California Group Leads National Effort Opposing Medicare Advantage Cuts

On Monday, a California trade association representing physician groups sent a letter to CMS officials — backed by more than 300 physician groups across the country — opposing proposed cuts to Medicare Advantage.

CMS is considering Medicare Advantage provider rate cuts, and is due to make a decision by April 6.

“If CMS’ proposal is finalized, physicians across the country participating in Medicare Advantage will face cuts for the eighth consecutive year!” the letter said.

“We cannot imagine a situation where eight consecutive years of funding cuts would be deemed tolerable for any other sector of the health care industry,” it said.

The letter comes from Donald Crane, president and CEO of the California Association of Physician Groups. That organization has added a number of non-California physician groups as members and now calls itself CAPG, the Voice of Accountable Physician Groups.

“We immediately think of the annual debate over the Medicare Part B Sustainable Growth Rate Formula,” Crane wrote. “Each year lawmakers bend over backwards to insulate fee-for-service physicians from cuts — often replacing proposed cuts with increases. Preventing these cuts is viewed as essential to maintaining access to services for Medicare beneficiaries.”

The same logic needs to be applied to Medicare Advantage, he said.

“[This] will directly reduce benefits and access to high-quality, coordinated care for seniors in that program,” he said.

Private health plans provide Medicare Advantage as a managed care type of Medicare to about 16 million seniors across the country.

Specifically, the physician groups want to roll back the 2014 risk adjustment model to the one used in 2013, and to focus on value-based payment models, rather than risk-based ones.

“It seems to us inconsistent to simultaneously try to drive physicians into risk-based models while cutting the program that has arguably the most successful examples of risk-based models,” the letter said.

“Seniors in Medicare Advantage deserve the same concern for their access and quality,” Crane said, “as seniors in original Medicare.”

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