System drops area doctors

Hundreds of Trumbull County Medicare Advantage beneficiaries are no longer covered for visits to their local physicians, and area doctors say that UnitedHealthcare and the Affordable Care Act are to blame.

The Medicare Advantage program is a network of providers that offers Medicare beneficiaries the option of getting benefits through a network rather than tradition Medicare Parts A and B.

But some area doctors say that the private program, which covers 14 million beneficiaries nationwide, was targeted for cuts under the Affordable Care Act.

“(Obamacare) made all of the Medicare Advantage companies like UnitedHealthcare take an 8 percent pay cut (in government payments), so what ends up happening is they needed to find a way to boost their (bottom line) back up,” Dr. James Martuccio said.

Martuccio, who operates an eye clinic in Warren, was one of the hundreds of Ohio providers recently dropped from the Medicare Advantage plan by UnitedHealthcare.

UnitedHealthcare has been reluctant to release official numbers on how many providers, locally and statewide, were dropped from their Medicare Advantage plans, but the company was in the news in mid-January for failing to alert patients of the removal of 660 Ohio doctors. The mistake, which UnitedHealthcare blamed on a database glitch, affected some 5,000 Ohio Medicare beneficiaries.

“In just Trumbull County, we’ve lost retinal coverage, orthopedic, internal medicine and GI doctors,” Martuccio said. “We lost a lot of talented providers, and it really damaged the medical coverage here.”

He said he has told his patients about their Medicare Advantage options, including major providers such as Aetna, Humana and Anthem, which have not made the same drastic cuts.

Insurers like UnitedHealthcare are preaching efficiency and quality as they face billions of dollars in government-payment cuts. UnitedHealthcare’s Jessica Baker said that the changes the company has made to its Medicare Advantage program stem from a handful of factors, including enrollment size as the “baby boomer” generation ages into the program.

“From a 50,000-foot level, it’s important to understand that specifically within Medicare, we’re faced with a booming population,” Baker said. “Enrollment (in Medicare) is expected to nearly double its current level by 2030.”

Baker said the company attempts to approach every region differently when it comes to working with providers.

“What we consider in Trumbull County isn’t necessarily what we consider in Mahoning County,” Baker said. “We look at many elements, including where members are concentrated geographically, to how individual providers are performing in relation to other providers and how many patients an individual provider may typically be seeing.”

UnitedHealthcare Medicare Advantage plan members have access to around 4,800 primary care physicians and more than 8,400 specialists across Ohio, Baker said.

Warren gastroenterologist Dr. Farid Naffah said, “I have heard that as many as 89 providers in Trumbull County have been dropped (by UnitedHealthcare). It seems to me that when you drop that many providers, you’re a company that has an agenda and a plan, and that plan really limits the choice that patients have in terms of who they can go to.”

Other states affected by similar cuts have taken legal action to bring providers back into network coverage. Ohio State Medical Association staff liaison Todd Baker said that Ohio is not one of those states.

“We’ve tried to be as strategic as we can to get people back onto plans,” Baker said. “We’ve been working with (the federal Centers for Medicare and Medicaid) to give them as much information as we can so that they can review the cases and see if there are issues with network adequacy in areas where patients can no longer receive reasonable (local) treatment.”

In mid-December, the state association and the federal agency were able to get 10 practices with more than 75 doctors in Ohio reinstates to UnitedHealthcare’s Medicare Advantage network.

Baker said that success like that gained without taking legal action give him hope that more progress can be made in getting Ohio’s Medicare beneficiaries the local treatment they need.