WASHINGTON, DC – Wednesday, U.S. Senator Maria Cantwell (D-WA) called for a critical examination of the Medicare Advantage Private fee-for-service plans. These plans have recently undergone increased scrutiny from Congress due to their explosive growth in the past few years.  Concerns have been raised about whether the private fee-for-service option is fulfilling the original mission of the Medicare Advantage program, which was implemented to give seniors a managed care alternative to traditional Medicare. 

 

“I have long been concerned about private fee-for-service plans,” said Cantwell. “These programs simply are not facilitating quality care for patients, and, as a result, we are seeing more providers refusing to accept patients using the plans.   Ultimately, seniors are on the losing end of private fee-for-service plans and can’t find physicians willing to accept these plans.”

Under current law, private fee-for-service plans do not have to comply with federal regulations that have made Medicare Advantage managed plans in Washington state work so well, including establishing working relationships with providers, paying fair rates, and reporting cost and quality measures.

 

Dr. Albert W. Fisk, Medical Directorfor the Everett Clinic in Everett, was asked by Cantwell and the Committee to share his experiences with the private fee-for-service plans. The Everett Clinic, a physician-owned group practice serving more than 20,000 Medicare patients, announced last year that it would no longer accept private fee-for-service plans. The Clinic experienced a lack of adequate reimbursements from the plans and encountered organizational inefficiencies that prevented the Clinic from coordinating services for patients.

 

“Economics are important, but the problems with the program extend far beyond the financial burden we have experienced.  Among our core values is to do what is right for every patient.  This means delivering coordinated care and promoting health and wellness.  Candidly, this approach is difficult with private fee-for-service plans,” said Dr. Fisk in his prepared testimony today.

 

Cantwell continues to work with her colleagues in the Finance Committee to make needed reforms to Medicare Advantage private-fee-for-service plans.  The Committee hopes to complete the legislation in the first half of the year.

 

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