Medicare Advantage plans to pay Central Ohio Primary Care to keep patients out of hospital

Advantage Plans title5The largest independent physician group in Central Ohio will get bonus payments for keeping the frailest patients well and out of the hospital under a new deal with five private Medicare Advantage plans.

Central Ohio Primary Care Physicians Inc. will get a fixed monthly payment for patients in the pilot program, plus a share of the savings from actuarial estimates of that group’s 2014 medical expenses. The plans also have agreed to pay for sending patients directly to a high-acuity wing of a skilled nursing facility without the usual requirement for a three-day hospital stay.

The average hospital stay costs at least $10,000, said Dr. William Wulf, CEO of the 270-doctor group. The practice’s hospitalists – specialists who follow patients through inpatient stays – say about one-fourth of patients admitted could have been cared for in a less-costly setting, but regulations and existing payment incentives encourage the hospitalization.

“What if that hospitalist was in a shared savings program for that $10,000?” Wulf said. “That’s where we need to go, that’s where we’re going with population health.”

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Medicare Advantage plans to pay Central Ohio Primary Care to keep patients out of hospital

Rep. Dingell Blasts Medicare Advantage Plans’ Sales Tactics at Hearing

Chairman of Energy and Commerce says Medicare Advantage marketing practices are disgraceful

June 26, 2007 – A House subcommittee hearing today opened with a blistering statement of charges and penetrating questions from Democratic Congressman John D. Dingell, Chairman of the Committee on Energy and Commerce. The hearing, held by the Subcommittee on Oversight and Investigation, was entitled Predatory Sales Practices in Medicare Advantage.

Dingell opened with, “I’ll be blunt. The Medicare Advantage marketing practices that have come to the attention of this Committee are disgraceful. But frankly, they come as no surprise to those of us who have long questioned the structure of the Medicare Advantage program.”

Included among his questions were –

   ● Why are Medicare payments for Medicare Advantage beneficiaries, on average, 12 to 50 percent higher than what Medicare pays for beneficiaries enrolled in traditional Medicare?

   ● Why should the vast majority of traditional Medicare beneficiaries pay higher monthly premiums to subsidize Medicare Advantage enrollees?

   ● Wasn’t privatization supposed to help contain costs and allow more efficient delivery of quality health care?

Dingell said he does not believe Medicare Advantage is containing costs and “there’s no evidence that it is providing value to beneficiaries commensurate with its greater cost.”

“On the contrary,” he added, “as we’ll hear today, the very structure of Medicare Advantage creates conditions ripe for swindling the elderly and disabled.

“The real beneficiaries of this program are the insurance companies, which have profited handsomely—Humana will reportedly earn 66 percent of its net income from sales of Medicare Advantage products this year.”

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Rep. Dingell Blasts Medicare Advantage Plans’ Sales
Tactics at Hearing

Coverage or Denial

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