Medicare Advantage claims should be available for research

Today my first piece in The Hill makes the case that claims data from Medicare Advantage plans should be made readily available for research. I will be writing 2x/month in the Hill, trying to look at the “story under the story” in health policy/reform. Several of my Duke Sanford Colleagues are also writing in the Contributors section of The Hill on different topics.

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

2 Responses to Medicare Advantage claims should be available for research

  1. Dennis Byron says:

    In reading your column in The Hill, I think it would be useful to civil debate about Medicare reform if we could get the facts correct about the public (not private) Part C Medicare Advantage health plan program… and use current facts.

    1. “Managed Medicare” been around “in one form or another” for over four (not three) decades, just about as long as there has been a Medicare. I don’t mean to quibble; the point is it’s been around since there have been accountable care organizations for people of all ages. It’s just a choice all should have, including we seniors.
    2. The last two significant academic studies I’ve seen (Song, et al in 2012 and Newhouse et. al in 2014) show much reduced “cherry picking” in Part C (actually Song found none). That is only natural given that 30% of beneficiaries now add a Part C plan to their Part A and B coverage, as opposed to a few percent back when earlier “cherry picking” studies were done using 1990s data. As you point out, 50 percent of baby boomers are choosing Part C as their supplement. But the left’s decades-long opposition to giving we seniors choice forces you to mention research done on 20-year-old data even when you probably do not believe it yourself.
    3. As to your emphasis on a recent Wharton study that I don’t believe was even peer-reviewed, you fail to mention that by law, none of the so-called “overpayment to MA plans” (assuming you mean the Part C rebate payment) can flow to insurance companies. The insurance companies’ profits for administering a Part C plan is baked into its basic bid to run a Part C plan just as its profits for administering Part A and B are baked into its bids to run a Part A or Part B plan. Sometimes the insurance company administering all three is one and the same. The left never explains that either, telling people that Original Democratic Party fee for service (FFS) Medicare is government run.
    4. The current so-called “overpayment” (referring to the legislated difference allotted per person and not the rebate in this case; you were unclear what you meant by the term “overpayment”) is in the neighborhood of 3% — see Note — on average according to MedPAC (not counting risk adjustment payments subject to claw back, which are supposed to balance out between insurers, and an expiring allegedly illegal Obama-administration bonus program) and pays for “extra” benefits mentioned in point 5 below. So why do you on the left keep beating the six-year-old 118% overpayment dead horse that didn’t apply to all types of Part C plans even when it happened and only happened one year?
    5. I don’t agree that “it is reasonable to expect the Affordable Care Act will continue this trend toward MA, as people gain experience with exchange based health insurance.” I don’t think PPACA matters one way or the other. What in the world does a web site have to do with it? People choose to add Part C to their Medicare Part A and B coverage primarily because Part C has an annual out of pocket (OOP) limit and FFS Medicare does not, and because Parts A, B and C combined (the only way you can buy C) is typically less expensive than Part A and B plus a private Medigap supplement and drug plan. The tradeoff is networked providers. As long as that combination of benefit vs. drawback stays in its current balance, public Part C Medicare Advantage plans will grow in popularity.

    [Secondarily, people on Medicare Parts A and B choose public Part C supplement plans because they typically include benefits not included with Part A and B plus a private Medigap supplement. These include annual physicals, fewer crazy rules (like your colonoscopy is “free” unless we find a polyp, admitted vs. observed differences, and that three-nights-admitted to an acute care hospital stuff) and to a lesser extent eyeglass, hearing-aid and dental discounts. I complement you for not throwing in the typical left-wing slur on seniors concerning gym membership discounts but you hit every other note in the anti-choice songbook.]

    In addition to dealing with the current facts in furthering Medicare reform debate, word choice and emphasis is also important. The fees (as opposed to premiums) paid with Medicare trust fund money by private insurers on behalf of FFS Medicare beneficiaries “are also determined administratively,” also “based in part on historical spending patterns where the patient lives.” Why call that out for Medicare beneficiaries with capitated plans but not for Medicare beneficiaries with FFS plans?

    One of the differences between FFS Medicare and capitated Medicare is that there is no attempt to look at “patient characteristics” in FFS Medicare as a condition of getting the service. Is that one of the possible reasons for the large estimated amount of fraud and waste in FFS Medicare–see Note. But CMS does track the information so there is a place you can do some useful research. The “private plan payment data for the care of beneficiaries” that you say “has never been readily available to researchers” is my personal medical record. Keep your hands off it. You have everything else you need for research on Part C already.

    Notes: And even though it might foster fraud and waste, seniors should be able to choose uncoordinated care if they want. I personally oppose the rebate-payment system and believe all seniors and people on Medicare should get a voucher of equal value adjusted for the cost of living in their county. I think the poor and minority seniors that disproportionately use public Part C Medicare Advantage plans for the benefit and financial advantages noted above should be helped by some other government program.

  2. Pingback: Rounding out the Moon Shot | freeforall

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