By Mindy Yochelson
Sept. 24 --The percentage of
beneficiaries in Medicare Advantage plans that are rated four stars on the
Centers for Medicare & Medicaid Services' one-to-five-star quality scale
will increase substantially in 2014, a top agency official said Sept. 24.
Jonathan Blum, the CMS's acting principal deputy administrator, told
America's Health Insurance Plans' 2013 Medicare Conference that 43 percent of MA
enrollees will be in plans rated four stars next year, compared with 28 percent
The percentage of beneficiaries in five-star plans in 2014 will
remain at 9 percent, according to Blum, who also serves as director of the CMS's
Center for Medicare.
This means, he said, that more than half of
beneficiaries will be in four- or five-star plans.
On the lower end of the scale, in 2014, 43 percent of
beneficiaries will be in plans that receive three stars, down from 56 percent in
“Plans have really dedicated themselves to quality improvement” and
put in place changes that would raise their rating, he said.
the greater percentage of MA enrollees in higher-rated plans means that
beneficiaries are making “active switches” from plans that are lower rated, he
said. The star ratings are intended to influence beneficiaries' choice of plans
with the stars--along with icons for those plans that are high and low
performing--indicated on the CMS's Medicare.gov website.
The star rating
system also allows for the payment of quality bonuses to MA plans with at least
Blum said that, surprisingly, plans with higher quality
ratings didn't necessarily receive higher scores on compliance audits.
The CMS's 2012 audit compliance program didn't reveal the “natural
relationship that I had hoped for” between the audit results and the 2011 star
ratings, he said.
Therefore, the CMS's strategy will be to focus audits
on all plans, not necessarily those with low ratings.
Blum also addressed a recent CMS report that said national
health-care spending is expected to continue growing at historically low rates
in 2013, as the Affordable Care Act is implemented and the economy improves
In the Medicare arena, he said, “I personally don't think it's the
economy that's driving the overall slowdown.” Instead, it is “fundamental
differences in how care is delivered.”
For example, the report indicated
that Medicare Part A hospital spending was estimated to grow 4.9 percent in 2012
but slow to 4.1 percent in 2013.
Blum credited the Part A slowdown to a
reduction in hospital readmissions.
The report also showed a slowdown in
Medicare Part D (prescription drug) spending.
The report said drug
spending fell 0.8 percent in 2012 in part due to a drop in the average price
paid for prescriptions as some popular brand-name drugs lost patent
Blum said beneficiaries switching from brands to generics was
also behind the Part D slowdown.
showed a chart indicating that while spending for Medicare Parts A and D is
slowing, Medicare Part B (physician) spending is continuing to rise and Part C
(Medicare Advantage) spending is flat.
The rise in Part B spending is
expected because of the shift away from care in hospitals to physician offices
and outpatient departments, Blum said.
However, he was less sure of the
reasons why the per capita cost growth in Part C remained flat between 2010-2011
and 2011-2012, despite the ACA cuts for Medicare Advantage.
ACA, Part C plans were paid about 113 percent of fee-for-service Medicare. Even
though they are now paid about 103 percent, the lower payments don't appear to
be driving lower spending.
The CMS will continue to focus on how all
parts of Medicare can contribute to the overall slowdown, he said.
To contact the reporter on this story: Mindy Yochelson in Washington
To contact the editor
responsible for this story: Ward Pimley at firstname.lastname@example.org