Trump’s Executive Order Appears to Favor Medicare Advantage Plans over Medicare FFS

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Original story posted on: October 9, 2019

Physicians are sure to bristle at a perceived push toward non-physician practitioners operating more independently.

EDITOR’S NOTE: President Donald Trump last Thursday signed an executive order tweaking the Medicare system during a campaign-style rally at The Villages, a Florida retirement community.

In reporting on last week’s executive order signed by President Donald Trump, Ronald Hirsch, MD made it clear to listeners during Monday’s broadcast of Monitor Mondays that the push toward the titular “Protecting and Improving Medicare for Our Nation’s Seniors” would not result in any immediate changes, but simply directs the Secretary of the U.S. Department of Health and Human Services (HHS) to make policy revisions to achieve the goals set out in the executive order.

“First, it is clear that this order favors the Medicare Advantage (MA) plans,” Hirsch said. “They will be given more latitude in what they may offer, including paying patients cash or giving rebates.”

Hirsch said the order also hints that the administration will try to eliminate the certificate of need laws and restrictive covenants. Hirsch went to report that the administration also will want to see the U.S. Food and Drug Administration (FDA) speed up approvals for Medicare coverage for new drugs and new technologies.

“It (the executive order) suggests that we will soon see payment parity from Medicare for physicians and non-physician practitioners, which appears to be another step toward allowing independent practice by non-physician practitioners,” Hirsch said. “This is certainly going to upset many physicians who went to four years of medical school and three to seven years of residency, and now get paid the same as a nurse practitioner who has much less education. Now, don’t get mad at me, since I am a doctor; I am simply reporting, and not taking a side.”

Hirsch also said that there may be many changes to the Medicare fee schedules, as the order directs a modification to Medicare payments to more closely reflect those paid by commercial insurance plans.

“This one is really baffling,” Hirsch said. “In general, commercial payments are higher than Medicare, so why would they want to raise payments? One policy wonk suggests that they want to raise payments to speed the demise of fee-for-service Medicare, to allow the transition to Medicare Advantage for all seniors to happen as fast as possible.”

Hirsch said the executive order addresses the quality of care in two ways. First, he noted that HHS has been ordered to produce more data on both quality and cost to allow beneficiaries to make informed choices, and also it appears that they want to expand the release of claims data to providers themselves so they can see if their practice pattern is, as the order says, “outside the recommended standard of care.”

“The order also stresses that they want patients to have more choice, and to them, that actually means the ability to choose an MA plan instead of Medicare fee-for-service,” Hirsch said. “But signing up with an MA plan does the exact opposite, as we just saw in Connecticut, where Anthem notified a large number of physicians that they were being dropped from their provider network, and an article published last month, which showed Medicare Advantage patients are more likely to be treated by a low-quality home care agency than traditional Medicare patients.”

Programming Note:

Listen to Dr. Ronald Hirsch’s live reports every Monday on Monitor Monday, 10-10:30 a.m. EST.

Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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