Daily Archives: June 8, 2014

United Healthcare Medicare Advantage cuts doctor network

UnitedHealthcare to cut hundreds of Bay State doctors from its Medicare Advantage network – Nation – The Boston Globe.

National insurance giant UnitedHealthcare plans to cut up to 700 Massachusetts doctors from its physician network for seniors enrolled in its private Medicare plan as a way to control costs, according to company officials.

For elderly patients enrolled in the plan, the cuts mean they will have to find a new doctor or eventually switch to a new health plan that covers their current doctor.

The move, effective Sept. 1, follows similar cuts made by the insurer to its Medicare Advantage provider networks in 11 other states, including in Rhode Island and Connecticut, where the reductions drew outrage from patients, doctors, and lawmakers earlier this year.

Note these cuts are for Medicare participants who use Medicare Advantage plans. If you are using standard Medicare with a Medigap supplement you are unaffected by changes to Medicare Advantage programs. Why are Medicare Advantage benefits being cut? You guessed it, Obamacare.

The changes come amid a gradual reduction of reimbursements to private insurers that offer Medicare Advantage plans as a way to offset costs associated with President Obama’s health reform law.

Medicare Advantage provides coverage for 30 percent of Americans on Medicare through private insurers. Consumers often prefer the program over traditional Medicare because it is a one-stop shop for hospital and doctor coverage, and often includes prescription drugs, eyeglasses, and gym memberships.

For years the federal government has paid the private plans up to 14 percent more than traditional Medicare for identical services, a benefit to the insurance industry that cost taxpayers an extra $1,000 per beneficiary, according to the National Committee to Preserve Social Security & Medicare, a Washington-based advocacy group. The 2010 federal health law was supposed to close the gap, as well as provide new bonus payments to plans with the highest quality ratings.

Perhaps the decision to select either Medicare Advantage or traditional Medicare should involve a little more thought than the lowest premium?

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ER visits up under Obamacare

 

More patients flocking to ERs under Obamacare.

It wasn’t supposed to work this way, but since the Affordable Care Act took effect in January, Norton Hospital has seen its packed emergency room become even more crowded, with about 100 more patients a month.

That 12 percent spike in the number of patients — many of whom aren’t actually facing true emergencies — is spurring the Louisville hospital to convert a waiting room into more exam rooms.

“We’re seeing patients who probably should be seen at our (immediate-care centers),” said Lewis Perkins, the hospital’s vice president of patient care and chief nursing officer. “And we’re seeing this across the system.”

That’s just the opposite of what many people expected under Obamacare, particularly because one of the goals of health reform was to reduce pressure on emergency rooms by expanding Medicaid and giving poor people better access to primary care.

Instead, many hospitals in Kentucky and across the nation are seeing a surge of those newly insured Medicaid patients walking into emergency rooms.

Ahh… those unintended consequences. The apparent reason(s)…

Experts cite many reasons: A long-standing shortage of primary-care doctors leaves too few to handle all the newly insured patients. Some doctors won’t accept Medicaid. And poor people often can’t take time from work when most primary care offices are open, while ERs operate round-the-clock and by law must at least stabilize patients.

Plus, some patients who have been uninsured for years don’t have regular doctors and are accustomed to using ERs, even though it is much more expensive.

“It’s a perfect storm here,” said Dr. Ryan Stanton of Lexington, president of the Kentucky chapter of the ER physician group.”We’ve given people an ATM card in a town with no ATMs.” (emphasis added)

Which brings up the point about Medicaid. If you go to an ER with no insurance, if you qualify, the Hospital will automatically start the enrollment process for Medicaid. Why? For Medicaid eligible patients, that’s the only way the hospital can reasonably expect any reimbursement, no matter how miniscule, at all. The article references doctors not accepting Medicaid. It’s real simple to read between those lines…. “low reimbursements”.

I suggest reading some of my other posts on Medicaid starting with: Medicaid is a type of insurance but is their coverage?

And the general Medicaid blog tag.

 

The article goes on to explore issues with Medicaid, why ER is the first stop for many patients and the primary care doctor shortage. It concludes…

Doctors and hospital officials said ER staff members try to let people know when it’s appropriate to use the department, when they should use immediate care centers and when they should seek care at a doctor’s office. They also refer patients to providers such as Family Health Centers for follow-up.

Mason said another promising solution is “care coordination,” in which primary-care doctors work with high-risk patients to help them control illnesses and navigate the health care system. She pointed to a study showing care coordination helped reduce ER visits by 9 percent from 2011 to the first half of 2013 among Oregonians in the pre-ACA expanded Medicaid program.

Mason said letting nurse practitioners practice and prescribe on their own also may help by giving people another treatment alternative.

But Mason and others said such efforts may not immediately alleviate the crunch on ERs.

“It will continue to go up if we don’t build our primary-care capacity,” she said. “It will continue to go up if we don’t support alternatives such as retail clinics. And it won’t get better if we don’t educate the public about the correct use of emergency departments.” (emphasis added)

To reduce the shortage of primary care doctors will take incentives and better pay. What it won’t take is more rules, regulations and paperwork/computerwork.

The rise of the “mini-clinic” may also be quite helpful, but that model will also be put under financial strain from low Medicaid reimbursements.

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