I am a retired RN, as well as a state-certified volunteer SHIP (Medicare) counselor. I am tremendously distressed by a little-publicized experiment underway with our Medicare program — an experiment with the potential to effectively privatize all of Medicare. Worse still, beneficiaries can be enrolled in this experiment without asking their consent.
I refer to the creation of Direct Contracting Entities (DCE’s) as an intermediary between beneficiaries and Medicare itself. Fifty-three such entities already exist; more than half are large insurance companies or venture capital organizations, rather than health care organizations. The DCE’s receive funds from Medicare; they contract with provider groups. The provider groups “assume risk” — that is, they receive funds to care for their clients. If they spend less, they retain profits — creating a perverse incentive to provide less care.
If your physician is in a group with such a contract, you are part of a DCE. You are not asked if you want to have your care under the supervision of a for-profit venture capital organization. If you do not like being part of a DCE, your option is to change doctors. On the other hand, the director of the Center for Medicare and Medicaid Innovation (the initiator of this experiment) at the time this started said it was her goal to have all of Medicare become part of such “value-based” management by 2030. In a few years, switching doctors may not be an option!
By law, the Center for Medicare and Medicaid Innovation, has the authority to expand any experimental model it deems successful to all of Medicare without the need for additional Congressional authorization. DCE’s stand to privatize and destroy our current tremendously beneficial Medicare program. We need to let our representatives in Washington know we wish them to halt this dangerous experiment immediately.