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Price Transparency’s Illusory Promise

Price Transparency’s Illusory Promise

Hospital Prices Must Now Be Transparent. For Many Consumers, They’re Still Anyone’s Guess, KHN, July 2, 2021, by Julie Appleby

The Health 202: Biden Says He’ll Enforce Trump-era Rules Requiring Hospitals to Post their Prices, Washington Post, July 12, 2021, by Alexandra Ellerback with Paige Winfield Cunningham

“Ultimately, the unanswered question is whether price transparency will lead to overall lower prices.” – Appleby

Comment:

By Hannah Leibson and Allison K. Hoffman, J.D.

Efforts to increase price transparency in health care have become a policy obsession of academics and policymakers alike, despite little evidence it provides any benefit to patients.

On January 1, 2021, the Trump Administration finalized the Transparency in Coverage final rule and drank the Kool-Aid. This rule requires hospitals to disclose publicly what they charge uninsured patients for items and services as well as the rates they negotiate with insurers. The Administration hoped that the rule would force insurers to compete with each for lower priced items and services, driving down the overall cost of health care.

The rule’s roll out has not gone as anticipated. Up to 83 percent of hospitals are not fully complying with the rule. For hospitals that have disclosed prices, they are often hidden deep on their websites – shielded from patients’ view. This week, the Biden Administration urged the Department of Health and Human Services to boost their enforcement of the rule.

But as Appleby and Ellerback have highlighted, the rule overlooks a key reality. Even when consumers have greater access to information, they generally do not use it to shop medical care as policymakers imagine. Empirical research has shown that consumers are unwilling to price compare, and even when they do, it does not drive their choices.

Instead, the role of referring physicians plays a far greater role in patient choice and decisionmaking. This is unsurprising. Price data says little about quality, which is just as or more important to people, and assessing quality and making price/quality tradeoffs is a herculean task for most of us. Various studies have shown that giving people price information, even in a fairly digestible form and even with regard to reasonably fungible services, does little. Consider just two:

One study examined the consumer choices of people with easy access to price shopping for lower-leg MRIs, where quality does not vary wildly. The researchers concluded that only 14 percent of consumers went to the lowest-cost MRI provider within thirty minutes of their home, often bypassing six lower-priced providers between their home and location of their chosen scan. They went to the location their doctor suggested.

Another recent study assessed whether consumers changed their behavior after a transparency tool was introduced in the California Public Employees’ Retirement System (CalPERS). The interface showed consumers the prices for lab tests, office visits, and imaging services. The researchers found that only 12 percent of people used the interface in the first fifteen months after it was introduced, and most did not choose a lower-priced service after use.

Given this reality, it is likely that the Transparency in Coverage final rule will have a trivial effect on lowering the overall cost of health care through consumer-driven behavior. Regulations like the Transparency in Coverage rule are rooted in a fallacy that when we make the market work better, patients can navigate in the front seat. And they perpetuate that fallacy.

More direct price regulation or central budgeting, like what occurs under the Medicare program, is the only way to rein in escalating prices going forward. Without such measures, we will continue to face rapidly rising health care costs.

http://healthjusticemonitor.org…

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Tinkering with Medicaid Eligibility Hurts Beneficiaries

When Is Tinkering with Safety Net Programs Harmful to Beneficiaries?, National Bureau of Economic Research, July 2021, by Jeffrey Clemens & Michael J. Wither

Abstract

Interactions between redistributive policies can confront low-income households with complicated choices. We study one such interaction, namely the relationship between Medicaid eligibility thresholds and the minimum wage. A minimum wage increase reduces the number of hours a low-skilled individual can work while retaining Medicaid eligibility. We show that the empirical and welfare implications of this interaction can depend crucially on the relevance of labor market frictions. Absent frictions, affected workers may maintain Medicaid eligibility through small reductions in hours of work. With frictions, affected workers may lose Medicaid eligibility unless they leave their initial job. Empirically, we find that workers facing this scenario became less likely to participate in Medicaid, less likely to work, and more likely to spend time looking for new jobs, including search while employed. The observed outcomes suggest that low-skilled workers face substantial labor market frictions. Because adjustment is costly, tinkering with safety net program parameters that determine the location of program eligibility notches can be harmful to beneficiaries.

Comment:

By Don McCanne. M.D.

Who should be deprived of health care? Likely most would agree that nobody should, and, ideally, everyone should agree.

With our dysfunctional, fragmented system of financing health care, a special funding program must exist to cover those who do not have the resources to pay for health care, thus we established Medicaid. But what threshold do we establish for eligibility? Is it all-or-none financing? Does minor tinkering invoke all-or-none decisions?

In the real-world example presented, an increase in minimum wage reduced the number of hours that a low-skilled worker could work and still maintain eligibility for Medicaid. The result was both less employment and less Medicaid. Such all-or-none decisions could be disastrous for the health care or income of an affected low-wage worker. Last year, evidence from Arkansas showed that a work requirement decreased Medicaid enrollment without increasing work.

Suppose we had a single payer Medicare for All system. Everyone would automatically have financial barriers removed from medical care. There would be no need to establish a special medical welfare program such as Medicaid. Controlling costs for the indigent would be accomplished by funding the entire system though progressive taxes. That way, everyone could have health care in a system that is affordable for each of us. The complexity and injustices of segregating patients into a Medicaid program would no longer be necessary.

http://healthjusticemonitor.org…

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People of Color Get Little Care from Specialist Physicians: New Harvard Study

Black, Hispanic, Native and Asian Americans receive much less specialist care than white Americans, likely due to differences in payment rates and insurance coverage.

FOR IMMEDIATE RELEASE: July 19, 2021

Contact: Christopher Cai, M.D., ccai4@partners.org
Samuel Dickman, M.D., samuel.dickman@austin.utexas.edu
Clare Fauke, Physicians for a National Health Program communications specialist, clare@pnhp.org

People of color are underrepresented in the outpatient practices of most specialist physicians, according to a study appearing today in JAMA Internal Medicine. Black, Hispanic, Asian/Pacific Islander and Native Americans received much less care (measured by outpatient visit rates) from surgical specialists such as orthopedists or medical subspecialists such as pulmonary (lung) specialists. Disparities persisted even after accounting for patients’ insurance, income, education and health status. In contrast, primary care physicians saw patients of color and white patients at roughly equal rates.

The study, carried out by a team of researchers at Harvard Medical School, The City University of New York at Hunter College, Planned Parenthood South Texas, and Tufts University, analyzed data from 132,423 respondents to the Medical Expenditure Panel Survey, a national survey of healthcare use. Compared to white patients, Black patients were underrepresented in the practices 23 out of 29 physician specialties. For example, Black patients’ visit rates to orthopedic surgeons, urologists, pulmonologists and cardiologists were 59%, 62%, 63%, and 81% those of white individuals, respectively. Native American patients were also markedly underrepresented in most specialties’ practices, as were Hispanic- and Asian/Pacific Islander-Americans. Notably, nephrologists — who care for patients with end-stage kidney disease, almost all of whom are covered by Medicare, and many of whom are people of color — provided significantly more care to minority groups than to whites.

“Black Americans die nearly 5 years younger than white Americans and are more likely to have chronic illnesses, due to discrimination and poverty. Yet physicians who could close these gaps are far less likely to see Black patients,” said Dr. Christopher Cai, the study’s lead author and a resident physician at Brigham and Women’s Hospital and Harvard Medical School. “Inequities in health insurance are probably the main culprit for the racial disparities we found. White people are far more likely to have private insurance, which pays doctors higher fees. In addition, white patients are more often able to afford copayments and deductibles for visits. Our insurance system tells doctors that people of color are worth less than white people, a pernicious form of structural racism.”

Dr. Samuel Dickman, the study’s senior author and Director of Primary Care at Planned Parenthood South Texas, noted, “Black patients’ experiences of mistreatment by the health care system in the past may lead them to avoid seeking care. People of color may feel more comfortable seeing physicians from their own communities, but medical schools are not training nearly enough Black-, Latino- and Native-American physicians. Location is an important factor too, since relatively few specialists have offices in communities of color.”

Study co-author Dr. Steffie Woolhandler, a Distinguished Professor at CUNY’s Hunter College and Lecturer in Medicine at Harvard Medical School added, “One hopeful finding was that kidney specialists saw patients of color at rates commensurate with their high rates of severe kidney disease. Almost all patients who need dialysis or a kidney transplant qualify for Medicare, even if they are under 65, and hence bring doctors the same fees. Universal and equal insurance could go a long way toward equalizing care.”

“Racial and Ethnic Disparities in Outpatient Visit Rates Across 29 Specialties,” Christopher Cai, M.D.; Adam Gaffney, M.D., M.P.H.; Alecia McGregor, Ph.D.; Steffie Woolhandler, M.D., M.P.H.; David U. Himmelstein, M.D.; and Danny McCormick, M.D., M.P.H.; Samuel Dickman, M.D. JAMA Internal Medicine.

Published online first, July 19, 2021 at 11:00 AM EST.

The full text of the article is available to media professionals upon request. Please contact mediarelations@jamanetwork.org.

Physicians for a National Health Program (www.pnhp.org) is a nonprofit research and education organization whose more than 24,000 members support single-payer national health insurance. PNHP had no role in funding or otherwise supporting the study described above.

Building the Path to Medicare for All

Democrats Have An Historic Opportunity To Advance FDR’s Vision For Universal, Guaranteed Health Care, Common Dreams, July 14, 2021, by Nancy Altman

FDR, his Labor Secretary Frances Perkins, and their allies had a much broader definition of Social Security than the one we use today. They understood the term as a synonym for economic security. They knew that to ensure economic security, all of us need the assurance that if faced with an illness, we or our loved ones will receive high-quality treatment as a guaranteed right.

They understood that to be economically secure, all of us must have universal, guaranteed health care as our birthright. Today’s Democrats appropriately proclaim that health care should be a right, not a privilege. Now is the moment to walk the walk, to add action to the rhetoric. …

Democrats have the opportunity to pass a package that takes the next big step in that direction. The following Medicare and Medicaid improvements are being debated as you read these words:

  1. Creating an out-of-pocket cap in Medicare, because no one should go bankrupt trying to pay for health care.
  2. Adding the essential benefits of vision, hearing, and dental care to Medicare.
  3. Lowering the Medicare eligibility age to 60, as Medicare’s architects anticipated and as President Biden promised in his campaign.
  4. Empowering Medicare to negotiate lower prescription drug prices not just for seniors and people with disabilities but for everyone in America.
  5. Allowing people to remain in their homes, rather than forced into institutions, by funding home and community-based long-term care.

Each of these steps would make Americans more economically secure, and enormously improve our lives. It exemplifies the promise to build back better.

Comment:

By Eagan Kemp

Nancy Altman, the President of Social Security Works–a staunch ally in the fight for Medicare for All–highlights how crucially important it is for Congress to improve and expand Medicare, while also lowering the cost of prescription drugs and improving access to home and community based long-term care in the next reconciliation package.

While these steps are important on their own, they also help us think about how we move from the fragmented health care system we have now to the health care system we truly need, Medicare for All.

The reality is that most people are fed up with the health care system and are ready for things to change. The question is then how do we change it.

Given the limitations of the current Congress and President Biden’s opposition to Medicare for All, how do we make progress on health care without making the situation worse?

Taking steps to reduce corporate power in health care while strengthening public programs is a good place to start. While these reforms aren’t perfect, they help us push back on the corporate onslaughts on Medicare and, if crafted correctly, will also take a bite out of prescription drugmakers’ power.

Getting these reforms over the finish line will mean relief for millions of Americans but will still take a lot of work, as corporate lobbyists fight to water them down.

But make no mistake, the fight for Medicare for All must continue, regardless of whether these interim measures pass. It will take the largest grassroots mobilization in decades to finally guarantee health care for everyone in the U.S.

Luckily, those fighting for Medicare for All haven’t lost focus. Over 20 municipalities passed Medicare for All Resolutions in recent months and many more are working to do so soon. Additionally, the Medicare for All bill in the House just added its 118th cosponsor, highlighting the progress that we continue to make in Congress. And with hearings on Medicare for All forthcoming in both the House and Senate, the support within Congress will continue to deepen.

http://healthjusticemonitor.org…

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Medicare for All Explained Podcast: Episode 60

Highlights, Vol. 1

July 15, 2021

For the landmark 60th episode, podcast host Joe Sparks highlights some of the most important points from Medicare for All Explained, including:

  • What Medicare for All is
  • Why the public option won’t work
  • Why our current health care system is not affordable
  • Why you can’t be sure that insurance clerks are giving you accurate information
  • How insurance companies arbitrarily make patients change medications; and
  • How Medicare for All helps prevent the spread of disease and protects public health

Additional episodes will be uploaded twice monthly. Subscribe in iTunes, or access a complete archive of the podcast, below.

https://medicareforallexplained.podbean.com

Good Long-Term Care Policy Should Support Care in Various Settings

When It Comes to People Like My Daughter, One Size Does Not Fit All, New York Times, July 4, 2021, by David Axelrod

I am profoundly grateful for the disability rights movement that has waged a decades-long battle to shutter such institutions, many of which were run by the states, and to win for people with intellectual disabilities the right to live in small apartments and homes with services in residential neighborhoods.

But now the ideal has hardened into dogma: All larger communities are bad. All small, neighborhood-based group homes are good.

Of course, neither of these things is true, and the rigidity of that thinking denies the simple truths that there are good and bad places, large and small, and people with disabilities are not all the same. Like anyone else, they have different personalities, capacities and preferences.”

Comment:

By Allison K. Hoffman, J.D.

I was touched by this op-ed by David Axelrod and his ability to illustrate pointedly why we need various options to meet the range of possible care needs of people with disabilities of all ages, through a telling of his own struggles to find the right support for his daughter, Lauren, who has suffered from debilitating and disabling seizures for decades.

As I discussed in my last post, Medicaid’s pendulum has swung from favoring long-term care in institutional settings to spending a majority of long-term care dollars in home-based settings. Underfunding care in home-based settings has increased reliance on friend and family as informal caregivers and as financiers of their loved-ones care (whether through dollars spent or hours spent and lost opportunities).

With the problems COVID-19 highlighted in congregate care settings, like nursing homes, some have doubled down on calls for shifting care home and dismantling care institutions, rather than making them better. Axelrod talks about a similar push that began during the mid-20th Century deinstitutionalization movement. What he does not note is that during that movement, some families who were unable to care for loved ones with disabilities at home abandoned the legal efforts when they realized that the end goal of the litigation was to shut down institutions, not to improve them. Elsewhere, I’ve advocated for why in this moment we need to keep nursing homes, other congregate care facilities, and larger living communities, and make them better.

One part of this effort is regulatory. Another is funding. A final one is designing flexible policies, what I’ve called a policy toggle. Public financing for long-term services and supports should be designed so that people can get care at home, when it makes sense for them and their loved ones. When it doesn’t, like in the case of Lauren Axelrod, they should have the option of care in high-quality and affordable community-based settings. Too often policies have been designed with a bias in one direction or another, rather than letting people who need care, in conjunction with their loved ones, figure out the right direction so that everyone can thrive.

http://healthjusticemonitor.org…

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Medicare Advantage puts Sick Enrollees at a Disadvantage

Cost-Related Problems Are Less Common Among Beneficiaries in Traditional Medicare Than in Medicare Advantage, Mainly Due to Supplemental Coverage, Kaiser Family Foundation, June 25, 2021, by Jeannie Fuglesten Biniek et al.

These cost-related problems are: the prevalence over one year of trouble getting health care due to cost, or problems with / non-payment of medical bills. Detailed wording here. And…

Costs in Medicare Advantage present barrier to care, JustCare, July 8, 2021, by Diane Archer

The Kaiser Family Foundation has a new report that underscores the likelihood of significant access to care issues in Medicare Advantage for people with modest incomes and people in fair or poor health.

Comment:

By Jim Kahn, M.D., M.P.H.

These findings from KFF, based on a national survey, are startling. They call out brightly the hazards of relying on private insurers to protect enrollees in our huge publicly financed Medicare program for the elderly and disabled.

The lesson is: If you’re at risk of fair or poor health, don’t choose Medicare Advantage. Especially if you’re Black.

Private insurance is not the way to deliver publicly funded services. Not if our goal is to provide affordable medical care for the sick.

There’s a second take-away: With financial problems for enrollees even in traditional Medicare (especially those with no Medigap coverage), we need to place a cap on individual annual out-of-pocket spending. That critical Medicare improvement should rank high on the Congressional agenda.

We need a government fund to directly compensate providers. No private intermediaries siphoning off profits and shifting costs to enrollees. And no cost-sharing. Single payer.

http://healthjusticemonitor.org…

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Physicians Supporting Single Payer Urge Medical Societies To Join Effort

By Amy Lotven
Inside Health Policy, July 14, 2021

A group of physicians that has advocated for single payer health care is seeking help from state and local and specialty medical societies to push the policy. Physicians for a National Health Program (PNHP) says that while surveys show a majority of doctors support Medicare for All, most medical societies do not reflect that view.

On Tuesday (July 13), PNPH launched a campaign encouraging medical societies to adopt pro-single payer resolutions.

“Covid-19 has made the need for Medicare for All even more urgent,” says Susan Rogers, president of PNHP, “but we can’t win single-payer reform without the full support of the medical profession.”

“We can be their voice,” Rogers, a Chicago-based physician, tells Inside Health Policy.

She says physicians are becoming increasingly frustrated by the administrative work, prior authorization, and other barriers to treating their patients. It is more important than ever that physicians understand that the burdens on them — and on their patients — could be eliminated or at least vastly reduced in a single-payer system, Rogers says.

The PNHP’s campaign comes after two years of “unprecedented” movement toward support for Medicare for All by the medical community, the group says in a release. It points out that in January 2019, the American Medical Association’s Student Section narrowly failed in its effort to get the AMA to rescind policies that ban the group from supporting single-payer. Shortly after the 53-47% vote, AMA announced it would leave a stakeholder group that was lobbying against Medicare for All, the Partnership for America’s Health Care Future.

In January, the American College of Physicians endorsed moving to single-payer to achieve universal health coverage and the Society of General Internal Medicine backed that position.

Medical societies in Vermont and Hawaii also endorsed resolutions supporting single payer.

PHNP is also active in Public Citizen’s campaign to pass single-payer resolutions in city councils and county commissions.

https://insidehealthpolicy.com…

Medical Journals are Allergic to Data on Racism

Medicine’s Privileged Gatekeepers: Producing Harmful Ignorance About Racism And Health, Health Affairs Blog, April 20,2021, by Nancy Krieger, et al.

We conducted a literature search for … papers including the word “racism” that were published between January 1, 1990 and December 31, 2020 by four leading medical journals (all with impact factors for 2019 exceeding 30). These journals were: the New England Journal of Medicine (NEJM), The Lancet, JAMA, and the British Medical Journal (BMJ). We focused deliberately on the term “racism” because naming racism is a critical step in addressing its impacts. And given evidence of some journals censoring its use, this focus allowed us to assess the extent to which use of this term has been permitted.

For comparative purposes, we also searched publications in one of the longstanding and leading global public health journals, the American Journal of Public Health (AJPH), and we additionally examined the Annual Review series for four disciplines (medicine, public health, sociology, and psychology) as a gauge of the extant evidence base. …

The four medical journals published markedly lower numbers of papers including the word “racism” compared to AJPH, despite their publishing many more papers between 1990-2020 (14,192 for AJPH, vs. 40,411 for JAMA, 43,378 for NEJM, 63,971 for The Lancet, and 78,545 for BMJ). Although we did not include Health Affairs in this analysis, Rhea Boyd (one of the authors of this post) and colleagues noted in an earlier Health Affairs Blog post, “A quick search of the Health Affairs website reveals only 114 pieces include the word racism in the 39-year history of the journal.” …

Exhibit 2: Analysis of article type for journal articles that included the word ‘racism.’

For the four leading medical journals, upwards of 90 percent of publications including the word “racism”… were commentaries, viewpoints, or letters. The percentage that were either original empirical investigations or review articles with a significant data component ranged from 4 percent (BMJ and NEJM) to at most 10 percent (The Lancet) (exhibit 2). By contrast, for AJPH, 60 percent of identified articles were empirical studies or review articles with significant data, and only 40 percent were commentaries, viewpoints, or letters. …

Non-publication of this research conveys the message that racism and its impact on people’s health are not important and not topics that warrant scientific study or publication, thereby minimizing concerns about these harms among scientists, funding agencies, and the broader public.

Second, non-publication of scientific research on racism and health by leading journals, especially in this era of evidence-based clinical medicine, fosters ignorance about these issues among health professionals, who as trusted sources of information then transmit this ignorance to their patients, clients, and the broader public.

Third, this non-publication of evidence undercuts and limits the important kinds of evidence needed by policy makers, health agencies, funders, lawyers, and advocates for their complementary work to prevent racism and rectify how it harms health.

Fourth, non-publication of this work effectively excludes scholars who study racism and health from high-impact journals, harming not only knowledge dissemination but also potentially the career pathways of these scholars.

Comment:

By David Himmelstein, M.D. and Steffie Woolhandler, M.D., M.P.H.

In recent months younger colleagues and others we know have had several studies documenting stark racial inequities in health care rejected by major journals based on: (1) minor quibbles about methods that have not been raised about closely similar analyses of age-, insurance or income-based disparities; or (2) claims that race-based disparities may simply reflect overuse of care by White people, and hence are not indicative of racism.

Our experience is apparently not unique.  This meticulous survey documents major medical journals’ refusal to publish data on racism.  While the journals have accepted commentaries and letters on racism, they continue to boycott studies documenting the patterns of care and outcomes indicative of structural racism.  So while we’re now allowed to say that racism in the health care system exists, we’re not allowed to provide the data that’s key to addressing it.

http://healthjusticemonitor.org…

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Physicians’ group launches new campaign to move the medical profession to Medicare for All

The 24,000-member Physicians for a National Health Program to target local, state, and specialty medical societies with Medical Resolutions Campaign

FOR RELEASE ON JULY 12, 2021

Contact: Clare Fauke, communications specialist, Physicians for a National Health Program, clare@pnhp.org
Dr. Susan Rogers, Physicians for a National Health Program President, s.rogers@pnhp.org

Physicians for a National Health Program, a nonprofit advocacy organization with more than 24,000 members, today launched its national Medical Society Resolutions (MSR) campaign. The goal of the MSR campaign is to organize the medical profession to support single-payer Medicare for All by passing pro-single-payer resolutions in local, state, and specialty medical societies throughout the U.S.

Surveys show that a majority of American doctors now support improved Medicare for All, but most physicians’ professional organizations do not reflect the changing views of their members.

“Covid-19 has made the need for Medicare for All even more urgent,” said Dr. Susan Rogers, a Chicago-based internal medicine physician and president of PNHP, “but we can’t win single-payer reform without the full support of the medical profession.” Dr. Rogers added, “Even though a large and growing number of physicians favor Medicare for All, the organizations that claim to represent us don’t yet endorse the policies we need to provide universal, equitable, and comprehensive coverage to everybody in the U.S. Our local, state, and specialty medical societies have the power to influence the national debate on health care, and we need them to use that power to win Medicare for All.”

The Medical Society Resolutions campaign follows two years of unprecedented movement towards Medicare for All within organized medicine:

PNHP members are also active in a sister campaign led by Public Citizen to pass single-payer resolutions in city and county councils. To date, the campaign has passed 65 local resolutions in favor of Medicare for All, including major cities such as Philadelphia, Oakland, Detroit, Minneapolis, Seattle, San Francisco, Cook County (Chicago), Los Angeles, Knoxville, and Milwaukee.

For more information on the PNHP Medical Resolutions Campaign, visit medicalsocietyresolutions.org.

Physicians for a National Health Program (www.pnhp.org) is a nonprofit research and education organization whose more than 24,000 members support single-payer national health insurance.

CMS Direct Contracting Scheme Will Privatize Medicare

Comment:

By Jim Kahn, M.D., M.P.H.

Medicare offers enrollees a choice of “traditional” Medicare (government-administered coverage for virtually all physicians and hospitals in the US) or Medicare Advantage (private insurance plans with restricted provider panels). Nearly 60% of enrollees select traditional Medicare, and financial analyses by CMS, MedPAC, and others consistently show that traditional Medicare is less costly than Medicare Advantage.

However, in 2020, the Trump Administration launched a new CMS experiment, the Global Professional Direct Contracting (GPDC) model, that is designed to privatize traditional Medicare. That’s right, end the public part of Medicare as we know it.

GPDC transfers cost and care management to private for-profit insurer and investor contracting entities. Under this model, CMS could auto-assign more than 30 million beneficiaries who have chosen traditional Medicareinto entities managed by private for-profit companies, without their understanding or consent. These entities are similar to Medicare Advantage plans even though the enrollees explicitly rejected this type of coverage. Although not technically permissible, contracting entities could shift enrollees to Medicare Advantage.

The direct contracting experiment, as designed, has four profound flaws:

  • Violates the spirit and public insurance essence of traditional Medicare.
  • Undoes the fundamental choice made by Medicare enrollees.
  • Will increase costs.
  • Likely will not improve quality or allow for objective quality assessment, based on the Medicare Advantage experience.

You’ll notice that this post includes no document link at the top. That’s because this program is happening behind closed doors, on the sly. No public discussion of a massive transformation of traditional Medicare. I know about it because of the excellent sleuthing of colleagues, who have assembled a compelling analysis and report. This will be public soon, but we agreed that there is great urgency to let people know about this threat, so they can speak against it.

Here’s the solution:

  1. Immediately suspend GPDC, pending full review and revision, including participation by relevant stakeholders and external experts.
  2. Restrict direct contracting to entities that are >75% owned by providers, not investors or insurers.
  3. Limit GPDC to < 500,000 participants.
  4. Traditional Medicare enrollees must be:
    • assured full understanding of the program;
    • enrolled only if they actively “opt in;” and,
    • properly informed of their ongoing right to see out-of-network providers and to opt out of GPDC.
  5. Participating providers must submit all medical claims to CMS to permit effective evaluation of cost (to CMS and enrollees), access to care, and health outcomes.
  6. CMS must end GPDC if, overall, it fails to lower costs and improve the care experience within three years.

The integrity of Medicare is at stake.

http://healthjusticemonitor.org…

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