Pressure From Industry, Lawmakers Protects Medicare Advantage Rates
The Obama administration has repeatedly backed away from proposed rate cuts as a result of the outcry from insurers and lawmakers of both parties. Nonetheless, DaVita HealthCare Partners warns investors that new risk calculation scores will hurt the company's bottom line.
The Hill:
Health Care Program Gets Harder To Cut
Medicare Advantage is becoming entrenched and harder to cut as support for the insurance program grows in both parties and enrollment numbers climb. The Obama administration has repeatedly proposed cuts to the program, but has twice backed away under pressure from the health insurance industry and lawmakers from both parties. (Sullivan, 4/9)
Modern Healthcare:
DaVita Warns That New CMS Risk Model Dings Providers That Focus On Wellness
The Centers For Medicare & Medicaid Services may have raised benchmark payment rates for Medicare Advantage plans, but at least one large provider group believes the new risk calculation scores will actually hurt, rather than help, its bottom line. Publicly traded DaVita HealthCare Partners warned investors Wednesday that the 2016 Medicare Advantage payments will amount to a 2% rate cut, or a loss of about $50 million in 2016 operating income. (Kutscher, 4/8)
Meanwhile, the continued dispute between UPMC and Highmark could affect Medicare Advantage enrollees in Pittsburgh -
Pittsburgh Post Gazette:
UPMC Threatens To Cut Off Medicare Advantage Access Beginning Next Year
UPMC is threatening to lock Highmark’s Medicare Advantage customers out of its hospitals and clinics starting Jan. 1, a move Pennsylvania’s governor calls an “unacceptable” violation of UPMC’s commitment to keep senior citizens out of the crossfire between the two Pittsburgh health rivals. UPMC, Pittsburgh’s largest hospital and physician network, has told the state it will make good on the threat unless Highmark, the state’s largest health insurer, agrees to increase cancer payments to the hospital system, and agrees to drop a lawsuit related to those oncology payments. (Toland, 4/8)
Pittsburgh Tribune-Review:
UPMC To Terminate Medicare Contract With Highmark
As many as 182,000 seniors in Western Pennsylvania could lose in-network access to UPMC hospitals and doctors at the end of the year, a casualty of the latest dispute between the health care system and insurer Highmark Inc. Downtown-based UPMC said Wednesday that it plans to terminate its Medicare Advantage contract with Highmark on Dec. 31, arguing the insurance company owes about $143 million for cancer care that UPMC has provided to Highmark customers since February 2014. (Smeltz, 4/8)
