{"id":2165650,"date":"2024-02-01T22:24:02","date_gmt":"2024-02-02T03:24:02","guid":{"rendered":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/medicare-advantage-plans-are-a-bargaining-chip-in-negotiations-between-hospitals-and-insurers\/"},"modified":"2024-02-06T08:13:46","modified_gmt":"2024-02-06T13:13:46","slug":"medicare-advantage-plans-are-a-bargaining-chip-in-negotiations-between-hospitals-and-insurers","status":"publish","type":"post","link":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/medicare-advantage-plans-are-a-bargaining-chip-in-negotiations-between-hospitals-and-insurers\/","title":{"rendered":"Medicare Advantage plans used as leverage in hospital-insurer talks"},"content":{"rendered":"<aside class=\"mashsb-container mashsb-main mashsb-stretched\"><div class=\"mashsb-box\"><div class=\"mashsb-count mash-medium\" style=\"float:left\"><div class=\"counts mashsbcount\">18<\/div><span class=\"mashsb-sharetext\">SHARES<\/span><\/div><div class=\"mashsb-buttons\"><a class=\"mashicon-facebook mash-medium mash-nomargin mashsb-noshadow\" href=\"https:\/\/www.facebook.com\/sharer.php?u=https%3A%2F%2Fwww.conservativenewsdaily.net%2Fbreaking-news%2Fmedicare-advantage-plans-are-a-bargaining-chip-in-negotiations-between-hospitals-and-insurers%2F\" target=\"_top\" rel=\"nofollow\"><span class=\"icon\"><\/span><span class=\"text\">Facebook<\/span><\/a><a class=\"mashicon-twitter mash-medium mash-nomargin mashsb-noshadow\" href=\"https:\/\/twitter.com\/intent\/tweet?text=&amp;url=https:\/\/www.conservativenewsdaily.net\/breaking-news\/?p=2165650&amp;via=ConservNewsDly\" target=\"_top\" rel=\"nofollow\"><span class=\"icon\"><\/span><span class=\"text\">Twitter<\/span><\/a><a class=\"mashicon-subscribe mash-medium mash-nomargin mashsb-noshadow\" href=\"#\" target=\"_top\" rel=\"nofollow\"><span class=\"icon\"><\/span><span class=\"text\">Subscribe<\/span><\/a><div class=\"onoffswitch2 mash-medium mashsb-noshadow\" style=\"display:none\"><\/div><\/div>\n            <\/div>\n                <div style=\"clear:both\"><\/div><\/aside>\n            <!-- Share buttons by mashshare.net - Version: 4.0.47--><h2>Hospital Systems Employ\u2062 New Tactic in Negotiations with Health Insurers<\/h2>\n<p>In \u200dtheir ongoing negotiations with health insurers, hospital systems have adopted a bold strategy: removing themselves from\u200b the \u2063networks of Medicare Advantage (MA) plans. Medicare Advantage is a program that allows beneficiaries to receive their Medicare benefits through\u200d private insurance plans.<\/p>\n<p>This tactic is becoming increasingly common. For example, \u2062starting in 2024, Scripps Health in San Diego\u200c will no longer accept\u2062 any MA \u2062plans at its hospitals or physician clinics. Other health systems have taken a similar approach\u200d by focusing on specific insurers. St. Charles Health \u2062System\u2062 in \u2062Oregon, for instance,\u200c no longer accepts \u2064MA plans from HealthNet, Humana, \u2064and WellCare. \u200bBaptist Health \u2064in\u2063 Kentucky, Vanderbilt University Medical System\u2064 in \u200dTennessee, and Memorial Hermann Health System in Texas have also dropped the MA plan with Humana. Baptist has additionally\u2063 terminated such plans from United HealthCare and WellCare, while\u200b Bon Secours in Virginia has ended \u2064its partnership \u2063with Anthem Blue Cross.<\/p>\n<h3>Increasing Challenges\u200c and Tension<\/h3>\n<p>According to \u200bMichelle\u200b Millerick, senior associate director of health insurance\u200b coverage at the American\u2064 Hospital Association, hospitals and health systems\u2063 across the country are facing\u2062 mounting challenges with\u200c certain commercial insurers, including Medicare Advantage plans. Millerick explains that\u2064 there is growing tension due to the administrative\u2063 burdens \u2063associated\u2062 with insurer \u2064policies, \u2063as well \u200das delays\u2064 and denials in \u200bapproving and paying \u200cfor\u2064 patient care that should be covered. As the enrollment in MA plans continues to rise, these\u200c issues are\u200b becoming\u2062 more acute\u200b for patients and their healthcare providers.<\/p>\n<p>When a hospital\u200c system removes itself from an MA plan&#8217;s network, patients\u200b are left with a difficult choice: either pay more to stay with that\u200c hospital system\u2064 or\u200c seek care elsewhere.<\/p>\n<h3>Hospitals&#8217; Perspective<\/h3>\n<p>Hospitals argue that MA plans \u200dcreate obstacles to providing optimal \u2063patient care. Dr. Steven Gordon, president and CEO\u200d of St. Charles, states that Medicare Advantage in Central \u2063Oregon has failed\u200b to deliver on its \u200dpromises. Instead of promoting seamless and high-quality care, \u2062the program\u2063 has become a fragmented system plagued by administrative\u2062 delays, denials, and frustrations. According to Dr. Gordon, the sicker\u2063 a patient is, the more hurdles they and their \u200ccare teams face.<\/p>\n<p>James Gelfand, president and CEO of the ERISA Industry Committee, believes that the issue\u200d goes beyond administrative burdens. He\u200c suggests\u2062 that \u200dinsurers focus \u200don obtaining higher\u2063 reimbursement rates from private \u2062plans and utilize government\u200d health programs to achieve this goal. Gelfand argues that\u200c hospitals are\u200c willing to remove themselves\u200b from MA plan networks because\u2062 it gives them more leverage \u2064in \u2064negotiating\u2063 higher reimbursement rates from employer-based plans, which typically offer higher payments than MA plans.<\/p>\n<p>Ensemble Health Partners, a company that assists hospitals in securing better rates from insurers, \u200dprovides tips on going out of network on its website. The company shares success \u200cstories\u200d of clients who have leveraged an \u2062out-of-network\u2064 strategy to\u2064 achieve contract rates\u2063 double the standard annual increase. This demonstrates the \u200dpotential\u200b benefits hospitals can gain from taking such actions.<\/p>\n<h3>Increased Bargaining Power and Concerns<\/h3>\n<p>Hospitals have <a title=\"UPS has abandoned negotiations, increasing the likelihood of a strike, according to Teamsters.\" href=\"https:\/\/www.conservativenewsdaily.net\/breaking-news\/teamsters-says-ups-walks-away-from-negotiations-raising-chances-of-strike\/\">gained increased bargaining power<\/a> in recent years through mergers, with 1,887 hospital mergers announced between 1998 and the end\u2062 of \u20622021. This consolidation allows hospitals to have a <a title=\"Xiaomi expands India retail presence to outshine Samsung rivalry.\" href=\"https:\/\/www.conservativenewsdaily.net\/breaking-news\/chinas-xiaomi-bets-bigger-on-india-retail-stores-amid-samsung-rivalry\/\">larger market \u2064share<\/a>, giving them more leverage\u200b over\u2064 insurers. However, research on hospital mergers suggests that they primarily serve\u2062 to enhance bargaining power with payers, resulting in increased\u200c costs without significant improvements in quality.<\/p>\n<p>James\u200c Gelfand expresses concerns about the impact of these\u2062 negotiations on \u200cemployees. If insurance\u2063 companies do not reject the hospitals&#8217; demands, premiums may rise, leading to \u2062higher\u2063 deductibles and increased cost-sharing for families.<\/p>\n<p>Overall, the negotiations between hospital systems and health\u2064 insurers, particularly regarding Medicare Advantage \u2063plans, are becoming increasingly complex and contentious. The decisions made\u200c by hospitals to remove themselves from MA plan networks have significant implications for\u2064 patients, providers, and the healthcare industry as a\u200c whole.<\/p>\n<p>\u00a0<\/p>\n<h2>What concerns do health insurers have about hospitals&#8217; actions in negotiations and their potential impact on patient access to care?<\/h2>\n<p>Ves that hospitals are taking this drastic step in negotiations as a way to regain control over\u200b their\u200c patient care and financial \u200dviability. He\u2064 explains that hospitals are tired of being at the mercy of insurance companies and are\u2063 looking for alternative ways to ensure they can\u200d <a title=\"California passes groundbreaking 'Stop Dangerous Pharmacies Act'.\" href=\"https:\/\/www.conservativenewsdaily.net\/breaking-news\/california-enacts-landmark-stop-dangerous-pharmacies-act\/\">provide high-quality care<\/a> without being hindered by administrative burdens and\u200b reimbursement delays.<\/p>\n<h3>Impact on Patients<\/h3>\n<p>The withdrawal of hospital systems from Medicare Advantage networks has significant implications for patients. With fewer options for receiving care,\u200b patients \u200dmay have to pay higher out-of-pocket costs\u2062 if they want to \u200dcontinue receiving treatment from \u200ctheir preferred hospital system. This can put a financial strain on \u200bindividuals, especially those \u2062with chronic conditions who require ongoing medical care.<\/p>\n<p>Furthermore, patients\u200d may be forced to switch\u200d healthcare\u200d providers and disrupt their ongoing healthcare\u200c relationships. This can lead to suboptimal\u200c continuity of care and potential\u2062 gaps in treatment.<\/p>\n<h3>The Response from Health \u200bInsurers<\/h3>\n<p>Health insurers, on the other hand, argue that hospitals&#8217; actions are jeopardizing patient access to care. They claim that hospitals are using their \u2063leverage to demand unreasonable reimbursement rates, which result in higher\u2064 premiums for beneficiaries.<\/p>\n<h3>Future Outlook<\/h3>\n<p>As hospital\u200b systems continue to remove themselves from Medicare Advantage networks, negotiations between hospitals and health insurers are likely to become \u200dmore contentious. The burden falls\u2064 on patients, who\u2063 may have to navigate the complexities of insurance coverage and \u200bchoose between \u200daffordability and continuity\u200d of care.<\/p>\n<p>A potential solution\u200b lies in improving the negotiations process between hospitals and\u2062 insurers. Stakeholders \u200dneed to come together and find ways to address the administrative burdens, reimbursement delays,\u200b and coverage denials that have strained their relationship. By focusing on patient-centered \u2064care and \u200dshared \u200cdecision-making, \u200chospitals and insurers \u200bcan work towards a more sustainable and <a title=\"Everclear to play at healthcare price transparency event before Congressional Baseball Game.\" href=\"https:\/\/www.conservativenewsdaily.net\/breaking-news\/everclear-to-perform-at-healthcare-price-transparency-event-ahead-of-congressional-baseball-game\/\">equitable healthcare system<\/a>.<\/p>\n<p>Ultimately, it is crucial to\u2063 strike a balance between the financial viability\u2064 of hospitals and the accessibility\u2062 and affordability of care for patients. As negotiations continue, the \u200chealthcare landscape could undergo significant changes, shaping the \u2062future of healthcare delivery in the\u2063 United States.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Hospital systems are adopting a new strategy in talks with health insurers by opting out of Medicare Advantage networks. Medicare Advantage allows beneficiaries to receive Medicare benefits through private insurance plans. This approach is becoming increasingly common, with San Diego&#8217;s Scripps Health ceasing acceptance of all MA plans from 2024<\/p>\n","protected":false},"author":1217,"featured_media":2165651,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_mo_disable_npp":"","fifu_image_url":"https:\/\/wex-s3.s3.us-east-1.amazonaws.com\/wp-content\/uploads\/2024\/01\/wb-health-medicare-advantage-hospitals-insurers-013124C6-1024x591.png","fifu_image_alt":"Medicare Advantage plans used as leverage in hospital-insurer talks","footnotes":""},"categories":[538],"tags":[],"class_list":["post-2165650","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-washington-examiner"],"fifu_image_url":"https:\/\/wex-s3.s3.us-east-1.amazonaws.com\/wp-content\/uploads\/2024\/01\/wb-health-medicare-advantage-hospitals-insurers-013124C6-1024x591.png","fifu_image_alt":"Medicare Advantage plans used as leverage in hospital-insurer talks","_links":{"self":[{"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/posts\/2165650","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/users\/1217"}],"replies":[{"embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/comments?post=2165650"}],"version-history":[{"count":0,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/posts\/2165650\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/media\/2165651"}],"wp:attachment":[{"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/media?parent=2165650"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/categories?post=2165650"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/tags?post=2165650"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}