Spokane7
59°
November 24, 2011 in City
Some Medicare patients could face insurance ouster
Group Health Cooperative says it plans to drop Medicare patients who are not enrolled in a supplemental plan that costs an additional $20 a month.
It’s a step the Seattle-based managed care company has been considering for years as Medicare’s fee-for-service reimbursements don’t adequately fund nor fit Group Health’s integrated care model, said Dr. Tom Schaaf, medical director of the organization’s Eastern Washington operations.
In a letter sent to about 4,000 patients earlier this month – including about 1,400 in Spokane – Group Health gave an end-of-the-year deadline for Medicare patients to enroll in its Group Health Medicare Advantage Clear Care plan.
“We believe that the best way to serve all patients is through the comprehensive and coordinated care that members receive from our integrated system,” the letter reads. “Like many medical practices, we are looking at the numbers and types of Medicare patients we care for.”
Health care providers ranging from small physician clinics to large trauma hospitals have complained for years that Medicare – the federal government’s insurance program for people older than 65 – reimburses at a rate that is often below the cost of care. In Washington, including Spokane, those reimbursement rates are exceptionally low compared with other regions in the country.
Medical providers and politicians say the disparity is based on a reimbursement formula that punishes Washington for its efficiencies, including less use of the health care system than in other parts of the country.
It has led many clinics to limit the number of Medicare patients they receive.
Spokane-based Rockwood Clinic faces many of the same challenges as Group Health when it comes to treating Medicare patients, said Ken Bryan, a revenue director for the multispecialty clinic.
“Let’s put it this way: If we treated only traditional Medicare patients, our doors wouldn’t be open for long,” Bryan said.
Supplemental plans such as Group Health’s advantage program are popular and help cover extra services that may not be fully covered by Medicare.
Group Health, for example, has about 70,000 patients enrolled in its Advantage Clear Care plan, which offers added patient services such as 24-hour nurse consultations; online access to medical records; email access to providers, including doctors; and online prescription refills with home delivery.
Whether such additional services are worth $20 a month to Medicare patients is the subject of debate. Several patients who didn’t want their names used said $20 more a month – or $240 a year – is a lot for some seniors, especially those with fixed incomes facing higher costs for other goods and services including utilities, gas and groceries.
Schaaf said Group Health hopes all of its Medicare patients enroll in the advantage plan and stay with their doctors.
“We really want to take care of these people. Many of them have been our patients for 20 to 30 years,” he said.
The issue, according to Schaaf, “frankly boils down to the fact that fee-for-service Medicare does one thing and doesn’t do another. What it does is encourages utilization of services whether they’re needed or not. So the more you do, the more you get paid, and that’s one of the things driving unnecessary procedures and costs.”
At Group Health, he said, the model of care is “designed around services that bring a lot of value to patients, but fee-for-service Medicare doesn’t pay for it. On the other hand, the Medicare advantage plan really does pay us to provide the kind of comprehensive care we want to offer.”
Schaaf said administrators and doctors at Group Health discussed such changes several years ago when the advantage plan was much more expensive. But at the time, doctors worried it would put too much financial strain on their patients.
The price has since dropped – to about $20 a month – and the issue was revisited and ultimately adopted.
At Rockwood, which is part of a care network linked with Deaconess and Valley hospitals, doctors may still accept new Medicare patients – including those who are considered traditional fee-for-service patients and those enrolled in a supplemental plan, Bryan said.
It’s the same scenario at the physician clinics connected to Providence Health Care, said spokesman Joe Robb.
“Our clinics continue to accept Medicare patients,” he said. “I don’t think any changes (are) being discussed right now.”
Parishes giving $1.5 million toward settling sex cases 
greyhound2 on November 24 at 7:33 a.m.
The United States has the most expensive health care system in the world at about 16% Gross Domestic Product, yet ranks 37th in the quality of care provided the average citizen, according to the UN WHO, an unbiased organization with no axe to grind.
The country which is number one in the quality of health care provided does so at a cost of only 8% GDP, or about half. What started out as a long overdue overhaul in health care reform was sabatoged by stakeholders and any real reform gutted. Turning sick people into profit centers is immoral and this article is just more BS from the medical-industrial-complex.
BlondeSquawker on November 24 at 8:39 a.m.
^^^Please take your foul language elsewhere.
Shadedmuse on November 24 at 9:27 a.m.
to recognize health
care as a right, not a privilege and put a stop to the
worst abuses by insurance companies including
discrimination against people with pre-existing
medical conditions. OPPOSED BY 100 % OF
HOUSE TeEA-BAGGER REPUGNANTS.
dataxman on November 24 at 12:03 p.m.
First, accept that insurance is nothing more than healthy people subsidizing the sick. In order to get as many healthy people into the pool, we need to mandate coverage. Once we mandate coverage - and no ‘pay for coverage or pay a fine crap’ - we have to be able to turn people without coverage away at the hospital door.
Only when dealing with medical insurance do people seem to think coverage should treat pre-existing conditions. Try calling State Farm to get homeowners insurance as the firetrucks are pulling up to your house to put the fire out. Or call Geico to cover the damage cause when you plowed into that family of five coming back from the bar….
Dazzeetrader11 on November 24 at 2:14 p.m.
What the article doesn’t point out is that Group Health, ROckwood plans, etc are nothing more than insurance carriers with in house services. It’s quite a spot to be in. One thing though, there is not one way any of this will happen in an election year. The politicians will fall silent. Obama’s plan (Obamacare) cuts $500 billion) from medicare. He’s the WORST offender in all this.
Not sure what’ll happen but it won’t be fun. Entitlements are sinking the ship..whether it’s unions, or other “legal” ways of siphoning on cash from those who pay taxes, it’s looking more and more like a big socialized country…and that’s what he wanted all along.
Obamacare is an absolute losing proposition. And now, the insurance companies are seemingly piling on. Cash is king.
If you have it, you do a “paygo” program. If you don’t, best be figuring it out. Raising the retirement age would help. If you’re disabled, those are the ones that should be taken care of…but look for the rules on disability to change.
I bet Obama had that $16,7 trillion back…he took it from the fed and sent much overseas. We NEED that money back. He’s trying to creat a poor country that must turn to socialism. It’s getting closer….much to my chagrin. It’s the same old trick Russia did…before it woke up to capitalism. They gave up countries that they couldn’t pay for . When he created joblessness, spent the Fed dry, and cuts programs..well you know what’s planned. He goes to Bali…..you can’t. Look who’s winning now. Boy does he need to be sent packing.!!
gmorton on November 24 at 9:31 p.m.
Shadedmuse wrote,
” … to recognize health care as a right, not a privilege and put a stop to the worst abuses by insurance companies including discrimination against people with pre-existing medical conditions. OPPOSED BY 100 % OF HOUSE TeEA-BAGGER REPUGNANTS.”
… . and anyone else who knows what a “right” actually is.
Sorry, muse. Medical care is a service which others must provide. Since you have no rights to others’ time, talents, or efforts, – others are not your slaves – you cannot have a “right” to health care.
And of course, insurers would be happy to cover your pre-existing condition, provided you’re prepared to pay premiums proportionate to the risk you are asking them to insure.
But since you are convinced others are your slaves, I’m sure you expect others to pay your insurance premiums also.
Please take your parasitic, slave ideology elsewhere. It has no place in a free country.