The orthopedic providers going out of network with Medicare Advantage plans

Orthopedic

2023 has been a big year for physician-payer relationships, with reimbursement rates dropping, new spine and orthopedic codes being added and removed from prior authorization requirements, and health systems cutting ties with Medicare Advantage plans. 

Medicare Advantage has "gotten much, much worse [than it was a year ago]. It was bad back then, but now it's five times worse," Harel Deutsch, MD, co-director of the Rush Spine Center in Chicago, said during a panel at the Becker's 29th Annual Meeting in October. "Every time I turn on the TV, I see ads for Medicare Advantage and basically Medicare Advantage, they'll disapprove any surgery you apply for. A lot of times I have to tell patients, look, you have to wait until you can unenroll and then do that. Then you can have your surgery."

Here are seven orthopedic providers going out of network with Medicare Advantage plans: 

1. The Craniospinal Center of Los Angeles no longer accepts Medicare Advantage plans. "The restrictions regarding these plans have made taking care of patients extremely cumbersome. Even routine studies are denied," Brian Gantwerker, MD, a neurosurgeon at the system, told Becker's

2. IGEA Neuro no longer accepts Medicare Advantage patients, according to neurosurgeon Ciro Randazzo, MD. 

3. The Deuk Spine Institute in Melbourne, Fla., has decided to opt out of all Medicare plans. " I decided because I saw my reimbursement from Medicare for my professional fees as a neurosurgeon declining year over year and under threat year over year to where I saw approximately a 50 percent decrease over 10 years from 2000 to 2004 to about 2012 for my same surgeries I was doing. I also saw the Department of Justice going after physicians like a witch hunt for unintentional miscoding of services, which of course is a felony and comes with steep financial fines. I decided the risk of being a Medicare in-network neurosurgeon provider far outweighed the benefits," Ara Deukmedjian, MD, CEO and surgeon at the facility, told Becker's.

4.  Louisville, Ky.-based Baptist Health has announced plans to cut ties with WellCare, Humana and UnitedHealthcare Medicare Advantage plans beginning Jan. 1. This will include Baptist's orthopedic program, which offers joint replacements, sports medicine care and rehabilitation services. 

5. Mayo Clinic in Jacksonville, Fla., and Scottsdale, Ariz., will no longer accept the majority of Medicare Advantage plans. Both facilities have a robust orthopedic surgery department, and orthopedic patients will likely be impacted by the change. 

6. Corvallis, Ore.-based Samaritan Health Services ended its Medicare Advantage contracts with UnitedHealthcare, effective Jan. 9, 2024. The system offers a variety of orthopedic services, including joint replacements and sports medicine care. 

7. Starting in January, Brookings (S.D.) Health System will no longer be in network with Medicare Advantage plans. The system offers a range of orthopedic surgical services that will be impacted. 



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