The effect of dropping doctors from Medicare Advantage plans

We all want the advantage.  We put our kids in special preschools so they have the advantage.  We work 100 hours a week so our kids can do 8 activities and get the advantage. Tall people have an advantage, we’re told.  Poor people are “disadvantaged.” Well folks, there are a whole bunch of senior citizens in Massachusetts who are about to get disadvantaged starting September 1.

UnitedHealthcare (UHC) will be cutting 700 doctors, or 2 to 4% of it’s providers (it has 18,600 in MA), from it’s Medicare Advantage plans. UHC is a mammoth national insurance company, and one of the main things it does is provide Medicare Advantage programs.  In fact, it’s the largest provider of such private Medicare plans in the country.  It has done this in 11 other states as well, and in some cases has dropped whole hospitals from it’s roster.

Why?  Company spokespeople say“they hope that streamlining the pool of doctors will not just save money but ultimately improve the quality of patient care.”  They do not specify how quality of patient care will be improved by abruptly removing patients’ doctors from their insurance plans.  But it will definitely save money.  And why does UHC feel it has to save money?  Because there has been a gradual reduction in the federal reimbursements to private Medicare contractors.

Why is the government using private, for-profit companies to provide Medicare services, and paying up to 14% more for the identical services provided by government-administered Medicare?  Excellent question.  Medicare Advantage, so-called because these plans generally cover more services, like eyeglasses and prescriptions, was created after private insurers insisted that not only could they meet the medical needs of senior citizens and the disabled more cost effectively than the government, they could do so and still make a profit. It became part of the Balanced Budget Act of 1997, but such plans have been available since the 1970s.

Well, it turned out that the claims were not true, and many of the private companies that participated dropped out when they lost money.  So the government essentially paid the companies to stay. Hence the 14% overpayment.

So, lot’s of money to be made. 15 million people are in Medicare Advantage plans, with payments from the government of $156 billion dollars, or 30% of all Medicare spending.  But you make more money for your shareholders if your patients don’t go to the doctor.  UHC cleared $1.1 billion dollars last year and increased it’s shareholder dividends by 30%.

Recently, UHC informed a bunch of doctors in Massachusetts that they’ve been booted from the plan.  They’ll tell the patients this week. Oh, and the changes go into effect September 1st but you can’t change your plan until the next open enrollment period, which isn’t until October.

When UHC tried this in Connecticut, county medical associations filed a lawsuit and got a temporary injunction from a judge to stop UHC from dropping 2,200 doctors.  Here’s what UHC had to say about this ruling, according to the CT Mirror:

In its statement, UnitedHealthcare said the ruling would “create unnecessary and harmful confusion and disruption to Medicare beneficiaries in Connecticut.  We continue to have a broad network of doctors that is designed to encourage higher quality, affordable health care coverage,” the statement said. “We know that these changes can be concerning for some doctors and customers, and supporting our customers is our highest priority.”

Right.  Because there’s no unnecessary and harmful confusion or disruption when you eliminate patients’ doctors.

Shirie Leng, a former nurse, is an anesthesiologist who blogs at medicine for real.

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  • ninguem

    I’m in this one Medicare Advantage plan that I really need to reconsider. It just went into business, I thought I’d give it a try.

    Started just a few months ago, and every single patient has hobbled in, canes, walkers, wheelchairs, oxygen, implanted spinal devices like stimulators……..and every single one, without exception, had three, four consultants over the complex problems.

    Again, every single one, without exception……NONE of their consultants are in network, not one. Actually, that included their primary care, which is how they ended up in my office.

    They didn’t want the “big box” places that guaranteed would shoehorn them into their 15 minute slots and require that they see only their own big box consultants, even if the better “fit” was another consultant working for a competing “big box”.

    And…..again without exception…….every single one is shocked and offended that their consultants are not in, shocked that their Number Two and Number Three alternative choices aren’t in network. Some of these were getting University-level tertiary service that would be hard to replace.

    And every single one, I swear, blames me for it, and blames the receptionist.

    I’m ready to drop the plan.

    Then no primary care doc in town would be in-network for primary care.

    It was a mistake for the patient……and me……to sign up for this MA plan.

    • Dr. Drake Ramoray

      Patients (it seems especially those with multiple chronic specialty medical conditions) will sign up for any plan that has lower co-pays, or premiums etc. regardless of the coverage.
      We have the same problem with certain Medicare Part D plans. The local Walmart here sells some Medicare Part D plans on the premesis, that happen to be the only ones that don’t have any coverage for any analog insulins or diabetes medications invented after 1998.

      And much like you, when they realize that their plan is crap they take it out on me and/or my MA. Of course, Walmart sells these plans so they can boost there sales of their regular and NPH insulin. Can’t really screen patients or drop them based on their part D coverage.

      When they realize that their monthly prescription for their long acting insulin is now $300, my fault. When they have to change to different medications than those that have kept their diabetes under good control for years, my fault. When they have a worse A1c with more frequent hypoglycemia on inferior medications, my fault. It’s miserable, all without even touching on the effect this would have on say a patient satisfaction survey or a pay for performance schema.

    • LeoHolmMD

      On what rational basis can a patient blame the doc for what their insurance company will or will not pay for? I make it very clear to patients where the problems are coming from.

      • ninguem

        Who said anything about rational?

        But, FWIW, the insurance companies are usually lying to the patients. You know the phone idiots at the insurance companies, they will say anything, whatever it takes to get the patient/caller off the phone. Blaming the doctor is their classic response.

        Very often it revolves around some document they claim they never received from me. I show them a copy of the document with a fax receipt and all of a sudden they can find it, “computer error” or some excuse.

  • Jenny Jackman

    Coincidentally (?), UHC is also the administrator of the military’s Tricare West region, which provides healthcare to active duty military, retirees, and their family members. They dropped 50% of the contract providers as of June 1st, and didnt bother sending letters to let the patients know that their doctors got fired until the middle of June.

    • DeceasedMD1

      wow i thought Tricare was the best. military retiree wrote to the Wahington Post that he thought he was actually overcompensated for his duties. Well he got that wrong. I guess he never used his med insurance yet to find out. People think they have the best until they use it.

      • Patient Kit

        In my experience, a lot of people have no idea what their insurance covers or doesn’t cover. Ask 20 people on the street randomly, for example, how much they have to pay for an ambulance if they need one and you’d be lucky to find 1 or 2 who know. Ask them how their plan works for mental health treatment or for physical therapy or what their copay is for the ER. Ask them almost anything other than their copay for primary care and specialists.

        I always knew the terms of my employer-provided Blue Cross plan because I was one of the union-represented employees who helped negotiate it. For example, we had no copay for physical therapy, which was a good thing because, if you need PT, you often need it 3x a week for a while. I currently know how my Healthfirst Medicaid plan works — because I read all the material they sent me about it.

        I agree that a lot of people only find out the details about their plan once they get sick, start using it and get the unexpected bills.

        • DeceasedMD1

          so true! and add on that there is little transparency in costs so whatever you are told sometimes has little bearing on actual cost anyway.

  • ninguem

    Trust me, southern, I’m at the edge with a couple right now.

    • DeceasedMD1

      Sure discharge these difficult pts and that dreadful plan. it is inappropriate. But seriously, can anyone blame them for being mad? It is not ethical what is happening to the pts or docs.

      • Mike Henderson

        “It is not ethical what is happening to the pts or docs.”

        Exactly. Unethical behaviors have been going on for a long time in the healthcare industry. How is it that physicians continue to accept it for so long? Are we not also complicit by continuing to go along with the perverse influences of insurance companies, the government and legal system?

  • ninguem

    FWIW, the one I’m describing is not United

  • Shirie Leng, MD

    Dennis. Nice to hear from you. My sources are solid. Thanks for reading.

  • Steven Reznick

    To be on a UHC private insurance panel they make you sign on to all their other products

    • Patient Kit

      Does it work that way only for Medicare? Or also for UHC’s plans that we can buy through the exchange? Can docs be on UHC’s panel but not accept the plans UHC sells on the exchange? Same question about other private insurers that are selling plans on the exchange.

      • ninguem

        Not sure of the question.

        Some private insurance companies, and UHC is the worst for this, have “all products” clauses, where you sign up for one plan with attractive terms, only to find yourself saddled with all sorts of Medicaid plans and other plans you would not touch with a ten-foot pole.

        Oh, and when signed up with United Health Care…….good luck getting out.

        http://www.youtube.com/watch?v=UPw-3e_pzqU&feature=kp

        • southerndoc1

          Varies by region. United isn’t particularly powerful where we are, and we can pick and choose which of their plans to accept.

          • ninguem

            ^^What Southern said^^

            Absolutely agree. All this varies across the map.

            Very location-dependent.

        • Patient Kit

          I guess I was asking how widespread that “all products clause” thing is and how it is effecting whether doctors’ accept those insurance company’s plans that are available on the exchanges. I think there are about 16 insurance companies with plans available via the exchange in NY (with 4 levels each), not all available in every county, but the last time I looked, there were about 10 companies selling exchange plans in Booklyn, including Blue Cross and UHC.

          My head is spinning just trying to get a sense of my health insurance options. I can only imagine what it must be like being a doctor accepting lots of them. So confusing.

          On average, how many different plans do you docs accept?

        • RES

          When my wife resigned from UHC after an egregious cut in payments we got a real run around: you must contact your local rep (who we had never met, spoken to on the phone, or otherwise interacted with), failed at moving up the hierarchy . . .
          I did what I have done in other such cases. Go to the investor relations page on their website, find the name and location of the CEO, and send a registered letter with cc to the state insurance commission if you feel the need. Include in the letter a statement of your intent to resign, your attempts at doing so, and works to the effect that ‘you are the only person in company who cannot say “this is not my responsibility”‘ It worked, as it has with banks on occasion.

          • ninguem

            I’ve experienced the same thing as RES.

            United is notorious for making it difficult to leave. They have all sorts of arcane rules, with the intent to deliberately keep you in their system, and subject to their rules.

  • Bradford Lacy

    Which brings us to the big question…is it better for these patients to be taken care of by the government creating more red tape for the physicians or by the private insurers who will leave them hanging as soon as they are no longer “profitable” to keep.

    • jpsoule@hotmail.com

      No, I think it begs a bigger question.
      Should highly trained professionals remain indentured servants after serving their 7+ years in training for the rest of their lives?
      Serving at the pleasure of big government, big brother and big business?
      Or something else?

      • Mike Henderson

        Absolutely agree. It is confusing why physicians, who know how the system should work better than any other “stakeholder”, continue to passively allow anyone else to hijack the system for their benefit.

      • Bradford Lacy

        I certainly understand the perspective of the physician who invested 7+ years of training only to find out that we have a “flawed” healthcare system. I also sympathize with the Medicare patient who worked for 30+ years and contributed into Medicare only to find it hard to find a physician who will take their plan. So while I believe the patient is misguided to blame the physician I also think the physician should not blame the patient for being a little frustrated.

        • Patient Kit

          I totally agree. And I continue to be amazed at how late in the game some docs realize how our Big Business healthcare system — that they worked so hard to become a part of — really “works”. Some docs have disdain for patients who are covered by plans that don’t reimburse well and some patients have disdain for docs who don’t accept their plan. Lots of Americans, docs and patients alike, are feeling very deeply betrayed these days.

        • jpsoule@hotmail.com

          As a physician, I can only blame myself for making my choices 30+ years ago when I chose this career path and believed what I was told.
          Now senior citizens and vets were promised decent medical care for paying their taxes and doing their duty.
          They are the ones most cheated.
          At least I have a doctoral degree.

  • Bob

    In 2006 when the MMA it was only “sold” as a Drug plan for Medicare, but it quickly switched all “quimbies” [seniors, blind and disabled] who used /3rds of the Medicaid Drugs to Medicare Part D, while there were a couple other “Medicare Drug Plans” including Advantage Plans, that differed the most as they had strong drug formularies.
    But the rebates drug companies pay to Advantage Plans are vanishing as almost all brand drugs are accepted by Advantage plans and rebates on penny a pill generics don’t pay the rent at Advantage Plans.
    Part D plans don’t have formularies or if they do they have the same reduced profits from formularies; but they all must carry every biologic drug advertised on T.V. CMS recently went to the House Energy and Commerce Committee and asked to institute a sort of “formulary” on certain classes of these extremely expensive drugs and was told “no way” your going to remove any drugs for seniors. Meanwhile Medicaid has the same problem and the state Medicaid Directors have said providing all of these will bankrupt all of them.
    Does United Health have any Part D business?

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