MedPAC Repeats Dubious Overpayment Number In Report
MedPAC, the congressional policy arm for Medicare, again has published a dubious overpayment number in a report to Congress. It says the federal government will spend $84 billion more in 2025 on Medicare Advantage (MA) enrollees than if they were enrolled in the traditional fee-for-service (FFS) program. This is about 20% more. This is slightly lower than MedPAC reported in 2024.
MedPAC says two factors accounting for the majority of overpayments to MA plans are risk score coding intensity and favorable selection. It says risk scores for MA enrollees will be around 16% higher in MA vs. FFS, which accounts for $40 billion. It says that $44 billion is favorable selection.
Many MA proponents and I do not buy the favorable selection number or all of the risk score coding number. But I have admitted that some plans take advantage of risk adjustment and do overcode. They get a disproportionate amount of the overpayments. MedPAC notes a wide variation among plans as well. I agree with MedPAC that heath risk assessments (HRAs) and manual chart reviews account for a good deal of the increased scoring and should be removed or reformed.
Given all of this continuing negative publicity, I do think MA reductions and overpayments could appear in the budget reconciliation bill or pass later this year. See this blog on areas they could cut: https://www.healthcarelabyrinth.com/medicare-advantage-in-the-gunsight/
#medicareadvantage #healthplans #overpayments #riskadjustment
BCBSMA and BCBSMN Latest To Sue CMS Over Star Ratings
Blue Cross and Blue Shield of Massachusetts is suing the Centers for Medicare and Medicaid Services (CMS) over an unfair calculation of its 2025 Medicare Advantage (MA) Star ratings. In the suit, BCBSMA alleged that CMS used an unlawful methodology to calculate its ratings, leading to a drop from a 4-star rating to a 3.5-star rating and the loss of $35 million in potential revenue. The suit is not yet available and it is unclear what measure, measures or calculations are being challenged.
As well, Blue Cross and Blue Shield of Minnesota is suing CMS as well over 2025 Star ratings revolving around calculation of call center ratings.
United Healthcare won its 2025 suit and Centene withdrew its suit as its ratings were adjusted like United’s. Alignment Health, Humana, Elevance Health, Louisiana Blue, and Florida Blue still have suits pending.
Additional article: https://news.bloomberglaw.com/health-law-and-business/blue-cross-sues-hhs-for-phone-calls-affecting-quality-rating and https://news.bloomberglaw.com/health-law-and-business/blue-cross-suit-says-us-made-35-million-quality-rating-mistake
(Some articles may require a subscription.)
#medicareadvantage #cms #stars #quality
Schumer Does About-Face On CR
Senate Minority Leader Chuck Schumer, D-NY, says he will vote to advance the House-passed continuing resolution (CR) that would keep government funded through September 30. This comes a day after Schumer said Democrats would oppose en masse. Schumer’s move likely allows moderate senators to vote in favor, increasing the prospects that the needed 60 votes will be achieved to pass the bill.
#governmentshutdown #cr #trump #congress #spending #ffy2025budget
https://thehill.com/homenews/senate/5194156-schumer-gop-funding-bill-shutdown
Cigna Announces Leadership Changes
The Cigna Group CEO David Cordani announced changes in his leadership team as the company battles uncertain financial times. Brian Evanko, who was CFO and led the health plan unit, becomes President and COO. Ann Dennison will succeed Evanko as CFO. Eric Palmer, who led services unit Evernorth, will depart. Cigna reaffirmed its outlook for 2025.
In other news, Highmark Health, a Pennsylvania Big Blue, saw its net income plummet 90.6% to $50 million while revenue rose nearly 9% to $29.4 billion. The company also reported operating losses of $209 million, compared with an operating gain of $338 million in 2023.
Additional articles: https://www.fiercehealthcare.com/payers/cigna-shuffles-top-leaders-names-new-coo and https://www.modernhealthcare.com/people/cigna-brian-evanko-eric-palmer and https://www.healthcaredive.com/news/cigna-new-coo-cfo-executive-reshuffling/742409/ and https://www.modernhealthcare.com/insurance/highmark-health-2024-revenue-operating-loss
(Some articles may require a subscription.)
#cigna #healthcare #healthplans
https://www.beckerspayer.com/executive-moves/cigna-names-coo-cfo-in-executive-shuffle.html
Trump Pulls Weldon Nomination
In a surprise move, the Trump administration pulled Dave Weldon’s nomination to head the Centers for Disease Control and Prevention (CDC). The move occurred shortly before a hearing was to be heard on his nomination. Several Republican senators either wanted the nomination pulled or might have voted no.
FDA commissioner nominee Marty Makary, a Johns Hopkins Medicine surgeon, and NIH pick Jay Bhattacharya, a Stanford University health economist and doctor, sailed through the Senate Committee on Health, Education, Labor, and Pensions (HELP).
Additional articles: https://www.fiercehealthcare.com/regulatory/trump-administration-withdraws-dave-weldon-cdc-nomination and https://insidehealthpolicy.com/daily-news/weldon-says-wh-axed-his-nomination-after-gop-lawmakers-balked-blames-pharma
(Some articles may require a subscription.)
#fda #cdc #nih #trump #congress #healthcare
https://www.modernhealthcare.com/politics-policy/senate-trump-fda-nih-nominations
— Marc S. Ryan
