Managed-care organizations and provider networks could be overwhelmed with administrative and clinical tasks if millions of elderly people immediately join private-sector plans under a restructured Medicare program, provider groups warned a congressional advisory panel.
Under congressional balanced-budget legislation, Medicare beneficiaries are expected to have expanded coverage choices.
Beneficiaries could enroll in private plans when they become available in areas that previously had not been served by a Medicare HMO. Beneficiaries also will have the opportunity to enroll when provider service networks become available in their area.
Under the proposed legislation, there would be monthly sign-up periods until October 1997, resulting in a rolling wave of new enrollees. Starting in October 1997, enrollment would be largely restricted to an annual monthlong sign-up period during October.
If Medicare beneficiaries migrate in large numbers to the private sector, healthcare plans and providers may be unprepared for the increased demand for healthcare services and educational materials that Medicare beneficiaries may require, provider groups told the Physician Payment Review Commission.
For instance, Medicare beneficiaries who enroll for the first time in private plans will require orientation about the plans and initial assessments of their medications and medical needs.
"We've certainly become aware of the clinical and administrative problems of large-scale signups at one particular time of year," said Kevin Carey, M.D., medical director for managed care at Guthrie Clinic in Sayre, Pa., who spoke on behalf of the American Group Practice Association. "We would want to support some type of rolling enrollment that would alleviate that stress."
If private-sector plans are unprepared for that potential increased demand, they could become a barrier to increased managed-care enrollment, said commission member Roger Taylor, M.D., executive vice president and chief medical officer of PacifiCare Health Systems.
At the end of 1994, about 8.8% of the more than 36 million Medicare beneficiaries were enrolled in a managed-care plan, according to PPRC. Medicare managed-care enrollment grew 63% between 1990 and 1994.
In 1994, enrollment in managed-care plans by Medicare beneficiaries exceeded 10% in eight states and 20% in Arizona, California, Oregon and Nevada, the PPRC said. Both the Republican congressional leadership and Clinton administration rely on increased managed-care enrollment to squeeze savings from Medicare as part of an effort to balance the federal budget.
The congressional balanced-budget plan anticipates $26.9 billion in Medicare savings over seven years as a result of increased managed-care enrollment.