government
Specialty physicians say state dual-eligible demos might disrupt care
NEWS IN BRIEF — Posted June 4, 2012
State demonstration projects to integrate care for patients eligible for both Medicare and Medicaid may have unintended consequences that could pose risks to patients, the Alliance of Specialty Medicine wrote in a May 24 letter to Marilyn Tavenner, acting administrator of the Centers for Medicare & Medicaid Services.
Under an initiative funded by the health system reform law, CMS will provide 15 states with up to $1 million each to develop new ways to address the costly medical needs of dual eligibles, the letter noted. Though the goal is to prevent duplication of services, expand access and lower costs, the alliance wrote that it was concerned about “the speed and varying state approaches to implementing these demonstrations, which could disrupt patients’ access to care and their choice of physician.”
A number of states, for example, have proposed implementing passive enrollment processes and/or limiting choice of plans available to beneficiaries. Under such proposals, “dual-eligible beneficiaries may potentially be subject to harmful disruptions in care, particularly if they have established provider relationships and care plans and those providers are not included in the plan the beneficiary is passively enrolled in, or the beneficiaries’ new drug plan has a different formulary impacting their existing therapy,” the letter said.
The alliance is a coalition of national medical specialty societies representing more than 100,000 surgeons and other physicians.
Note: This item originally appeared at http://www.ama-assn.org/amednews/2012/06/04/gvbf0604.htm.
