Issue link: https://beckershealthcare.uberflip.com/i/1512717
13 THOUGHT LEADERSHIP 'It's a scam': Why 2 practices no longer accept Medicare Advantage patients By Claire Wallace H ealth systems have been cutting ties with Medicare Advantage plans left and right, including Raleigh, N.C.-based WakeMed and Zanesville, Ohio-based Genesis HealthCare System. Systems that previously treated patients covered by Medicare Advantage plans from major payers including UnitedHealthcare, Humana and Anthem no longer find treating those patients cost effective or sustainable. Physicians from two practices, including the Craniospinal Center of Los Angeles and Bedminster, N.J.-based IGEA Neuro, told Becker's they are also no longer accepting MA-covered individuals, citing hefty administrative requirements, continued reimbursement decreases and coverage denials. Question: Do you/does your practice currently accept Medicare Advantage patients? Why or why not? Brian Gantwerker, MD. Neurosurgeon at the Craniospinal Center of Los Angeles: We currently are no longer accepting Medicare Advantage. The restrictions regarding these plans have made taking care of patients extremely cumbersome. Even routine studies are denied. I had a patient I met when on call with an odontoid fracture. I fixed the fracture by fusing the first and second vertebrae together from the back. Her plan denied a follow-up CT scan, which is routine, at six months. The plan denied the scan because she "did not have a spinal cord injury." We appealed because: 1) The whole reason I did the surgery was so she wouldn't get a spinal cord injury; and 2) The proper study for a spinal cord injury would very likely be an MRI, except in certain situations. Either way, the denial was ridiculous. If you couple that with payment issues — late or no payment all, along with increasingly uncovering the money-making scam MA plans have turned out to be — taking these plans becomes a losing option. I feel for the members and encourage them to talk to their insurance agents, or in some cases, their human resources people to seek other options. Many hospitals have also stopped taking them altogether. The unfortunate truth is that the companies offering these plans and TV commercials mislead patients into thinking they are doing the right thing. The patients lose by giving these for-profit companies their hard-won Medicare benefits while the companies don't pay anyone who is giving care. It's a scam whose end time has come. Ciro Randazzo, MD. Neurosurgeon at IGEA Neuro: No, we do not. We have stopped seeing these patients due to poor and decreasing reimbursement as well as increased paperwork and administrative requirements for the plans. n 6 principles to ASC success: An administrator's guide By Patsy Newitt J oe Peluso, administrator at Aestique Surgical Center in Greensburg, Pa., joined Becker's to discuss his ASC teams' approach to leadership. Editor's note: is response was edited lightly for brevity and clarity. Joe Peluso: Building a state-of-the art, sustainable, growth-oriented ASC, amid uncertainty, is associated with many challenges that are oen interrelated, creating a complex array of risk and ramifications demanding swi decision-making. e economic environment is shaping today's ASC decision-making. Financial stability and growth rely on leadership's ability for proactive decision making and developing reliable teams and partnerships. Aestique's overall approach to promote our commitment to the patient experience and compliance with all acceptable laws, rules, and regulations in conducting our business with integrity is driven by six key guiding principles: 1. Aestique fosters an open culture in which concerns can be raised without fear of retaliation. 2. Our clinical and professional staff must act with the highest standards of personal and professional integrity in the best interest of providing the highest quality care and services to our patients. 3. Aestique's people are our greatest assets. We are people who care for people. 4. Aestique competes fairly and complies with applicable laws, rules, regulations, and the highest standards of ethical conduct. 5. Quality patient care is our highest priority. Our staff act to support and advance our goal of providing care and services that meet or exceed our patients' expectations for safety, quality, cost effectiveness, and integrity, advancing healthcare together. 6. We are a multispecialty surgical center supporting our communities focusing on access, cost, quality, and convenience with highly trained clinicians. Winning strategies that address controlling costs, improving patient outcomes and satisfying/engaging patients require leadership alignment, strong partnerships, dedicated group members, organizational agility and a culture that welcomes ideas from all levels of the organization. When organizational synergy exists between and among leadership, managers, employees and physicians, challenges can be addressed to create a sustainable ASC that keeps pace with changes in community health, competition, workforce and payers. Cross-collaboration encourages innovation, creativity and a collaborative fresh view on problem solving by listening to the needs and ideas of colleagues resulting in better decision making. Strategic opportunities will be considered that have all the necessary information from all parties to be in a position to complete due diligence through critical thinking, financial acuity and the ability to take on more risk. is type of strategic thinking leads to strong decisions by leaders that are clearly articulated and communicated as to why all group members of the organization should be excited about the new ideas and perspectives. n