Medicare Advantage is "failing patients" and "jeopardizing" Nebraska hospitals, according to a survey of 92 member hospitals from the Nebraska Hospital Association.
MA provides health coverage to more than 55% of the nation's older adults, about 33.8 million people, but some hospitals and health systems are ending their contracts with MA plans over administrative challenges that include excessive prior authorization denial rates and slow payments from insurers.
"Medicare Advantage challenges the future of critical access hospitals due to lower reimbursement rates, slower or denied payments, and increased administrative burdens," Jed Hansen, executive director of the Nebraska Rural Health Association, said during an Oct. 2 virtual meeting with hospital leaders. "Without changes to MA, our rural hospitals may be forced to cut staff and services, further harming patient care. Over time, some of our rural hospitals may be forced to close altogether."
North Platte, Neb.-based Great Plains Health will stop contracting with MA plans in 2025 and is pushing patients to opt for traditional Medicare to continue receiving care from its providers.
"At Great Plains our focus has always been on patient care, access and affordability. Unfortunately, Medicare Advantage does not align with our mission to put patients first," CEO Ivan Mitchell said.
As of 2025, the Great Plains Health Innovation Network, which includes the system's clinics and independent practices, will no longer participate in Centene's Wellcare, Blue Cross Blue Shield and UnitedHealthcare MA plans.
"We can no longer be under contract with a plan that causes significant delays in care, longer hospital stays and outright denials of care," Narayana Koduri, MD, Great Plains Health's chief medical officer, said.
MA enrollment in rural communities has increased 48% between 2019 and 2023, according to a recent report from the Chartis Center for Rural Health. However, because MA does not follow cost-based reimbursement, MA net reimbursement to critical access hospitals is often lower than traditional Medicare for similar services.
Robert Dyer, CEO of Cozad (Neb.) Community Health System said, "even though [MA] plans are supposed to follow the same rules and regulations, we find additional barriers to care."
A separate study published in the American Journal of Managed Care found that increasing MA enrollment in rural areas did not increase rural hospitals' financial distress or risk of closing
Researchers examined rural hospitals in 14 states from 2008 to 2019. During this period, MA enrollment in these areas rose from 14.3% to 28.4%, and the share of inpatient stays covered by MA plans grew from 6.5% to 20.6%. The study found that for each 1% increase in MA enrollment, hospitals' financial stability improved slightly, reducing their closure risk by 5%.
The NHA ended the meeting by emphasizing the need for policy changes in MA plans, including streamlining prior authorization policies, paying rural adequately to preserve health care services, and additional federal oversight of the program.
"Hospitals are cornerstones of the community and provide much needed access to affordable, quality health care for patients close to home," Jeremy Nordquist, president of the association, said. "Medicare Advantage impairs their ability to care for patients with undue administrative burdens, payment denials and lower reimbursements compared to traditional Medicare."