Medicare Advantage plans make inflated dialysis payments, study says

Dive Transient:

  • The biggest Medicare Benefit plans pay hefty markups for kidney dialysis, particularly to giant dialysis suppliers, and people inflated quantities may enhance sufferers’ out-of-pocket spending for remedy, a research revealed within the August version of Well being Affairs discovered.
  • The twenty first Century Cures Act may expose MA plans to a better share of dialysis sufferers, making a monetary burden to this system that leads to lowered advantages to MA enrollees general, the College of Southern California researchers warned.
  • Reforms that may enhance market competitors could also be wanted to deal with the cost disparities, and policymakers ought to think about rules that restrict consolidation amongst dialysis suppliers, the research authors concluded.

Dive Perception:

The twenty first Century Cures Act of 2016 lifted rules in 2021 that prohibited Medicare Benefit enrollment after sufferers started dialysis remedy, prompting elevated MA enrollment amongst dialysis sufferers, the Well being Affairs research mentioned.

Medicare Benefit plans are already fashionable with Medicare-eligible sufferers and now cowl 45% of all Medicare members.

Dialysis is the first remedy for finish stage renal illness sufferers, who’re sometimes eligible for Medicare no matter age. In 2020, greater than 80% of the 525,000 sufferers receiving dialysis remedy had been enrolled in Medicare, the report mentioned, citing federal knowledge.

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A big shift of dialysis sufferers into Medicare Benefit may disrupt the market, the research mentioned, as a result of the consolidated dialysis business would be capable of negotiate cost from MA plans increased than for fee-for-service Medicare. Within the dialysis market, giant suppliers present greater than three-quarters of all dialysis remedy, the report mentioned.

The research discovered that MA plans at three giant insurers representing practically half of the Medicare Benefit market in 2016 to 2017 paid 27% extra for the median outpatient dialysis remedy than fee-for-service Medicare, with bigger dialysis middle chains commanding increased markups. Practically all amenities of the 2 largest chains had been in community, suggesting that bigger dialysis chains leverage their market energy into all-or-nothing negotiations with plans, the report mentioned.

The findings distinction with these from non-dialysis settings, the place MA supplier funds are much like or decrease than these for fee-for-service Medicare, the researchers mentioned.

Rising MA plans’ risk-adjusted funds for sufferers with finish stage renal illness may quickly alleviate the monetary stress on some plans however inflate the general value of care to Medicare, the research mentioned.

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