Obamacare and Rad Onc

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More than a few patients in my practice have received notice that their insurance policies will be terminated effective 12/31/13 due to ACA guidelines. In some cases, this has caused us to b.i.d. XRT on a couple of days to ensure that they are done before 2014.

I'm curious if this is a recurrent theme in other states?

 

[medgator]

Yes. I believe the ACA is defunding/cutting funding to private insurers to administer medicare replacement plans. United healthcare administers the biggest chunk of these replacement plans and their "AARP Medicare Complete" plan has dropped our practice as well as a number of others (including bigger centers like Moffitt) in the SE and NE. In order for patients to continue, they will need to see us out of network. Many of our patients are switching to other insurances Jan 1st.

http://online.wsj.com/news/articles/SB10001424052702303559504579200190614501838

UnitedHealth Culls Doctors From Medicare Advantage Plans
Physicians in 10 States Notified; Insurer Cites 'Funding Pressure' From Federal Government

UnitedHealth Group Inc., UNH +1.29% the nation's largest provider of privately managed Medicare Advantage plans, has dropped thousands of doctors from its networks in recent weeks—spurring protest from lawmakers and physician groups and leaving many elderly patients unsure about whether they need to switch plans to keep seeing their doctors.

Doctors in at least 10 states have received termination letters, some citing "significant changes and pressures in the health-care environment." The notices also tell doctors they can appeal within 30 days. That means many physicians and patients won't know for sure who is in or out of UnitedHealth's Medicare Advantage networks before the open-enrollment period to switch Medicare plans ends on Dec. 7.

UnitedHealth said its provider networks are always changing and that it expects its Medicare Advantage network "to be 85% to 90% of its current size by the end of 2014," although it declined to say how many doctors are being cut in individual states or what criteria it is using.

The federal government pays private insurers a per-capita fee to manage the benefits. The rate is currently about 12% more than the average Medicare patient spends annually. The Obama administration plans to cut those extra payments to insurers by about $150 billion over the next 10 years to help pay for the health law. Some experts expect enrollment in Medicare Advantage plans to decline sharply if that occurs.

Other Medicare Advantage providers, including Humana Inc., Aetna Inc. and WellPoint Inc., said they are always evaluating their provider networks, but doctor groups say none appear to be shrinking them to the extent of UnitedHealth.

UnitedHealth is the biggest player, with nearly three million members in Advantage plans, many of them sold under the AARP brand. The company says it had over 350,000 doctors in its Advantage provider networks.

Among the practices UnitedHealth has dropped are Moffitt Cancer Center in Tampa, Fla., and the Yale Medical Group in New Haven, Conn., which includes 1,200 faculty physicians.

"Instead of a scalpel, United is using a chain saw," said Michael Saffir, a rehabilitation specialist and president of the Connecticut State Medical Society, which estimates the insurer has cut 2,200 doctors across the state.

Two Connecticut county medical groups filed suit against UnitedHealth in U.S. District Court, alleging that the terminations violated contract provisions.

Several state attorneys general are investigating. Congressional delegations have complained about the company's timing and tactics to Medicare administrator Marilyn Tavenner, as did 43 national medical associations and 40 state medical societies in a joint letter on Nov. 6.

http://www.tampabay.com/news/health...jor-changes-says-unitedhealthcare-ceo/2150512

The Affordable Care Act incorporated financing changes for Medicare managed care, but these cost-reducing trends are not new. For years, many in Washington have worked to reduce Medicare Advantage's high cost to taxpayers until it reaches a level playing field with original Medicare.

Medicare managed care programs began years ago, when insurance companies assured the government they could run their networks for 5 percent less, per person, than what traditional Medicare was paying — and still turn a profit.

Though Advantage plans were a hit with consumers, the cost savings did not last for long. Over the years, the average Medicare Advantage payment ballooned to 114 percent of traditional Medicare's rates.

Now, with baby boomers and rising health costs threatening Medicare's solvency, the Medicare Advantage disparity has become hard to defend.

AARP will not disclose its royalties for letting UnitedHealth use its name, but a report to Congress pegged the total at $427 million in 2009. That included AARP Medicare supplement insurance, Part D drug insurance as well as Medicare Advantage plans.

Ironically, AARP has been among the loudest advocates for reform.

"Paying more for Medicare Advantage is just not acceptable,'' said AARP health policy expert Joyce Dubow. "People in both the traditional program and managed care are paying more for their Medicare premiums because of these overpayments. The system should not tilt one way or another.''

As of this year, Congress has pared Medicare Advantage's average stipend to about 103 percent of what traditional Medicare pays, shooting for parity by 2017.