'We're Hearing This Over & Over': Carol Miller Blasts Medicare Advantage Over Low Reimbursements

5 months ago

During a House Ways and Means Committee hearing in July, Rep. Carol Miller (R-WV) spoke about reimbursement rates in Medicare Advantage plans.

Transcript

00:00Thank you, Mr. Chairman, and thank you all for being here today.

00:03I appreciate the opportunity to discuss the Medicare Advantage program,

00:07especially as the program has grown with my generation nationally and in my district.

00:13West Virginia's population is aging, and over a quarter of my home state's population

00:19receives their health care through Medicare.

00:22Of those patients, of course, 54 percent of them choose to enroll in Medicare Advantage plans.

00:28Patients in my district have gravitated towards MA plans because of their affordability

00:33and supplemental benefits that they provide.

00:36The time and effort it takes to travel to a doctor in my district is a key factor for

00:42many patients when they're trying to decide what particular benefits they want to go with,

00:49what plan.

00:50So, MA plans have become increasingly popular.

00:54As MA coverage has increased, we've unfortunately also heard some of the concerns from the patients

01:01and providers around prior authorization and payments.

01:05You're hearing this over and over.

01:07Across the country, rural hospitals and health care providers report experiencing lower reimbursements

01:13from MA plans, and this has led providers to leave the MA networks, which then creates coverage

01:19gaps in rural areas.

01:20Dr. Bazzell, some quick questions.

01:24What can be done to ensure Medicare Advantage plans work with rural providers to allow beneficiaries

01:30to get the coverage that they need?

01:33Dr. So, particularly in the rural, we are not as sophisticated at being able to fight on

01:40behalf of the prior authorizations.

01:43And so, anything that we're doing to streamline that process, you're hearing this same theme

01:48over and over again about transparency, efficiency.

01:53One of the things that I think is going to be helpful as we talk about this, you know,

01:57I'm a clinical informaticist as well, and we always talk about making the right thing

02:03to do the easy thing to do.

02:05And right now, we're not doing that effectively.

02:08And so, if you can do that, you know, to remove a lot of the administrative burden, that's

02:12where I think we're going to make progress.

02:14My second question is really, how can we make rural areas more in line with urban areas

02:20in terms of access and value?

02:23Yeah, so there's still, when we look at our own provider-sponsored Medicare Advantage plan,

02:30I come back a little bit to that network adequacy.

02:33It's difficult for us to expand into a lot of our counties because we can't get the specialty

02:38access that it requires to be able to even offer MA plans in a lot of our rural counties.

02:43And so, that limits us to kind of some of our bigger counties.

02:47And so, I think there's some telemedicine improvements that have helped with that, being allowances

02:52of telemedicine to account for network adequacy.

02:54But I think they probably need to go a little bit further because that's still probably the

02:58primary item that's preventing us from expanding into some of our rural counties.

03:02I've also noticed some of the doctors with certain specialties are now coming to rural

03:08hospitals, say, one day a month or one day every other week, and I think that helps.

03:14Dr. Miller, I've heard concerns from rural providers about the prior authorization process

03:20when working with Medicare Advantage.

03:23Rural providers are less likely to have resources for dedicated teams to handle their authorization

03:28requests and denials.

03:30The paperwork associated with prior authorization takes time away from patient care.

03:36Can you walk me through the process for a referral for a patient who is covered by Medicare Advantage

03:42versus the traditional Medicare?

03:44And what are the staff resources required for those two types of admissions, and how can we

03:50streamline that?

03:51I'd say it depends upon the plan, it depends upon the service, whether you're talking

03:56it's elective surgery, an MRI imaging study, or whatever it is.

04:01I actually did part of my training in Cooperstown, New York, a village of 1,400 people in upstate

04:06New York at a small 228-bed hospital.

04:10So I would say that the main issue is that the administrative friction takes time, and that

04:15that administrative friction, when unnecessary, takes time from patient care.

04:20And that's why I think one of the things that we all have mentioned here is that eliminating

04:25those steps of human-driven data submission, human-driven diagnosis coding, like have the clinician drive

04:37the data to the plan, but have it be easy, like we're sitting next to an informaticist,

04:41have it be one click.

04:43So a lot of those friction steps and prior authorization is the actual process as opposed to the plan

04:51oversight, if that makes sense.

04:53I think so.

04:56I yield back my time.

'We're Hearing This Over & Over': Carol Miller Blasts Medicare Advantage Over Low Reimbursements

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