Many Medicare Advantage Plans Wouldn't Qualify for Upcoming Quality Payments Based on Current Data

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When CMS begins reimbursing Medicare Advantage plans based on quality in 2012, plans covering three-quarters of enrollees wouldn’t be eligible for bonus payments, if current quality scores still hold, according to a report by the Kaiser Family Foundation.

One-quarter of Medicare Advantage enrollees nationwide are in plans receiving four or more stars, the quality ratings needed for CMS bonus payments, which have yet to be calculated. While many plans are at the three-star level, 17 percent of enrollees are in contracts with one to two stars.

What's more, performance varies widely by state. States' share of Medicare Advantage enrollees in plans with four or more stars varies from 67 percent in the District of Columbia to zero percent in Arkansas, Mississippi, Montana, Nebraska and Vermont. In 27 states, less than 10 percent of Medicare Advantage enrollees are in contracts with four or more stars.

The ratings are based on the Healthcare Effectiveness Data and Information Set (HEDIS), the Consumer Assessment of Healthcare Providers and Systems (CAHPS), the Health Outcomes Survey (HOS), and CMS data on member satisfaction and disenrollment, plans' appeals processes, audit results and customer service.

CMS then groups the individual quality measures into five domains: screenings, tests, and vaccines; managing chronic conditions; health plan responsiveness and care; member complaints, appeals and exiting the plan; and customer service.

Read the Kaiser Family Foundation issue brief on Medicare Advantage (pdf).

Read more coverage on Medicare:

- Wall Street Journal Opinion Piece Says ObamaCare will Gut Medicare, Ax Payments to Hospitals, Physicians

- CMS and Board of Trustees Releases Sobering Report on Medicare Finances

- Health Law's Controversial Payment Board Holds Promise But May Backfire

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