That often is the case. Modern Healthcare experiences:
Last month, St. Charles Health System threatened to chop ties with all Medicare Advantage plans subsequent yr, a transfer that would go away an estimated 26,000 native beneficiaries with out entry to a hospital lower than 100 miles away.
“The reality of Medicare Advantage in central Oregon is that it just hasn’t lived up to the promise,” St. Charles Health System CEO Dr. Steve Gordon wrote in a information launch on the time. “A program intended to promote seamless and higher quality care has instead become a fragmented patchwork of administrative delays, denials and frustrations,” he mentioned. The Bend-based nonprofit firm declined to make an govt obtainable for an interview.
St. Charles Health System isn’t the one one. The article goes on to say that rural hospitals are “disproportionately affected by factors such as reimbursement cuts or denied and delayed payments from Medicare Advantage plans because Medicare enrollees make up most of their patient populations.”
Rural hospitals are notably delicate as a result of enrollment in Medicare Advantage amongst rural beneficiaries has grown from 11% to 40% of all rural Medicare beneficiaries between 2010 and 2023.
On the optimistic aspect, plan selection for rural Medicare Advantage beneficiaries has elevated, however this competitors has lead MA plans to purpose to decrease premiums and go by means of these decrease prices to hospitals with decrease reimbursement and reimbursement delays.
My FTI Consulting colleague Adam Broder was additionally cited within the article, stating:
“It’s like, ‘What’s the point of fighting about rates if we can’t even get paid?’” Broder mentioned. “They make money on the commercial contracts. The margins are just so much smaller from Medicaid or Medicare, and if they can’t get paid on time or properly or in the full amount, then that’s going to lead to a dispute.”