Congress should do more to control Medicare Advantage spending and put traditional Medicare on more equal footing, a major nursing home advocacy group told a federal healthcare task force last week.
Halting overpayments to Medicare Advantage organizations and examining how the program’s “advantages” have actually made MA more expensive than traditional Medicare “warrant a look by Congress,” LeadingAge said in a letter.
The provider association made its views clear to US House Health Care Task Force Chairman Michael Burgess (R-TX) last week, following a request for information on ways the government could “modernize and personalize the health care system, support innovation, and increase patient access to quality and affordable care.”
MA organizations are especially concerning because some wrongly deny services or don’t pay providers enough, while overwhelming them with administrative tasks, said Nicole O. Fallon, vice president of Integrated Services & Managed Care for LeadingAge.
Her letter included harsh words for MA plans that say they are reducing costs. Expenditures are lowered “on the backs of post-acute care providers and beneficiaries who are wrongfully denied Medicare covered services based upon an artificial intelligence algorithm,” Fallon wrote.
‘Alarming’ pattern
She also highlighted a report from MedPAC, an advisory group to Congress, that found Medicare pays 6% more for MA beneficiaries than those enrolled in the original fee-for-service program.
“In both the home health and SNF settings, MedPAC claims that payment must be adequate because providers accept contracts from Medicare Advantage. [But] this interpretation does not reflect that providers must accept Medicare Advantage contracts to stay competitive in the market,” Fallon explained. “Often our members must choose whether to limit access for Medicare Advantage patients due to the administrative and financial burdens of accepting MA — but this pattern limits access for patients.”
She called the pattern “even more alarming” because providers “have no leverage to negotiate rates in either Medicare Advantage or in Medicaid.”
Medicare itself could see cost reductions through the adoption of nonmedical interventions such as adult day services, meals and transportation that are already in effect in veterans’ programs and Medicaid, the letter said.
“[W]e urge CMMI to be bold and test payment for a bundle of long-term care services and see the impact on Medicare spending,” Fallon wrote.
Expensive staffing rule
LeadingAge also continued its vehement opposition to the proposed staffing mandate, opening the letter by reiterating that huge costs would be foisted on providers.
It wrote that independent estimates put the cost of the mandate at $7.1 billion, which is significantly higher than the CMS estimate of $40.6 billion over 10 years, with an average annual cost of $4.06 billion.
With the rule in place, labor costs would soar, the group warned. There would be greater dependency on agency staff and facilities would wind up competing against each other even more for workers, it said.
“Hourly wages will be driven higher to entice people to work,” the letter noted. “As these higher wages are reported on Medicaid cost reports, reimbursement will increase for these services. Higher Medicaid cost reimbursement will result in a need for more state dollars and more federal dollars to cover these costs.”
In the letter, Fallon also lobbied to ease the regulatory process. She recommended refocusing audit contractors on practices by providers that try to “minimize or avoid” therapeutic care and support services; more education for providers and creating clear standards, instead of just clawing back payments; and better education for auditors in order to minimize inconsistencies.
