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ACP: Increased Medicare Advantage transparency will reduce burdens, confusion
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In a new policy paper, the American College of Physicians encouraged Medicare Advantage to increase transparency and better align plans to diminish excessive and burdensome administrative tasks on clinicians, as well as confusion among patients.
“As enrollment in Medicare Advantage [MA] plans increases, there is a growing interest in understanding the differences in care delivery, quality, resource utilization and cost between MA and traditional Medicare,” Jack Ende, MD, MACP, president of American College of Physicians (ACP), said in a press release. “If MA plans were to increase transparency, that would give the Centers for Medicare and Medicaid Services the opportunity to examine them more closely and promote alignment, thus lessening the administrative burden associated with clinician participation in these plans.”
In the paper, ACP offered three recommendations to address concerns with the MA program, namely physician burdens and patient confusion. First, ACP highlighted its support of policies that guarantee funding of MA plans at the traditional Medicare program level and recommended that at least 85% of the funding go to beneficiary care.
In addition, ACP called for more transparency in the processes, policies and procedures that Medicare Advantage Organizations (MAOs) implement to develop and administer MA plans and portfolios. Collaboration with relevant stakeholders is essential in streamlining and aligning policies, procedures and contracting arrangements with physicians, according to ACP.
Lastly, ACP emphasized the need for further research on how MAOs utilize federal payments to the MA program, such as research comparing the types of payment models used and the prices paid to contracted physicians, hospitals and other clinicians of MAOs with traditional Medicare and commercial health insurance plans.
“As Medicare moves away from its traditional fee-for-service and toward the Quality Payment Program linking physician payment to high-value care, it is a critical time for the MA program to make improvements,” Ende concluded. “The relief from administrative burdens that our recommendations would provide to clinicians is an important component of promoting high-value care for all Medicare beneficiaries.”
Perspective
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Alan Sager, PhD
The ACP is absolutely right in highlighting the burdens Medicare Advantage plans inflict on physicians, but I fear that their recommendations look like unwarranted optimism and pious posturing, not things that will improve the lives of doctors. When you have multiple MA plans with multiple formularies, step therapies and other provisions on the drug side and when you have multiple plans with multiple reporting requirements, quality measures and prices, the life of a physician is made unnecessarily crazy. MA’s unnecessary burdens on doctors is a problem. This is also a growing problem for the multiple private insurance plans that cover most people through their employer, and also for Medicaid.
It is hard to argue with the ACP’s call for transparency; sadly, that word is used so often that it is almost devoid of meaning. When the ACP recommendations discusses reducing excessive and burdensome administrative tasks, its objective is right on target. Sadly, though, the existence of multiple private plans almost guarantees the persistence of burdensome administrative, financial, quality, and other reporting requirements because each plan has its own rules. Moreover, the plans would assert that it would be a conspiracy and a restraint of trade for them to collude beyond the most basic and mechanical coordination like a uniform billing form. Even then, different plans could use the billing form in different ways and have different rules for using the information.
The ACP’s recommendations look good on paper, but are unlikely to have any practical effect. They are a cry for help. The ACP is unwilling or unable to offer suggestions that would actually reduce administrative burdens on physicians instead of pleading for them — a plea that’s likely to go unheard because the burdens are inherent in the MA model of multiple insurers offering multiple plans.
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