Medicare's Controversial Direct Contracting Program Hits Biden Administration's Radar

[Auggie]

The Biden administration is hearing mounting calls to end a program that advocates warn will radically transform Medicare. At the same time, the administration is getting counter-pressure from the health care industry that sees sudden threat to the potentially lucrative plan. A decision may be coming soon.

As recently as early December 2021 the program, known as Direct Contracting, wasn’t on the radar of most Medicare beneficiaries or members of Congress. Rep. Pramila Jayapal (D-WA) called it the “biggest threat to Medicare you’ve never even heard of.”

But by early January, 54 lawmakers had joined Rep. Jayapal in signing a letter urging Health and Human Services Secrectary Xavier Becerra to permanently end the controversial program. Direct Contracting, the letter said, would maximize the profits of new fiscal intermediaries while limiting the care options of the 38 million beneficiaries of traditional Medicare, which now offers free choice of any doctor or hospital.

SNIP

Physicians for a National Health Program (PNHP), which represents 25,000 health professionals and has spearheaded the opposition to Direct Contracting, said that immediately pulling the plug on the program would be in the best interests of Medicare beneficiaries.

https://www.elderlawanswers.com/medicares-controversial-direct-contracting-program-hits-biden-administrations-radar-18715

What is Direct Contracting?

It's a backhanded way to privatize Medicare, decrease care, and increase profits for private equity.

Direct Contracting Entities (DCEs) receive a monthly payment for a specific group of patients. But while Medicare Aadvantage insurers are required to spend 85 percent of their revenues on patient care, DCEs are allowed to keep up to 40 percent of the taxpayer dollars they receive as profit and overhead. By contrast, traditional Medicare spends 98 percent of its budget on patient care.

This is an assault on Medicare, started by the Trump Administration.

[dalton99a]

1. Kick

[rog]

9. They are aware, and just putting lipstick on this pig (article).

I just found this article from Feb 28.

CMS redesigns controversial Medicare direct contracting model

The decision to retain the direct contracting model — albeit with numerous changes and a new name — was met with mixed reactions from stakeholders.

https://www.healthcaredive.com/news/cms-direct-contracting-medicare-biden-value/619507/

Following pressure from progressive Democrats and advocacy groups, the Biden administration is redesigning a controversial payment model that aims to introduce value-based payment arrangements in traditional Medicare, and canceling another Trump-era model that CMS paused early last year.

Thursday's announcement effectively sunsets the Global and Professional Direct Contracting Model in its current form, and transitions certain participants and members into a newly established model, called ACO Realizing Equity, Access, and Community Health (REACH), beginning next year.

...clip...

The decision to retain the direct contracting model — albeit with numerous changes and a new name — was met with mixed reactions from stakeholders, with some cheering the newest iteration of an accountable care model in traditional fee-for-service Medicare, and some arguing ACO REACH doesn't fix direct contracting's core problems.

...clip...

... the model has recently come under increased fire, resulting in rumors the Biden administration was considering terminating the program altogether. Its critics, including many progressive Democrats, said the program could lead to the privatization of Medicare, threatening access to high-quality care for all Americans.

CMS appeared to address those concerns on Thursday with ACO REACH's announcement.

...clip...

The global and professional direct contracting model will run through the end of this year before transitioning to the ACO REACH model. Current participants must agree to meet all of the new model's requirements by January 2023 in order to participate.

ACO REACH will test-run through 2026.

A number of physician groups applauded the Biden administration's to keep the core tenets of direct contracting ...

...clip...

"Many of the criticisms against Direct Contracting were a product of great misunderstanding about the model and the overall shift to value-based payment," NAACOS CEO Clif Gaus said in a statement. "Instead, keeping the model with additional focus on equity, increased provider governance, improvements to risk adjustment, and other changes is best moving forward."

America's Physician Groups, which represents more than 300 U.S. medical groups, said it was "extraordinarily pleased" that CMS is retaining the direct contracting model with "important revisions."

[rog]

33. Dr. Susan Rogers (of PNHP) explains the threat to Medicare

Physicians For A National Health Care Program has a website dedicated to taking action on ACO REACH. We can all participate.

Protect Medicare: https://protectmedicare.net/

"The Medicare REACH program puts middlemen between patients and the care they need. This threatens the future of Traditional Medicare as an effective, efficient, and truly public health care program."

Dr. Susan Rogers explains the threat to Medicare

[Hoyt]

35. Roy, I listened. God bless her, but her organization doesn't even represent 0.25% of

physicians, although they do represent a lot of worthy physicians treating poor and uninsured.

Second, she does not realize Medicare Advantage was started under Clinton Administration. But that’s common misinformation.

Third, this was produced before Biden’s recent changes.

I’m fine with physician led DCEs, which she criticizes. Heck, her organization could be a DCE, if she really wanted to do something for healthcare. How many DCE’s do you really think are venture capitalists. Biden’s changes require the board to be 75% providers, if I’m not mistaken (need to verify that).

Sorry, a bunch of doctors acting independently is not the best way to deliver coordinated care. I’ve seen the bad results of that often,

I’d love to have her as my physician. But we need modern approaches to care and pay for healthcare for everyone. She’s right, the old Medicare system ain’t working well. 42% voluntarily select Medicare Advantage — which she criticizes too - over traditional Medicare. That will likely increase next year.

Appreciate your post.

[rog]

40. Direct Contracting and the 'Medicare Money Machine'

Yes, these two articles were written before the 'Biden Changes', but they seem to offer a much-needed deep dive into this very complex issue. On first glance it seems very clearly written. I have not read them yet, but I certainly will this weekend. Perhaps these articles might interest you, as well.

I will say I never expected to learn this much, but as a 77-year-old musician on Original Medicare ... which seems to be working pretty well, so far ... I think it's really important. The long knives are out for Medicare.

I have seen the 'risk-score game' mentioned in other articles I've seen today.

Medicare advantage, direct contracting, and the Medicare ‘Money Machine,’ part 1: The risk-score game

Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine,’ Part 2: Building On The ACO Model

In this two-part post, we will attempt to explain the perverse Medicare Advantage business model that underlies this elevated level of investment, and we will explore its connection to the Direct Contracting model now being tested by CMS. The story is complex, but we think it is worth telling because the stakes for beneficiaries, the public treasury, and our health care system are very high. This business model is distorting health care delivery, creating excessive costs for taxpayers and Medicare beneficiaries, draining the Medicare Trust Fund, obstructing the badly needed value transformation of American health care, and diverting the money needed to fund other social services and goods.

Part one of this post focuses on Medicare Advantage. Part two ... will discuss Direct Contracting and suggest some reforms for both MA and Direct Contracting. We also offer a broader reform agenda that calls for expanding the accountable care organization (ACO) model by working directly with providers, rather than investors.

[Hoyt]

49. I've heard the hatred for Medicare Advantage here. Yet 42% of beneficiaries select it,

including many here.

[Auggie]

55. Because the premiums are cheaper than MediGap options

[Hoyt]

56. Obviously. So you want to tell those 42% to fork up an additional $250/month for MediGap and drugs?

Plus, there are some expanded benefits. $1000 of dental coverage ain't much, but it's $1000 more than traditional Medicare covers.

Coordinated health care might not mean much to those who like to select multiple doctors, but it means a lot to me, especially for diabetes, heart and lund disease, Alzhiemers, etc.

[Auggie]

69. I've suggested nothing of the kind

MediGap premiums should lowered. And Senator Bernie Sanders (and others) have been fighting to include dental coverage with traditional Medicare (for example).

If billions in government funds weren't being siphoned by for-profit Medicare Advantage and Direct Contracting entities there'd be more money available to cover more health care needs and offer more comprehensive coverage.

[Hoyt]

71. OK. They couldn't get the largest Part B premium increase in history lowered.

How much more money do you think would be available if they weren't doing what 42% of Medicare beneficiaries choose?

Sanders has gotten nowhere in his Medicare-for-All proposals. Wish it were different. But, maybe, it's time to try something else.

You do realize that just about every Medicare participating provider is "for profit," and some of them have stolen hundreds of billions through fraudulent billings, services, etc.

[rog]

57. I posted these articles as items of interest.

As I mentioned, the articles seem well researched and well written. I plan to read them this weekend. My hope is that they will help to clarify a very complex and serious constellation of issues regarding decisions that are being made out of our sight and under the radar, by design.

Medicare advantage is run by private insurance companies. You still have premiums and co-pays. You still have out of network surcharges that can hit hard, and are sometimes unexpected. There is no 'out of network' with Original Medicare.

You asked someone downthread if they would prefer a healthcare system similar to the UK. I would be fine with the Canadian plan. I have a relative who has dual citizenship with Canada. She and her husband have raised two kids to adulthood. Her husband had knee replacement surgery recently. They have never seen a medical bill, and she does not know what a co-payment is ... they just go to the doctor. When her son had a broken bone, the only charge was for the rental of crutches.

Medicare is not the best, but speaking strictly for myself, I don't want private insurance involved, and I don't want a for profit system.

I shared the articles above in the hope that someone might find them helpful in understanding what's going on. Your mileage may vary.

[Hoyt]

59. Medicare Advantage is highly regulated. They have to provide everything traditional Medicare does.

Plus, they are actually subjected to quality of care review, something traditional Medicare doesn't do.


I'd be fine with Canadian system too.

But if you lived in Canada, guess where they get drug coverage-- private insurance companies, heavily regulated by the Canadian health system.

[rog]

62. Honestly, I'm not here for an argument.

I hope the articles provide information to anyone who might be interested.

Re: Canadian drug coverage, I don't know the ins and outs of that, but if true, 'heavily regulated' seems key.

When my mom and dad were living, they got their drugs from a Canadian pharmacy by mail. They saved a ton of cash.

Be well.

[Hoyt]

63. Nor am I. But I think there is more than one side to this, and 26 million beneficiaries show that.

[llashram]

64. it has ALWAYS

been profit before people...one day, a post-op bladder procedure and a night in the hospital recovering, 25000+. All medicines etc are in that cost. I did prepare for this...so I only have my cost-co-pays. At 74 I hope Medicare changes won't hurt me too much. More money into COO-CEO pockets less in ours.

And don't get me wrong I love my hospital cancer team staff.

[montanacowboy]

2. About time

This has been creeping up and Biden needs to do something about it asap or the repukes will get their wet dream of privatizing Medicare

[leftstreet]

3. It shouldn't be a difficult decision

DURec

[Auggie]

4. BTW, I understand it's up to the Medicare patient to check with the doctor or medical group ...

to see if they're a victim or potential victim of Direct Contracting. You won't be told until you're already enrolled.

[Farmer-Rick]

10. OMG all the gobbledygook used to describe this Direct Contacting scheme

No wonder most people don't understand what the f*ck is Direct Contracting.

First they claim it is not a fee for service system where Medicare pays and you pay your deductible. It sounds like you pay an amount up front and some private corporation gets your money and tells you what services you can and can not have......or something like that.

Then it gets worse. You can be enrolled merely by living in a certain geographical area. What areas you ask? They don't know.

Then on top of that if you go to a doctor or clinic that is in the direct contracting scheme, and you may not know, you got to give your money to them at a price they don't always reveal. So, you may have a monthly payment to make in order to pay off the cost of the doctor.

It sounds so convoluted. Designed so complicated in order to cheat you no doubt.

[Auggie]

12. One consumer/advocacy group warns to read all Medicare correspondence carefully ...

should you be given the advance opportunity to opt out of a DCE before you are automatically aligned to one.

40% profit margin is incentive to deceive in any and all ways possible.

[Rebl2]

22. I turn

65 in June and all I have gotten is information on do you want traditional Medicare or Advantage. I chose traditional and already have a secondary plan. It said nothing about this DCE.

[yorkster]

5. Maybe they should also rein in

Medicare Advantage while they're at it.

[Wounded Bear]

18. Indeed! nt

[yorkster]

19. I think today is the last day of 2022

that they can run those obnoxious ads on the telly. They should not have been allowed to use the word medicare in the name.

A fair number of people think they're on some form of Medicare.Of course that's all part of the pro-privatization plan...

[Rebl2]

24. People turn

65 all year. Why would they stop these commercials now. I agree they should not be allowed to use the word Medicare in the ads.

[yorkster]

25. I read a few months ago -google I think-

that regular ads for medicare signup run for part of the
year and ads for medicare advantage start at a later date and stop on March 31st.

So, if I read correctly there should be part of the year w/o any of those ads, hopefully from now until October.
(Sorry about no source - I had to dig to find info re ads.
and I'm pulling together what I remember of what I read.)

[Rebl2]

27. Hope you are

right. So sick of hearing them and sick of all the calls I have gotten since the beginning of the year trying to sell me secondary insurance. I normally do not answer the phone if I don’t recognize the number. The few times I have, they get earful from me and they hang up on me.

[Backseat Driver]

72. I turned off the ringer of my landline at beginning of Open Enrollment; use my cell only.

No Medicare, car warranty, free cruises, listing realtors, etc...Calls not in my call list that I don't recognize go unanswered by me and get transferred to a voicemail without a greeting; none have left a message except the library about books I had checked out before the pandemic. Ahhhhh...relief!

[Hoyt]

51. Yeah, go tell 42% of Medicar beneficiaries who choose MA as best for them that they are stupid.

[yorkster]

58. See American Prospect Jan.24 2022

article by Barbara Caress. Title is The Dark History of Medicare Advantage. The section entitled Why Medicare Advantage Was Invented is particularly relevant.
There is a pop up you can close but not a pay wall.

Medicare Advantage was the first chink in the armor.

Direct Contracting would be far worse as the op states.

[Hoyt]

60. So, you don't think the 42% -- that's 26 million people -- should have that option?

[yorkster]

65. Not what I said.

Modifications to Medicare, changes to Medicare Advantage, etc. could improve the situation.
Or, expand Medicare and offer Medicare for all. (Expand to include dental, etc..)

[Hoyt]

67. Would love to see Medicare expanded to all. But ain't gonna happen without a Public Option to

smooth the way. If a government option is as good as we thing, folks will gravitate to it quickly.

We can't even mandate vaccines or masks in this country. Try telling people they have to convert to a government health program, even when in their best interest.

[yorkster]

68. There should be a public option

and we should be able to have mandates for a vaccine, but we're not there yet and may never be. Just crossing our fingers when the next pandemic comes along...

[SheltieLover]

6. K&R!

[Hoyt]

7. Direct contracting has been going on since Clinton Admin.

[Auggie]

8. To this extent, 40% of all money?

[Hoyt]

26. 40% of PROFITS, Augie. Guess where the other 60% goes if "profits are made-- back to the government.

And, if the DCE doesn't make profits, guess what happens? Tough chit, Medicare beneificaries got needed care at expense of DCE.

Quality is part of the reimbursement formula. So your fear that the DCE -- which might be Mayo Clinic, for example -- would just not provide care, is unfounded. Same old BS criticism used against HMOs.

https://innovation.cms.gov/innovation-models/gpdc-model

If you ever want a single payer system, we are going to have to ensure the system is affodable for patients and government. We are going to need chronic disease management-- diabetes, heart, COPD, Alzheimers, etc.

Finally, DCEs are just the next step in Obama's ACO programs.

[Hoyt]

28. Post moved. Hoyt, you are so stupid.

[Farmer-Rick]

11. No it hasn't.

"In Part two below, we explore the approach fostered originally by the Trump Administration to implant those same dynamics (Medicare Advantage) into the traditional Medicare side of the Centers for Medicare and Medicaid Services (CMS) ledger in the form of the misnamed “Direct Contracting” model."

https://www.healthaffairs.org/do/10.1377/forefront.20210928.795755

So, no Direct Contracting was not a part of Medicare until Trump. What you are thinking of is Medicare Advantage which is a bit like direct contracting but you get no choice in it. So, it's very different in that respect.

Yeah Medicare Advantage is a scam. But Direct Contracting is an even bigger scam.

[Auggie]

13. Thank you

[leftstreet]

17. +1

[Hoyt]

23. Sorry, you are wrong. As to Medicare Advantage, tell that to the 42% who voluntarily choose it.

Guess you are smarter than them.

And, DCEs are touted as the new ACOs. Do you know where ACOs came from-- President Obama's ACA.

[former9thward]

36. Why is Medicare Advantage a "scam"?

I have a MA plan and it has far more benefits than regular Medicare at the same price. It has vision, dental and hearing.

[Auggie]

41. It allows providers to rip-off the government ...

by charging Medicare estimated health care costs rather than actual ones. The estimated costs are bloated, of course. My mother (93) thinks her annual interviews with a United Health Care nurse is a free check-up. Far from it -- they're manufacturing a yearly "risk score" so they can receive higher compensation from Medicare.

That money could be distributed for better, more comprehensive vision, dental and hearing coverage, for example.

[Farmer-Rick]

43. Good explanation.

My Mom had the same experience. She thought they were checking up on her. She complained that all these health workers came to visit her but they could never get to the bottom of her reoccurring UTIs. And when she asked for specific health advise the interviewing nurses frequently bowed out and she didn't understand why the nurse wouldn't help her.

I'm about to go on Medicare and after a ton of research, I figured out I don't need a for profit corporation between me and my Medicare. Some corporations offer more services......for now, but later as your risk score changes you lose some of the services they offer. Or once they have enough elderly enrolled, they morph into fewer services.

Some others only offer exactly what Medicare offers, but make it sound as if you are getting more. A lot of them who claim they offer dental or vision for example, require an additional monthly copay or large deductible or premium. But you don't find that out until you really dig into their literature on line. Or they use gobbledygook to hide the fact that they are really just charging you extra for the same services.

I really hate that our federal government sics all these healthcare scammers on us when we turn 65. Just as we become older and more vulnerable.

I had so many robo calls, junk mail and even people knocking on my door to sell me their crappy for profit insurance. I accidentally threw away my Medicare card because I thought it was just another healthcare scammer. And these scammers are relentless. I have managed to block most of the calls but usually late at night 1 or 2 get through. I think they target you at night because you are tired and may agree to something you don't really understand.

The bottom line is when has a corporation ever done anything that really helped you without attaching a huge price tag?

[Auggie]

50. Thanks Farmer-Rick

I agree 100%

I'll be applying for Medicare soon too (I'm in the research phase). It's MediGap "G" or nothing. Biggest challenge is finding the provider I trust the most. Mind if I PM you in the future and ask who you sign with?

In my state (CA) I'm finding Humana as the option that gets the best reviews ... but I don't trust them.

[Farmer-Rick]

75. Sure

But I'm just getting Part A and B as required by TriCare because I have Tri-care For Life through my military retirement....Well, I will soon. They have a good prescription plan and the VA is offering dental and vision soon. But I still have to pay Medicare's premium for part B.

I looked at those other insurance plans and they really only duplicate my current coverage only they want more copays and such. Humana runs TriCare and they are pretty good.

[Auggie]

76. Thanks!

[former9thward]

44. Regular Medicare does not have those benefits.

You really think costs in regular Medicare are not "bloated"? They are.

[Auggie]

47. Certain MediGap policies offer vision, dental and hearing

And you can choose any doctor you want.

[former9thward]

73. You have to pay for those,

I don't pay anything extra and I have no end of doctors to choose from.

[Jakes Progress]

70. Medicare Advantage is basically an HMO.

You work with "network" of services. All good as long as you don't move or don't have serious needs. If you live in Arizona and want to go to Johns Hopkins for services, you can't. If you want a procedure your doctor says you should have and it falls into some categories, the insurance provider can deny it. Wanna go back to regular medicare. You have to medically qualify.

Whole swaths of retirees from public services got baited onto these.

[former9thward]

74. I am happy to be "baited".

And what you are saying is simply not accurate. Moving is not an issue and out of network services are approved.

[Jakes Progress]

79. Enjoy the quick snack.

I hope you do not have a serious illness or find it necessary to move to another state. Moving is an issue. Out of network services must be approved by an insurance company. If it doesn't cost them money, it is approved. If the procedure is expensive, it is substituted. I know this from four separate instances from friends and family members.

Medicare Advantage is not Medicare. It is an insurance run HMO that receives money from Medicare to manage your care - manage being the operative word.

And those friendly home health visits. They generate more income for the managing HMO and set it up so that it is very difficult for you to switch back to real Medicare. All those "suggestions" and "aids" they prescribe put you in a category that has Medicare paying more the HMO more money because now you are in a category of "serious medical need".

The program takes money from Medicare to turn into profits for the HMO. It is a baby step towards privatization.

What I am saying is very accurate. Look at your program. But, of course, that won't help because they don't tell you these things when the offer free stickers and hearing aids. But you can always call and ask if they will approve targeted disk stem cell injection at Johns Hopkins. Or you can do the research that I did after it was too late. (They tell you that you can always switch back to medicare if you want, but they don't tell you that is only if you have been on Medicare Advantage for less than a year. I'm four years in. As my premiums keep rising, I can't switch back to Medicare without going through medical qualification.)

[Hekate]

14. KnR

[rog]

15. Follow-up to this excellent post.

Thanks, Auggie, for putting this up here.

At the end of the article you posted, there is a link to another page with more information ... definitely worth a read.

Rather Than End Controversial Medicare Initiative, Biden Gives It a Makeover
https://www.elderlawanswers.com/rather-than-end-controversial-medicare-initiative-biden-gives-it-a-makeover-18725

In the face of mounting criticism that its Direct Contracting initiative will undermine traditional Medicare, the Biden administration announced that rather than terminate the model, it is changing its name and adding protections against abuse. The revamped program is a mouthful: the Accountable Care Organization Realizing Equity, Access, and Community Care (ACO REACH) Model.

Direct Contracting’s critics, who view the scheme as a backdoor effort to privatize all of Medicare, were not reassured.

...clip...

“ACO REACH is Direct Contracting in disguise,” said Dr. Susan Rogers, an internal medicine physician and president of Physicians for a National Health Program (PNHP) ...

...clip...

“You can’t slap a band-aid on a tumor and call it cured,” PNHP’s Dr. Rogers said. In an email to supporters, she outlined ways that ACO REACH is, in her words, Direct Contracting’s “evil twin”. The REACH model will:

-- Pay third-party middlemen a flat fee to "manage" seniors' health, allowing them to keep up to 40 percent of what they don’t spend on health care as profit and overhead;

-- Automatically enroll traditional Medicare beneficiaries into REACH without their full understanding or consent;

-- Require beneficiaires to change primary care providers if they wish to opt out of the program; and

-- Allow virtually any type of company to be a REACH middleman, including those owned by commercial insurers and private equity investors, as well as every company currently participating in the Direct Contracting program.

[Auggie]

16. Thanks for adding this

I did see the link but thought it too complicated to add to my OP. It is, in fact, worthy of its own thread. If you care to follow through, be my guest.

Think we should make something clear: this is more a "Bacerra" action than a "Biden" action, though I really want and expect Joe to step in and just kill the program. Crap, it's a product of the TFG.

[burrowowl]

21. Thanks for added info!

[CousinIT]

39. I posted those links here before. MEDIA WON'T COVER THIS AT ALL.

So NOBODY knows it’s going on and it’s virtually flying under the radar. It’s sneaky backroom bullshit.

[Hoyt]

52. ACOs were an important part of Obama's ACA.

[PatrickforB]

20. All we have to do to determine whether healthcare should be publicly funded or not is

ask, "Is the profit motive in direct conflict with the interests of the patients?"

YES

Okay. Then healthcare is a public good, should be funded with public monies and NEVER privatized.

Good job Bidens.

[Hoyt]

29. Would you like a healthcare system like UK? Guess what, NHS direct contracts.

"In England, direct contracts are awarded to entities nationally by NHS England and regionally by Clinical Commissioning Groups (CCGs), based on national priorities laid out in the 10 year NHS Long-Term Plan and the Shared Planning Guidance. NHS England contracts include national cancer screening and primary care services.

"CCGs are led by a board of healthcare executives and clinicians who invest a total budget of around $110B. There are 106 CCGs in England serving regions of 250K people on average. For each contract, a procurement process is initiated whereby companies are invited to tender. Contracting entities include emergency care, elective hospital care, maternity services, community and mental health services.

"Successful entities demonstrate strong health economics with agreed performance measures and health outcomes, that are monitored by the CCG. Payment models for the contracts include capitation models, block contracts, national tariff pricing and payment for performance. In 2017, over half of all CCG contracts reported were for one or two years, and almost a third were for three years (Figure 1). Contract values ranged from $350K to $7.6M per CCG (Figure 2)."

https://onthepulseinvesting.substack.com/p/value-based-care-what-is-direct-contracting?s=r

https://www.england.nhs.uk/primary-care/primary-care-networks/network-contract-des/

[Auggie]

30. Medicare is OUR MONEY. Why do DCEs suddenly deserve up to 58% of our benefits?

They do NOTHING. Fuck that. We're not stupid Republicans.

[Hoyt]

32. Where do you get that? Christ, the world is changing and you want Marcus Welby

healthcare.

They don’t get 58% of your benefits.

The Biden revisions essentially turn this into an extension of Obama’s ACA.

https://www.healthcaredive.com/news/cms-direct-contracting-medicare-biden-value/619507/

[rog]

34. Dr Susan Rogers of PNHP explains this in about 5 minutes.

Susan Rogers can explain why this is bad very clearly. It will only take a few minutes of your time.

Here's a link to my post upthread ... worth a click.

https://www.democraticunderground.com/100216548535#post33

[Farmer-Rick]

31. Boy that is a lot of info to digest

With poorly explained acronyms and difficult to follow sentence structure, it was not easy reading.

But I tried.

So it seems there no 50% profits, like in the US direct contracting model, allowed under the UK system. This UK system is new. From your NHS link:

"PCNs are formed via sign up to the Network Contract Directed Enhanced Service (DES) Contract Specification 2020/21, which was first introduced on 1 July 2019 and sets out core requirements and entitlements for a PCN. PCNs are also supported by the PCN Development Programme which is centrally funded and locally delivered."

Also

"Since the applications for the Year 2 GPDC Model are currently paused and under review by the new Administration."

So, it is basically an experiment in the UK and they haven't agreed to a 2nd application of the program it seems. So, it really isn't the UK's well regulated NHS.

[ymetca]

37. All this obfuscation regarding Medicare

stems from pressure by greedy bastards hell-bent on excising government from its employees to administer the program properly.

Government, now lacking the personnel to root out corruption, is vulnerable to scammers, like Rick Scott, and many, many, MANY others, who abuse the system for a mere slap on the wrist fine, making big bank, hiding behind walls of inscrutable "incorporation".

At the same time, these same con-artists declare it would ALL be better run as a "privatized" (aka for profit) system, which of course, it simply cannot be. It's impossible. You can't have cheaper heath care for profit. Period. Not possible. No amount of technological wizardry will ever fix that problem.

They can bloviate all day long about "innovation", but that's just private skimming off of tax-payer investment into our universities. Some lowly schmucks in lab coats do the innovating, while usurious fucks like Scott take all the lucre, at our expense.

It's just more of the oldest game in town, which is figuring out how to siphon off our hard-earned dollars into their bulging wallets.

[CousinIT]

38. I have posted here about that numerous times trying..

…to get DUers to holler at Biden, HHS, CMSInnovations, and Xavier Bacerra (not sure of the spelling) to STOP THIS SHIT NOW.

It is a dirty deal designed to privatize Medicare within 5 years, cooked up by the Trump admin. Big pharma, big insurance, big investment firms are begging them to keep it because they want to suck up that gov’t gravy train money while slashing / refusing care.. It’s flat out BULLSHIT.

[Auggie]

42. Please keep trying ...

and THANK YOU for your previous posts.

This is such a blatant attempt to screw-up Medicare that it's hard to believe it's an actual conversation.

[area51]

48. +1 n/t

[notinkansas]

45. I received a letter from the provider network I have been

using for many years - Advocate. It said that they will be ACO participants. I was amazed that they were actually up-front about the profit driven focus.

"An ACO is a group of doctors, hospitals, and/or other health care providers that work together to improve the quality and experience of care you receive. ACOs receive a portion of any savings that result from reducing costs and meeting quality requirements.

Medicare evaluates how well each ACO meets these goals every year. Those ACOs that do a good job can earn a financial bonus. ACOs that earn a bonus may use the payment to invest more in your care or share a portion directly with your providers. ACOs may owe a penalty if their care increases costs."

Emphasis mine.

The motive to cut/restrict services in order to cut costs is blatant. I'm thinking the only way to opt out of this is to find different providers. Not sure.

[Hoyt]

53. ACOs were an important part of Obama's ACA.

[Auggie]

54. If it were me I'd call ...

and if I couldn't get a straight answer I'd find another provider.

[SCantiGOP]

46. Why not just privatize Congress?

Let Koch and the oil companies appoint directly members of Congress. Think of all the money we could save on campaigning.

[turbinetree]

61. And just think if that Fraudster Rick Scott that defrauded Medicare has his way this is

what seniors and those on disability will have to deal with.....less service more cost , or no Medicare at all.......

[jalan48]

66. Corporate Insurance Industry national healthcare system. What's not to like? Right?

[c-rational]

77. K&R. Advantage plans in general are an assault on Medicare, DCE is more on steroids.

[Auggie]

78. +1

[Jakes Progress]

80. True. +1

[Tree Lady]

81. They are really trying to push those plans

We have our Medicare with supplement through my husband's old job and can do advantage but I believe it costs more would have to check.

Just got bill from my yearly woman's checkup that was coved 100% until Medicare, now I had to pay $185 because visit portion where they did breast exam not covered but pab test was.

This doesn't make sense to me. Wouldn't they want to encourage people to get exams and catch things early?

I am going to see if my regular doctor does this exam thinking maybe it was because my gynecologist hates getting less money on Medicare. Lady in bill department told me if I was on Medicare advantage it would be covered.

Meanwhile my husband who has been on Medicare for years has never had things not covered with our current supplement.

[c-rational]

82. Not sure why a preventive care was not covered. My wife and I both have original Medicare with

a Supplemental. I do know if you do get sick with an Advantage Plan you will be out of pocket $7-9K per year with the deductible. What galls me is how complicated the entire mess is. That is by design and it is disgraceful in our Country. My last piece of rant is to say we should call is like it is, we have a national sickness care system - this is not health care.

[Tree Lady]

83. Totally agree I have been going to this

Doctor for years no problem and this year first year on Medicare they made sure i signed a bunch of stuff saying i would pay what Medicare didn't. I am going to try to get same service with regular doctor I am thinking it's because he is a specialist and makes most his money delivering babies.

[c-rational]

84. Again, I am no expert, but I understand with Medicare you do not need any referral for a specialist,

what you do need is a Dr. that accepts Medicare. Maybe your thoughts about this Dr.are correct, and he might not typically take a Medicare patient as he then has to accept what Medicare pays - again, too much fog. Before you change why not just ask?

[Tree Lady]

85. I asked and got a big story about

What is covered and what isn't, sounded weird to me. I mostly think he is trying to get all older patients to quit.