MedPAC Chair Defends MA Analysis
Dr. Amol Navathe, the new chair of congressional Medicare policy arm MedPAC, defended the work and Medicare Advantage over-reimbursement estimates of his organization. He doubled down on MedPAC’s view that MA is reimbursed 14% more than what is spent in traditional fee-for-service (FFS). Critics of MedPAC, including me, stand by our assessment that MedPAC is relying on old data that does not recognize risk adjustment reforms and updates. In addition, MedPAC has picked up some spurious academic analyses on so-called favorable selection and has essentially adopted them as fact. The chairman himself is an academic and his defense of this process is expected.
Republicans in Congress are challenging MedPAC’s way of thinking, considering a bill to force MedPAC to broaden its viewpoints, including definitively setting aside the favorable selection argument. As MedPAC always does, it says it will open the doors and encourage engagement, but its studies seem to be closed to alternative ways of thinking. When it is found to be errant, it seems to obfuscate that fact with more of the same research. Indeed, the Centers for Medicaid and Medicaid Services (CMS) seems convinced the 14% number is absolutely inflated. Numerous other reports seem to conclude that as well, arguing MedPAC simply does not understand the difference between managed care and a 60-year-old FFS system.
#medpac #medicare #medicareadvantage
Oz says MA Needs Careful Regulation
Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz compared Medicare Advantage (MA) to lovingly tending a garden attacked by weeds. That means that we will see more regulation of MA over time even as the Trump administration is a major supporter of the private program. It dislikes, though, some costs, abusive practices, and some profiteering in the form of vertical integration. It also has focused on removing certain barriers to care in MA.
Because it is a supporter, CMS likely will carefully balance regulatory efforts even as it goes further down that road. But a deputy notes the high per member cost and a crisis in confidence in MA. Indeed, the administration has made several reforms on risk adjustment and payment that has demonstrably reduced dollars to MA and led to the retrenchment we have seen.
#medicareadvantage #trump #regulation
https://www.healthcaredive.com/news/oz-medicare-advantage-garden-weeds-bma-cms/831062
— Marc S. Ryan
