Medicare Advantage is working for many, but it falls short for the sickest patients, according to Steven Gordon, MD, CEO of St. Charles Health System in Bend, Ore.
In August, the system said it is considering dropping all Medicare Advantage plans and encouraged patients not to enroll in the private Medicare plans during the next open enrollment period.
The system is in negotiations with four Medicare Advantage plans for the 2024 plan year, according to an Aug. 31 message to patients from Dr. Gordon. At least some of these plans are open to continuing to negotiate, he wrote, and the system believes it will be in network with at least some Medicare Advantage plans in 2024.
Dr. Gordon acknowledged some patients are concerned about having to switch insurers or face higher costs at the health system.
"We take these concerns seriously and are certainly weighing potential impacts on community members in our decision-making. But we have also seen and felt for years the impact of not publicly acknowledging these problems, and the burden often lands on the shoulders of our sickest patients and our caregivers," Dr. Gordon wrote.
Dr. Gordon said Medicare Advantage plans do "a pretty good job" covering outpatient visits and procedures.
"For patients sick enough to need hospitalization or high levels of specialty care, however, the plans too often fall short. Patients on Medicare Advantage plans frequently end up staying in the hospital longer than traditional Medicare patients," Dr. Gordon wrote.
Patients can also face prior authorization denials, leading to long waits for care, Dr. Gordon wrote.
"As a physician, I have firsthand knowledge of how delays in care can impact a patient both emotionally and physically. I started out in my career when managed care plans were just coming into existence," Dr. Gordon wrote. "I'm struck now by how dramatically the administrative burden has piled up on the backs of my colleagues, our caregivers and our patients since those early days."
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