UnitedHealth, the nation's largest provider of privately managed Medicare Advantage plans, has dropped thousands of doctors from its networks in recent weeks citing "substantial funding pressure from the federal government." The WSJ reports [5] that physician groups are protesting as many elderly patients are now 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." 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," due to the new health law (Obamacare). More job creation?
[6]
Via WSJ, [5]
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The company said it is managing its network, in part, to provide more value for members, particularly given Medicare's new five-star rating system that ties bonus payments for insurers to certain measures of cost and quality.
"That's what's driving our actions," said Austin Pittman, president of UnitedHealth's networks. He also said, "It's no secret that we are under substantial funding pressure from the federal government."
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Medicare Advantage, an alternative to traditional Medicare, combines hospital and doctor coverage and often includes prescription drugs and perks like gym memberships. Enrollment has more than doubled since 2004 to 13 million in 2012, which represents about 27% of Americans on Medicare.
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.
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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.
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"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.
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A spokeswoman for the Centers for Medicare and Medicaid Services said CMS is reviewing UnitedHealth's and other provider's networks "to ensure that beneficiaries have full, transparent and timely information and access to needed care."
"We recognize that change is hard," said Mr. Pittman. "This is about meeting the needs of patients in specific geographic areas, improving the quality and sustainability of our networks and deepening our relationships with providers over the long term." The company said it had no comment about the investigations.
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So yet another unintended (and yet foreseeable) consequence of government intervention in free-markets...
"Fewer practitioners mean longer waits, longer drives, less convenience,"