AHA: Zochita Zamalamulo Zofunika Kuletsa Mapulani a MA Kuwononga Opindula ndi Medicare

Mapulani a Medicare Advantage amagwiritsa ntchito ndondomeko zomwe zimavulaza opindula a Medicare, madokotala otopa ndi kuonjezera ndalama zothandizira zaumoyo, American Hospital Association (AHA) inatsutsa lipoti laposachedwapa. Report. Pofuna kuthana ndi mavutowa, American Heart Association ikufuna kuchitapo kanthu.

Makamaka, AHA ikunena kuti mapulani ena a MA ali ndi miyezo yolimba yachipatala kuposa mapulani achikhalidwe a Medicare, amagwiritsa ntchito “zowonjezera” zofunikira zovomerezeka, kugwiritsa ntchito zida zosafunikira zoyendetsera ntchito ndipo amafuna kutumizidwa pafupipafupi kwachipatala kuti athandizidwe.

American Heart Association yalengeza kuti “zochitazi zimabweretsa kuchedwa kwa chisamaliro ndipo zingayambitse kuvulaza mwachindunji kwa wodwalayo.” “Kuonjezera apo, amawonjezera mavuto azachuma komanso kupanikizika pazithandizo zachipatala, zomwe zimafuna kuti ogwira ntchito ndi zipangizo zamakono ziwonjezeke kuti zigwirizane ndi zofunikira za ndondomeko, komanso zimathandizira kwambiri pakutopa kwa ogwira ntchito zachipatala.”

Lipoti la AHA likubwera pambuyo pa Nyumba ya Oyimilira ku US Zadutsa bwino Lamulo Lokulitsa Kupeza Kwa Okalamba Kusamaliridwa Panthawi Yake sabata yatha. Biluyo ifotokoza zofunika zingapo panjira yovomerezeka asanavomerezedwe pansi pa mapulani a Millennium Assessment. Chilolezo chisanachitike chimatsimikizira ngati wolipirayo apereka chithandizo chamankhwala.

Ngakhale bungwe la American Heart Association likugwirizana ndi biluyo, ikukhulupirira kuti boma likufunika kuchitapo kanthu. Mu lipotilo, Congress ikufuna makamaka:

  • Kuletsa mapulani a zochita za migodi pamene njira zololeza zisanachitike zichedwetsa chisamaliro
  • Kuonjezera kuyang’anira ndi Centers for Medicare ndi Medicaid Services (CMS). Izi zikuphatikizanso malipoti ochulukirapo pakukana kufalitsa, madandaulo, ndi madandaulo; kupangitsa kuti zidziwitso za magwiridwe antchito a pulani zizipezeka poyera; ndi kupereka zowunikira zowunikira malinga ndi momwe mapulani amagwirira ntchito.
  • Pangani ndondomeko kuti opereka chithandizo apereke madandaulo ku CMS
  • Pangani zofunikira zachipatala kukhala zofanana pakati pa mapulani a master ndi mapulani achikhalidwe a Medicare
  • Wonjezerani zofunikira pamanetiweki pamawebusayiti ena ovuta kwambiri. Kukwanira kwa maukonde kumatanthawuza gulu lalikulu lokwanira la opereka chithandizo mu dongosolo laumoyo lomwe odwala angalandire chisamaliro choyenera.

“Kuchitapo kanthu kwa Congression kumafunika kuletsa mwachindunji mapulani a MA kuti asagwiritse ntchito zofunikira zachipatala zomwe zimakhala zolemetsa kuposa zomwe zimagwiritsidwa ntchito kwa odwala omwe amalembedwa kuchipatala,” American Heart Association inatero mu lipotilo. “Izi zimapangitsa kuti odwala asamalandire chithandizo chofunikira chachipatala chomwe chiyenera kulipidwa ndikupanga kusalingana kwa kupeza chithandizo pakati pa omwe amalembedwa mu ndondomeko ya MA motsutsana ndi Medicare.”

Poyankha lipoti la AHA, American Health Insurance Plans (AHIP), bungwe lolimbikitsa olipira, linanena kuti zina mwazochitazi ndizofunikira kuti tipewe kusamalidwa kosafunika komanso kuchepetsa ndalama. A 2019 Maphunziro a JAMA Zinapeza kuti mtengo wa zowonongeka ku dongosolo lachipatala la US limachokera ku $ 760 biliyoni mpaka $ 935 biliyoni, zomwe ziri pafupi 25% ya ndalama zonse zothandizira zaumoyo.

Othandizira inshuwalansi ya umoyo amaimira anthu omwe amawatumikira poonetsetsa kuti chisamaliro choyenera chikuperekedwa panthawi yoyenera komanso pamalo abwino – ndikulipira mtengo umene odwala angakwanitse. Chilolezo choyambirira chimalepheretsa kuwononga komanso kumapangitsa kuti odwala, ogula, ndi olemba anzawo ntchito athe kukwanitsa,” Mneneri wa AHIP a Christine Groff analemba mu imelo. kapena mankhwala amene Madokotala amawalembera kuti ndi otetezeka, othandiza ndiponso otsika mtengo kwa odwala.

Izi sizikutanthauza kuti machitidwe ena sangathe kuwongoleredwa. Kufewetsa njira yovomerezeratu, Grow imalimbikitsa kuvomereza kale pakompyuta. Mu 2020, AHIP idakhazikitsa fayilo Njira yachangu yotsatsira ukadaulo wa pre-authorization Njira yodziwira mphamvu ya chilolezo choyambirira chamagetsi. Iye, Iye Zinapeza kuti 71% ya opereka chithandizo omwe adatengera njira zamagetsi kwa ambiri kapena odwala awo onse adanena kuti odwala adalandira chithandizo mofulumira.

Chithunzi: Bet_Noire, Getty Images

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