Rep. Kevin Hern on Biden Admin. Policies Hurting Medicare Advantage Patients

Impact of Biden Administration Policies on Medicare Advantage

• 📉 Medicare Advantage (MA) plans have faced significant funding reductions due to Biden administration policy changes, making it harder to offer a wide array of supplemental benefits to seniors.
• 💡 The V28 risk model implementation has resulted in a revenue haircut for the industry, leading to less generous benefits for beneficiaries.
• ⚠️ Changes to the star ratings methodology have led to a decline in four-plus star rated plans, reducing bonus dollars that fund supplemental benefits.

Challenges in Star Ratings and Revenue

• 🎯 The star ratings system is described as distorted, with a single customer service call potentially causing a significant revenue swing, necessitating lawsuits against CMS.
• ⚖️ There's a call to grade plans on a continuum rather than a cliff ratings system to avoid reducing benefits to beneficiaries.

Analysis of Medicare Advantage vs. Fee-for-Service

• 🔍 A call for a 360-degree view when analyzing Medicare Advantage, including populations that switch from MA to fee-for-service and those entering the program.
• 🤖 The need to automate diagnosis coding at the point of care under physician purview to ensure accurate coding across all programs.
• 📊 Some coding intensity differences are appropriate, but others may be fraudulent, requiring oversight.
• 📈 A demand for transparency of data and statistical coding in Medicare Advantage to fee-for-service comparisons, similar to pharmaceutical development analysis.