Medicare Fun

The Medicare Payment Advisory Commission is exploring options for moving further away from fee-for-service reimbursement that include allowing beneficiaries unrestricted choice of health care providers while incorporating bundled and site-neutral payments as well as new quality incentives. Here are the models:

  • Scenario 1: Traditional FFS continues and incorporates reforms such as bundled payments, site-neutral payments and new quality incentives. Beneficiaries continue to receive their choice of “any willing provider.”
  • Scenario 2: Traditional FFS option is removed. Providers must join ACOs to be eligible for FFS payments and Medicare assigns all FFS beneficiaries to ACOs. The Centers for Medicare and Medicaid Services (CMS) pays claims for ACOs using FFS rates. Beneficiaries retain the option to enroll in Medicare Advantage (MA) plans.
  • Scenario 3: Traditional FFS option is removed. MA plans and ACOs pay providers for all services, but CMS continues to release the FFS fee schedule. “ACOs effectively become capitated health plans,” according to MedPAC briefing documents.
  • Scenario 4: Total elimination of FFS program. CMS would not maintain the FFS fee schedule. MA plans and ACOs pay providers for all services.

My thoughts? Thank god for Direct Primary Care. I will never deal with this stuff. Ever.

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  3 comments for “Medicare Fun

  1. April 14, 2019 at 8:26 pm

    Hoping the day never arrives that we can only give our clients MAPD’s. (Dislike them. A lot). We provided our clients with Medigap 99.9% of the time. When people understand what they’re buying; they don’t want MA plans. But, as you point out, the govt push is getting stronger and stronger….

  2. Steve O'
    April 14, 2019 at 11:52 am

    ACO’s appear to be Frankenstein HMO’s of 30 years ago, but deliberately fragmented so that they can’t be well-organized. Insurance companies don’t want them as competitors.
    Rather, they can be middlemen who absorb all the financial risk.
    Insurers don’t want risk. That’s all the insurance biz is about. No risk, plenty of profit. Voters don’t want risk. That costs them fees for services. Let someone else underwrite the risk.
    Some stooge will be stuck with all the risk, preferably some dummy without an MBA.
    The problem is, stooges get smart or go broke. That takes a couple of years, and the can gets kicked down the road aways.
    The plan isn’t to make something that might work. The problem is to get another couple of years.

  3. James Tinsley
    April 14, 2019 at 11:15 am

    Thanks. Used this in a FB add.

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