The AMA on Medicare Advantage
AMA calls for financial neutrality in Medicare Advantage
American Medical Association
May 22, 2007
A new American Medical Association (AMA) survey, released today, paints a bleak picture of physicians’ experiences with Medicare Advantage plans. In a statement provided today to the House Ways and Means Subcommittee on Health, the AMA highlighted physicians’ concerns with Medicare Advantage, based on the survey findings.
“The results of our new survey of physician experience with Medicare Advantage plans are troubling,” said AMA Board Chair Cecil Wilson, M.D. “More than half of the physicians report that their patients in a Medicare Advantage HMO or PPO plan were denied coverage of services typically covered in the traditional Medicare plan, and 84 percent reported patients have had difficulty understanding how the plan works.”
Also, 51 percent of physicians report that Medicare Advantage payments are below the traditional Medicare rate. Of the physicians with patients in a Medicare Advantage private fee-for-service plan, 45 percent have experienced denial of services typically covered in traditional Medicare and 80 percent report patient members have had difficulty understanding how the private fee-for-service plan works.
“The private health plans were supposed to inject competition into the Medicare program, but instead we’ve ended up with a federal handout to the insurance industry,” said Dr. Wilson. “Eliminating the overpayments to the insurance companies will save Medicare $65 billion over five years, according to the government’s own estimate.”
In a written statement to the House Ways and Means Subcommittee on Health today, the AMA expressed its “staunch support of fiscal neutrality between the regular Medicare program and the Medicare Advantage program.”
The government now pays Medicare Advantage managed care plans on average 12 percent more than it spends on patients enrolled in traditional Medicare. The overpayments jump to 19 percent on average for Medicare private fee-for-service programs, the subject of today’s congressional hearing.
“It’s shameful that under current law Medicare will slash payments to doctors well below the cost of caring for seniors, while increasing payments to highly profitable managed care companies. Congress has to make a choice — preserve access to care for all seniors by stopping next year’s Medicare cut to doctors, or continue to help insurance companies line investors’ pockets.”
http://www.ama-assn.org/ama/pub/category/17602.html
Comment:
By Don McCanne, MD
So the AMA supports adequate funding of the traditional Medicare program and opposes “a federal handout to the insurance industry,” especially when the experience of physicians is failing to match the pro-market rhetoric of the private insurance industry.
It doesn’t seem to be that much of a stretch for the AMA to extrapolate that concept to the entire private insurance industry. A handout is a handout, whether publicly or privately funded. Why would the AMA continue to support handouts to private insurers when that money could be better spent on patient care through a more efficient public insurance program?