You may never find a wonkier set of people than the folks with the Medicare Payment Advisory Commission.
For those in the nursing home ecosystem, MedPAC is largely considered tone deaf for its annual recommendations to cut skilled nursing reimbursement. (To be fair, it adheres to the MEDICARE — emphasis added — group’s mission. But it does nothing for the overall sustainability of the system.)
One way or another, operators should not be so quick to dismiss this group with a wave of the hand.
Its annual report to Congress was officially released late Wednesday. Mixed in beside the “nursing homes are making too much money” nonsense is an interesting finding about Medicare Advantage plans.
In brief, it seems they’ve not only been given the keys to Uncle Sam’s car, they’re using his ATM card for unauthorized withdrawals too.
Like some flesh-eating bacteria, Medicare Advantage plans have been devouring market share. It seems that many folks are either mostly fine with it, or feel too powerless to do much about it. Your occasional Special Needs Plan or other self-insurance risk-sharing vehicle is nice, but face it: Most nursing homes are not going to be involved in one any time soon.
So for now, most people are left watching federal authorities lose or cede even more power to MA plans. It’s almost as if somebody came to the conclusion it’s too hard to keep everybody healthy and happy. Or at least healthy, especially with all those old folks! So they’re content enough to fob off at least part of the chores to MA plans. (To review: Medicare Advantage is NOT a part of Medicare, as some lawmakers have sputtered into the wind lately.)
Let’s just say that it pays to keep a special eye on your subcontractors.
Among the voluminous MedPAC filings this week, it came to light that MA plans charged the government $27 billion more than expected. That’s billion with a “B.” This from the guys who are supposed to be crafting better, more efficient healthcare.
That equates to about 6% more than what the government would have paid through traditional Medicare plans.
Maybe the best thing that could come of this is that consumers, who have swallowed the MA pitch hook, line and sinker, and their advocates should start demanding more accountability. They’ve bought into the well-advertised MA plans, creating justification for them. But in the end, it’s their loved ones who are being presented with the ol’ “Watch my right hand (while my left hand does something unnoticed)” trick.
Of course it’s care providers also often left holding the bag. MA algorithms dictate how pay — and care — should start and stop, too often regardless of the human condition. Figure out a way to deal with it.
The next MedPAC report is liable to find less than $27 billion overdrawn, but it still might not be reason to cheer. These MA folks aren’t stupid. They just have to make sure they don’t kill the golden goose.
James M. Berklan is McKnight’s Executive Editor.
Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.