Discover and read the best of Twitter Threads about #MedicareAdvantage
Most recents (13)
THREAD on distinctions between the phrases "#unifiedfinancing" and #singlepayer, in the context of #CalCare and #SB770. TL;DR, the phrase "unified financing" is the new "access to coverage" and we need to dispense with it for good ššš
1) I have some thoughts about the phrases "#unifiedfinancing" and "#singlepayer." Some people use them interchangeably, but they should not. They are distinct, and those differences really matter.
2) "#singlepayer" is a specific policy. It is a health care system where payment for all essential health services are delivered by one entity, one single payer, for a given population. There are no middlemen, no insurance companies, no ACOs, just one single, public plan
Hereās the dirty secret of emergency medicine:
We donāt have to do prior auth. Like ever. We just order what the patient needs, and the patient gets it done in the ED.
But hereās why we care about prior auth anyways:
B/c not a shift goes by where a patient doesnāt land in theā¦ twitter.com/i/web/status/1ā¦
We donāt have to do prior auth. Like ever. We just order what the patient needs, and the patient gets it done in the ED.
But hereās why we care about prior auth anyways:
B/c not a shift goes by where a patient doesnāt land in theā¦ twitter.com/i/web/status/1ā¦
Need your gallbladder taken out electively? Too late (waiting for auth), now youāre in the ED with cholecystitis.
Had a ānoduleā seen on a CT, but couldnāt get a repeat scan authorizedā¦ever? Now itās metastatic and youāre in the ED for crippling pain.
DVT? No problem, startedā¦ twitter.com/i/web/status/1ā¦
Had a ānoduleā seen on a CT, but couldnāt get a repeat scan authorizedā¦ever? Now itās metastatic and youāre in the ED for crippling pain.
DVT? No problem, startedā¦ twitter.com/i/web/status/1ā¦
Why does this matter?
1. Itās terrible for patients
2. It stresses the healthcare system in ways it shouldnāt
3. Itās cumbersome and wasteful to insurers and clinicians both
1. Itās terrible for patients
2. It stresses the healthcare system in ways it shouldnāt
3. Itās cumbersome and wasteful to insurers and clinicians both
Remember "#DeathPanels"? @SarahPalinUSA promised that #UniversalHealthcare was a prelude to a Stalinist nightmare where unaccountable bureaucrats decided who lived or died based on a cost-benefit analysis of the cost to keep you alive versus how much your life was worth.
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If you'd like an essay-formatted version of this thread to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:
pluralistic.net/2023/04/26/deaā¦
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pluralistic.net/2023/04/26/deaā¦
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Palin was right that any kind of healthcare rationing runs the risk of this kind of calculus, where we weight spending $10,000 to extend a young, healthy person's life by 40 years against $1,000 to extend an elderly, disabled person's life by a mere two years.
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US healthcare is the worst of all worlds. Unlike other wealthy countries, the US leaves insurance to the private sector, where your health and your life come second to profits. Worse: the majority of "private" insurance companies earnings come from public subsidies. 1/
If you'd like an essay-formatted version of this thread to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:
pluralistic.net/2022/10/13/sicā¦ 2/
pluralistic.net/2022/10/13/sicā¦ 2/
In other words, the US has a privately run health care sector that is publicly financed, without any public accountability or duty to the public good. Insurance companies take ever more billions from the federal government and deliver ever less care to their customers. 3/
ā¦@TheJusticeDeptā© ālisted #MedicareAdvantage as one of its top areas of #fraud recovery.ā
ādevised to help lower health care spending [MA] has instead become substantially more costly than the traditional government program it was meant to improve.ā nytimes.com/2022/10/08/upsā¦
ādevised to help lower health care spending [MA] has instead become substantially more costly than the traditional government program it was meant to improve.ā nytimes.com/2022/10/08/upsā¦
2/ āCongress gave the agency the power to reduce the insurersā rates in response to evidence of systematic overbilling, but @CMSGov has never chosen to do so.ā
Meanwhile bonuses to #MedicareAdvantage continue to ā¬ļøā¬ļø
Meanwhile bonuses to #MedicareAdvantage continue to ā¬ļøā¬ļø
3/ MA is more expensive per beneficiary served.
āļøFrom 2010-2020 Medicare spent 29.4% MORE per enrollee in Medicare Advantage (Part C).
āļøYET Physician fee schedule CUT -1.0%.
Physician spending growth does not require the extraordinary constraints that have been imposed.
āļøFrom 2010-2020 Medicare spent 29.4% MORE per enrollee in Medicare Advantage (Part C).
āļøYET Physician fee schedule CUT -1.0%.
Physician spending growth does not require the extraordinary constraints that have been imposed.
A majority of Medicare benes are soon expected to be enrolled in #MedicareAdvantage, but how do private plans compare to traditional Medicare? And how are the experiences in MA vs TM different (if at all) for beneficiaries of color? 1/4
Our review of 62 studies found few differences. Notably, however, few studies looked specifically at beneficiaries of color, despite the fact that MA enrollees are growing increasingly diverse. 2/4 bit.ly/3dnMDcN
Specifically, no studies looked at satisfaction with care, care coordination, the use of low-value care, or utilization of hospital or post acute care by race/ethnicity, though these measures were all examined overall. 3/4
šØNEW ANALYSISšØ The #Medicare Trustees' report shows that the Part A HI trust fund is only 6 years from insolvency, facing a large shortfall with rapidly-growing spending. The outlook is slightly improved, but substantial structural imbalances remain.
crfb.org/papers/analysiā¦.
crfb.org/papers/analysiā¦.
1ļøā£ The HI trust fund is only š² šš²š®šæš from insolvency.
The Trustees project the trust fund will be insolvent by 2028, just six years from now but two years later than projected last year. At that point, provider + insurer payments would have to be cut by 10% (20% by 2046).
The Trustees project the trust fund will be insolvent by 2028, just six years from now but two years later than projected last year. At that point, provider + insurer payments would have to be cut by 10% (20% by 2046).
2ļøā£ Total #Medicare spending will grow significantly.
All parts of Medicare will grow rapidly in the coming decade. Gross Medicare spending will ā¬ļø from 3.9% of GDP in 2022 to 5.4% in 2032 and 6.2% in 2045. This rise is driven partially by the rising cost of #MedicareAdvantage.
All parts of Medicare will grow rapidly in the coming decade. Gross Medicare spending will ā¬ļø from 3.9% of GDP in 2022 to 5.4% in 2032 and 6.2% in 2045. This rise is driven partially by the rising cost of #MedicareAdvantage.
1/ Iām excited to unveil our new @KFF interactive on #Medicare spending.
We do a deep dive on enrollment growth, spending trends, the expanding role of #MedicareAdvantage, Part A trust fund solvency & more.
Here's a quick look at what's inside: kff.org/interactive/meā¦
We do a deep dive on enrollment growth, spending trends, the expanding role of #MedicareAdvantage, Part A trust fund solvency & more.
Here's a quick look at what's inside: kff.org/interactive/meā¦
2/ #Medicare now covers 65 million older adults and younger people with disabilities, or about 1 in 5 Americans. Its size and importance often make it a big part of federal budget and health care spending discussions.
By 2060, enrollment is expected to grow to 93 million people.
By 2060, enrollment is expected to grow to 93 million people.
3/ The share of the US population ages 65+ will grow from 17% to 23% over that time ā and this group will grow older.
24% of seniors are now age 80+. In 2060, it will be 35%.
24% of seniors are now age 80+. In 2060, it will be 35%.
Pls allow me to take a minute to gather myself as we read the #NC DOI has sanctioned a health plan for non-compliance w/ NCās OON āhold harmlessā & presumably prudent lay person āNorth Carolina slaps Humana with fine over out-of-network, emergency coverage beckershospitalreview.com/payer-issues/nā¦
2/ Despite many requests & data showing non-compliance w/ PLP over these many yrs., it has been about 12+ yrs since @BlueCrossNC was sanctioned for illegally denying ED claims for ~$2M.
3/ Presser says that @Humana has exited the commercial insurance market in NC but still a major player in #MedicareAdvantage plansāso Commish @MikeCausey2020 how about @UHC, you have evidence of their non-compliance on multiple levels? What say you about a major plan in #NC?
COVID-19 has exposed problems with a health care system that relies on employer-based coverage and has millions w/o any coverage. The US canāt replace its health insurance system overnight, but there are things we can do to improve it.
wsj.com/articles/covidā¦
Thread:
wsj.com/articles/covidā¦
Thread:
W/ unemployment skyrocketing, @KFF estimates ~50M US workers and their dependents will lose their health insurance. Many unemployed will end up enrolled in Medicaid, unless they live in states that havenāt expanded it. 2/7
So that everyone has some coverage, letās make #Medicaid an entirely federal program, w/out shared state costs and responsibilities. Nationalizing Medicaid should also come with auto-enrollment for anyone who lacks another form of insurance. (More: nytimes.com/2020/06/15/opiā¦) 3/7
Our sources tell us that @UHC spent an hour this AM in their Legal Department scrambling to stop the needless pain and suffering of their member...P&S...that was caused by their neglect, gross negligence and utter disregard. cc: UHC General Counsel @ThadJohnson CMO @AnneDocimoMD
Pain/Suffering is something that juries are tasked with putting a price on. Daily pain is hard to calculate but in reality they look at what the Defendant Insurance Co did to not just cause but prolong that pain/suffering. Folks like Mike Bidart, Esq. of @BadFaithLaw teach this.
Here's @BadFaithLaw talking about managed care mega-companies like @UHC and the problems with the HMO system...which is why delays/denial of care is such a bad thing. The only real check on this behavior is big lawsuits or the loss of profits...
Happy anniversary, Sen. Ben Nelson! On this day ten years ago, your #CornhuskerKickback got approved -- just one of the many #BackroomDeals @SenatorReid had to cut to get Democrats to approve #Obamacare...
@SenatorReid Likewise, happy anniversary to @SenLandrieu! The #Obamacare bill the Senate passed ten years ago today included your #LouisianaPurchase -- a multi-billion dollar giveaway to #Louisiana in exchange for her vote for #Obamacare... #lapol #lalege
@SenatorReid @SenLandrieu And a happy 10th anniversary to Senator Bill Nelson, whose #GatorAid provision giving #Florida residents a carve-out from #Obamacare's #MedicareAdvantage cuts was also included in the legislation that passed a decade ago today...
@kgoochBHR You quote ManagedCareCosts.com "The median pricing model is the correct solution for a truly economically fair market rate..."beckershospitalreview.com/finance/viewpoā¦
@kgoochBHR Fair to whom?" To the insurers who exacerbate out of network by aggressively narrowing those networks?
@kgoochBHR Ignoring that your source is ManagedCareCosts, you do realize that in NY the increased cost did not materialize, that infrequently used arbitration resulted in 50:50 split of verdicts, and DFS reports no systemic FAIL
