Health Affairs February 7, 2022
Dr. Richard Gilfillan and Dr. Donald Berwick recently authored a two-part article appearing in Health Affairs Forefront voicing criticism of the Medicare Advantage (MA) program and the Center for Medicare and Medicaid Innovation’s Global and Professional Direct Contracting (GPDC) pilot program. The authors cite their belief that MA is beset with cost and coding abuses committed by participating physicians, organizations, and health plans and that GPDC has the potential to introduce these same abuses into fee-for-service (FFS) Medicare. They suggest that the Centers for Medicare and Medicaid Services (CMS) replace the risk-scoring system based on hierarchical condition categories in two years, feel Medicare Advantage is “fundamentally flawed,” and recommend stopping the GPDC program entirely.
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