetna Medicare Advantage allows hospitalizations and testing at either hospital. Another brand only allows it at one of the two hospitals. Trying to figure out which is which BEFORE the hospital encounter is almost impossible.
In the early days, we refused to work with any Medicare Advantage plans due to the hassle factor. Yet, they have now proliferated to such an extent that most patients don’t even know they have a Medicare Advantage plan. In fact, the plans keep telling their patients: “You not only have Medicare, you have BETTER than Medicare!” Now, if we refused to work with such plans, we would find all of our patients have disappeared.
Specialty offices used to also refuse most Medicare Advantage plans in the early days. That created serious problems with basic Cardiology and GI referrals. Now, those barriers have fallen. Like us, they’ve found themselves overrun by the Medicare Advantage mob.
Long time Medicare patients are suddenly shocked their Medicare Advantage plan now requires a copay. Thanks to Medicare Advantage, running a practice has become even more horribly complex. The net effect is the destruction of independent practices. A few doctors in our area are attempting to switch to DPC or Concierge models, but patients who have grown accustomed to “total coverage” are not buying it. “You want me to pay a COPAY PLUS some sort of extra fee? Frankly, doctor, I’m not convinced you’re worth it.” So, they are leaving such practices, even if it means trying to use Urgent Care as their PCP.
The workload and expertise required to navigate the maze of different plans grows worse each year. Practices are finding they cannot opt out, lest they lose their patient base. Yet, they also find opting in is also its own special catastrophe.
So, practices are increasingly selling to hospitals or other big groups, finding themselves unable to manage the increasing needs of an independent practice. Say “goodbye” to the personal touch as soon as your doctor is incorporated into a big group. “That prior authorization you needed? Sorry! It may be a few weeks away! Your call is very important to us.”In the past, we physicians used to look at our loss of control as a failure to stand firm against the insurance companies. The problem is the companies are using their massive power to completely overwhelm our resistance. The independent medical practice will soon be a quaint museum artifact. Maybe I could sell some of my old writing desks and paper charts to the Smithsonian for a future exhibit?
The very few Medicare Advantage Plans I will work with, I’m finding they are all now asing for all chart notes on EVERY. SINGLE. PATIENT. EVERY. SINGLE. VISIT. They are asing for us to extract the data and send to them. So far, we have been insisting they send someone to get the data they want. I don’t know how long that’s going to ast, but I’m in a position where I can walk away from MA plans if they get too bad.
Is anyone else seeing this, the demansd for chart notes, every single patient, every single visit.
Only thing I did was get a Medicare Supplement Policy from a national and supposedly reputable company. I started looking the year before I hit Medicare age and took my time. I dealt with the agent in person. I’ve contacted the agent about these ads I see now and he reminds me I’m covered. So far no health issues like hpt or diabetes but would like to lose 20 pounds! Oh, I only take calcium supplements and a residronate pill monthly as my mom and maternal grandmother had bad osteoporosis. I took care of patients my current age (66) who I had to use a butt load of meds to get their “problems” under control.
I am “hammered” with snail mail about getting an advantage plan but am sitting tight. My mom is 93 and my dad died at 89 so I think I have a bit of genetics on my side. Heck, paternal grandpa nearly made 100 and paternal grandma died at 97. My maternal grandma died in her 80’s but would’ve lasted longer as she lived next to a dry cleaning plant and I expect they poured the spent chemicals on the ground in days gone by. Likely got into the well water and she got acute myelogenous leukemia and was dead in a month.
This is all about privatizing Medicare. These companies make a profit by enticing patients to sign on, and then making the delivery of real care as difficult as possible. They have restricted networks and convoluted rates and regulations involving the provision of such care. Each product has a different copay/deductible. Here in Florida I have committed this recurrent TV commercial to memory: “Did you know that there are Medicare benefits to which you are entitled but you will not get unless you ask for them by calling this number…….
i am 75. I have average 10 calls a day since June telling me I do not have the right Medicare coverage. Most of the callers have an Indian accent. i tell them why I am against the Advantage programs. I have my experience as a provider where patients are told to go to nursing homes and not to rehab units after strokes. i give other details of denied or delayed care. Some hang up. Others then tell me that I had the wrong advantage program and they will connect me with a licensed person to get me the appropriate one.
At least it’s providing out-of-work comedians (Jimmie Walker), football players (Joe Namath), and actors (William Shatner and William Devane) with a few bucks! I have Blue Medicare Advantage and I’m going to see a cute little young P.A. at my former practice next week for my annual “wellness” checkup for which Blue Cross will (allegedly) send me a $25 gift card. Whoopee! I had to spend 10 minutes online answering questions about anxiety & depression, alcohol and drug use, exercise, etc. There was no option to check “None of your f***ing business!”
Important article about fraud and corruption in all the big Medicare Advantage plans:
https://www.nytimes.com/2022/10/08/upshot/medicare-advantage-fraud-allegations.html?searchResultPosition=5
We don’t take any Advantage plans and life is good.
Those patients who appreciate the quality of care we provide are glad to stay and pay at the time of service. Those who don’t – well, good luck on finding a doc who will take you and don’t let the door hit . . .
It may be an important article, but the newspaper wants you to buy a subscription in order to read it.
Life may be good without having to accommodate advantage plan patients, but for those of us who are on these plans, the difference between paying a $5 copay and paying you $200 to see a doctor is a no-brainer. Most of us on these plans cannot afford to pay cash for medical services. I’m sure you’re worth it, as is my pcp, but my bank account says ” I don’t think so”.
This is my first year on Aetna’s Medicare advantage plan and it has its disadvantages. But I’m not sure that straight Medicare is a good thing either, although I have an appointment for my wife and I to review our plan and see which of the two makes better sense. If doctors are going to refuse to see us, I think that’s an even bigger problem. There needs to be a better solution than doctors refusing care to those of us who need it the most right now. Now retired after more than 20 years in medicine, I can’t remember ever wanting to refuse care to someone. I do understand the difficulties you’re experiencing and hope some kind of solution can be found.
Choosing not to contract with every lousy insurance plan under the sun is not “refusing to care for someone.”
We put a lot of effort into counseling our patients as they approach Medicare age. Our manager sits down with them one-on-one and explains that if they are going to choose a Medicare Advantage plan and want to continue to see us, they should choose a plan with out-of-network benefits. They pay us at the time of the visit, we submit the claim, and they get reimbursed by their insurer in 4-6 weeks. Works well, and helps us to keep our fees well below the market average.
Thank you for the explanation. That makes a lot more sense to me.
My 3rd-year Med student nephew is bigger and stronger than me, but I told him I would beat his ass if he even considered primary care.
Then again, I think every single member of the University of Minnesota Twin Cities Medical School Class of 2026 should be forced into primary care without possibility for parole.