A recent article noted that hospitals, too, are at a breaking point with Medicare Advantage and plans’ wrongful denials of needed care. The hospitals suggest that CMS should incorporate the frequency with which plans denials are overturned upon appeal into their star rating system.
LeadingAge agrees that plan denials and appeal practices should be part of the public record. National suggested that this information should be tracked at the plan level and reported on the Medicare.gov plan finder so beneficiaries know the plan’s history related to care denials before the beneficiary selects the plans. While the hospital idea sounds like a good one, one must question whether a potential unintended consequence of such a move might be that plans don’t overturn as many denials upon appeal. This would be a worse outcome.
The reality is that star ratings impact MA plan quality bonuses and how much of rebate they get to use for supplemental benefits, so adding a new measure into this star rating system that would reduce their payout would definitely impact plan behavior but perhaps not in a positive way. National and LeadingAge Kansas look forward to talking further with the hospitals about ideas for holding MA plans accountable on wrongful care denials and learning more about their proposal.
