Reaction to Executive Order on Future of Medicare Mixed

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ACP supports strategies to reduce unnecessary administrative burden and allow beneficiaries to choose preferred plan but cautions against providing any favor to Medicare Advantage plans

Oct. 18, 2019 (ACP) – The American College of Physicians supports some aspects of the executive order recently signed by President Donald Trump regarding the future of Medicare but is concerned that other parts of the order could harm patient care.

The Executive Order on Protecting and Improving Medicare for Our Nation's Seniors, signed by President Trump on Oct. 3, directs the Department of Health & Human Services to improve the existing Medicare program through a number of strategies. The policies set forth in the executive order include aligning reimbursement across traditional Medicare, Medicare Advantage (MA), and commercial insurance; reducing physician burden; studying pay disparities between physicians and other health care professionals; and expediting Medicare coverage decisions for innovative technologies.

ACP supports efforts to reduce unnecessary administrative burden for physicians and beneficiaries and to ensure Medicare beneficiaries have the ability to choose the optimal type of Medicare plan for them, according Shari Erickson, ACP vice president for governmental affairs and medical practice.

Another strategy set forth in the executive order involves bolstering the MA program, the private version of Medicare. The changes are “intended, in part, to guarantee that Medicare Advantage plans are on equal footing with the original version when people join the program, and permit the private plans to offer a greater array of health-related services,” The Washington Post reported.

“ACP policy emphasizes that government efforts to improve the Medicare program, including this executive order, should not favor or give competitive advantage to MA plans over traditional Medicare,” Erickson cautioned.

ACP believes that beneficiaries need clear and understandable means to compare benefits and options when deciding between an MA plan and traditional Medicare. “ACP has called for the Centers for Medicare & Medicaid Services and MA plans to provide this important information, including updated ‘provider’ network details,” Erickson said.

ACP has also called for MA and traditional Medicare to be funded at the same levels. “We also support efforts to identify ways for traditional Medicare reimbursement to align more with MA and commercial insurance rates, which could improve physician reimbursement down the line,” Erickson said.

ACP is concerned with the proposal in the executive order for non-physician clinicians to be allowed to practice outside of a patient's care team and to practice at the “top” of their training, subject to state licensing and scope of practice laws. ACP believes this could hurt the patient-physician relationship and reduce the level of coordinated, high-quality care that is delivered. “ACP strongly believes that patients should have access to a personal physician who is trained in care of the ‘whole person’ and has leadership responsibilities for a team of health care professionals,” Erickson said.

In place of this policy, ACP would like the Trump Administration to focus efforts on encouraging innovative payment and delivery system models that emphasize teamwork, coordination and value.

The implications of the executive order are complex, and ACP will continue to review its effects. “We will also continue to call for transparency across MA plans to ensure program integrity, reduce unnecessary administrative burden, and promote value-based care delivery and payment within Medicare,” Erickson said.

More Information

ACP's 2017 position paper “Promoting Transparency and Alignment in Medicare Advantage” is available on the ACP website.

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