The Trump administration’s effort to ensure that Medicare doesn’t favor traditional coverage over private insurance plans is a clear indication the government is shifting away from fee-for-service and toward alternative may models, one expert said.
President Donald Trump signed an executive order Thursday that seeks to “protect and improve” Medicare for seniors. It also blasted a recent “Medicare for All” proposal.
The Medicare program will now ensure that FFS Medicare is not “advantaged or promoted” over Medicare Advantage in an effort to provide more plan choices for seniors, the order states. Other actions include: encouraging innovative MA benefit structures and plan designs and adding a payment model that adjusts MA benefits to allow Medicare beneficiaries to share more directly in the savings from the program.
Other actions include efforts to improve access through network adequacy, increase time providers spend with patients, encourage innovation and eliminate waste, fraud and abuse.
“Instead of ending the current Medicare program and eliminating health choices for all Americans, my Administration will continue to protect and improve Medicare by building on those aspects of the program that work well, including the market-based approaches in the current system,” the order states.
Steven Littlehale, chief innovation officer for Zimmet Healthcare Services Group, said the move is “clearly away from FFS and toward alternative payment models.”
“The concept of moving away from FFS Medicare has been popular by the last two administrations. Many believed that the Affordable Care Act would ‘be the end of Managed Care’ when in fact, (it was) just the opposite. The same sentiment was expressed early on in the Trump administration but that hasn’t been the case either,” Littlehale told McKnight’s on Thursday.
“It won’t have any direct provider impact whatsoever, except for possibly accelerating migration from FFS. This is the de facto ‘privatization’ that has been discussed for 20 years,” added Marc Zimmet, president of Zimmet Healthcare Services Group on Thursday.
He said the effort could possibly impact added benefits, like telemedicine and home-care, for SNFs that are integrated providers, but noted “that may be a stretch.”
A recent study found that long-term nursing home residents enrolled in UnitedHealthcare’s Medicare Advantage Institutional Special Needs Plans (I-SNPs) were more likely to use skilled nursing services than those with Medicare FFS plans.
A survey of skilled nursing CFOs and finance professionals, however, found that many providers are being hurt by Medicare Advantage plans — 70% of those surveyed reported a moderate to significant negative impact.
“Any Medicare Advantage billings that we have had have been terrible. The insurance company pre-authorizes the care; pays for it and then 6 months to a year later takes the money back,” one CFO stated.
