A crazy way to spend a healthcare fortune

I’d like to announce that the folks who run Medicare Advantage plans will be shaking in their boots soon, fearful of what authorities are going to do to them.

But I also like to tell the truth. So there will be no pronouncements of grievous Medicare Advantage practices, and the leaders behind them, being yanked into line.

It seems the weather isn’t the only thing people protest with inaction.

These past weeks have seen perhaps an unequaled amount of criticism leveled at these private Medicare Advantage insurance plans that are neither Medicare nor an advantage for so many. Long-term care operators have aired their displeasure for far longer than a few weeks. Perhaps more importantly, more and more hospitals are also starting to crab — and even fight back. These still rare instances are a scenario that LTC providers can only dream about.

The din only has intensified when you add in national news reports about MA plans’ soulless use of algorithms to guide care decisions.

Maybe the rise in accusations being tossed by all sides coincides with increasingly bold MA marketing programs. Anyone who takes full-page ads in newspapers nowadays has to have something up their sleeves, don’t they?

The come-ons for added fluffy perks have almost gotten silly. They are now well beyond the original added vision and dental coverage. “We have a plan that’s perfect for you!” gushes at least one plan’s sales pitch.

It’salmost taken on the air of adults waving candy at kids.

“But it’s giving consumers what they want!” is the justification that the enticers have offered.

This, of course, leads to even bolder “No soup for you!” door slamming on providers — and, somewhat ironically, beneficiaries. While patients might ease through the front door for coverage at their local SNF or rehab center, they’re also just as liable to get hustled early out the back.

It’s not an entirely new phenomenon, as long-term care sage Brendan Williams, the leader of the New Hampshire Health Care Association, pointed out to us earlier this week.

“They’re getting away with banditry. They revel in it,” Williams quotes then Sen. Jay Rockefeller (D-WV) as saying back in 2009.

It’s almost as if we’ve all been watching bad weather bearing down from the horizon and we haven’t done anything about it. If we aren’t wet yet, we soon will be, and we’ll be getting more drenched by MA plans acting with apparent impunity with every tick.

One of the most galling things I’ve read about MA plans lately is our story about how some MA plans confide they are simply going to ignore or tap-dance around new federal rules that become live Jan. 1.

As Williams put it: The only thing that has changed since 2009 with MA plans is that taxpayers are not only getting fleeced, they’re willingly handing over the loot.

That’s right: Uncle Sam has found somebody to change the baby’s diaper. On top of that, he’s paying that baby-sitter upfront before heading to the movies, washing his hands of any mess that may come.

It’s in this way that the system has built an unsavory dependency on the hired help.

The babysitter’s payout is more each time out, even if the baby isn’t getting cleaned up as well. But at least the kid will be given a sucker to stick in his mouth, and that counts for something, right?

And the sitter will laugh all the way home. Only to be invited to do it again and again.

James M. Berklan. (2023, December 1). A crazy way to spend a healthcare fortune. Retrieved from https://www.mcknights.com/daily-editors-notes/a-crazy-way-to-spend-a-healthcare-fortune