So now we have had a partial win of extended use of telehealth. For now we have access to use it until the end of September. While this is a significant partial win, we need to continue to push to make it permanently part of our toolbox.
Medicare Advantage scrutiny next
So currently Dr Mehmet Oz is in the process of confirmation hearings to be the head of the Centers for Medicare and Medicaid Services. There are more questions than answers at this point as to what will truely be his focus and plan.
There have been times during the confirmation hearings with the Senate Finace Committee that questions regarding Medicare Advantage was brought up.
Dr Oz had done advertising that promoted Medicare Advantage plans, and even has stock in United Healthgroup. Both of these factors can complicate an unbiased approach to establishing rules and regulations.
Medicare Advantage “rules”
The current environment of Medicare Advantage relatively allows the companies to make their own rules. These rules include pre-authorizations, continued authorization, documentation requirements, as well as discharge guidelines.
These companies have contined to be under scrutiny for the difficulties of not only the beneficiaries to deal with, but also the providers to deal with. There are multiple class action lawsuits regarding lack of coverage, inappropriate discontinuation of service, use of AI and algorithms to establish care plans, and retroactive denial of payment for services rendered and authorized.
The need for continued advocacy is more important than ever
Regardless of Dr Oz, there needs to be continued advocacy with our House of Representatives and Senate to keep them informed and aware of what does not work with these programs
There needs to be more simplicity, decreased burden of documentation, fair and proper payment of services, and accountability.
The true guardrails for these companies ultimately comes from our legislative branch with guidance from CMS. So please continue to let them know that our seniors deserve better.
