Coalition comment letters urge changes to V28 risk adjustment initiative

ANNAPOLIS, MD, UNITED STATES, May 9, 2025 /EINPresswire.com/ -- Physicians for Medicare Advantage (MA) Beneficiaries (the Coalition), a non-profit organization of physician groups providing value-based care to Medicare patients continues to highlight how the V28 risk adjustment model and other payment cuts are negatively impacting senior care. Provider groups assuming risk under MA Plans are facing serious business issues due to falling reimbursement levels and MA beneficiaries are now paying the price with reduced covered health insurance benefits.

The Coalition is made of risk-bearing value-based care provider organizations (RBOs) collectively treating more than 1 million Medicare beneficiaries at more than 800 locations across 10 states. The Coalition sent in a comment letter on February 10, 2025 to the Centers for Medicare & Medicaid Services (CMS) outlining the membership’s concerns.

Following an analysis of the 2026 Medicare Advantage and Part D Rate Announcement on April 7, 2025 by the CMS, Coalition President Donna Walker comments that “While the final 2026 rate announcement includes a larger increase in estimate of the Effective Growth Rate than we’ve seen in recent years, in reality, we are still trying to catch up from the disproportionately low increases relative to medical costs under the previous administration. In addition, the increase is offset by the finalization of other policies from the Advance Notice that significantly reduce funding. That insufficient funding ultimately puts extreme pressure on value-based primary care practices serving a disproportionate number of patients with multiple chronic conditions.” Walker also serves as Chief Executive Officer at the IMA Medical Group.

“We’ve seen firsthand how policy changes like V28 have strained the very practices caring for our most vulnerable seniors,” adds Eugene DiBetta Jr. D.O., Chief Medical Officer at Paxton Medical Management. “Now is the time to restore balance, return physicians to the center of care design, and reaffirm that healthcare is, at its best, a calling rooted in service. We must also inspire the next generation of doctors, especially those entering family medicine and internal medicine, to see primary care not as a fallback, but as the front line of transformation. The future of this model rests on those of us who still believe healthcare is a calling, not just a contract, and who are willing to lead it forward together.”

“The Coalition exists to educate policymakers on key perspectives of physicians on the front line of day-to-day care for MA beneficiaries,” adds Walker. “Unfortunately, reductions in federal payments to MA plans are generally passed through to providers who take sole responsibility for the entire health services spend on a percentage of risk adjusted premium, and as a result, the V28 risk adjustment model and other MA payment cuts over the last three years have directly reduced advanced primary care services, closed offices, reduced physicians and clinical staff to treat patients, increased wait times and reduced access for beneficiaries.”

The Physicians for Medicare Advantage Beneficiaries’RBO membership is dedicated to amplifying the voices and unique perspectives of doctors who want to ensure that senior citizens enrolled in Medicare Advantage continue to have access to care they need. The Coalition will continue to educate federal policymakers on the extent to which MA funding reductions are passed through from plans to providers and the legislative and regulatory options to preserve for MA enrollees to coordinated value based care.

To learn more about the Coalition, see www.Docs4Seniors.org or email the group at info@docs4seniors.org

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About The Physicians for Medicare Advantage (MA) Beneficiaries – www.Docs4Seniors.org

Formed in early 2024, the Physicians for MA Beneficiaries is a nonprofit coalition of value-based care provider organizations collectively more than 1 million Medicare beneficiaries at more than 800 locations across 10 states. The primary purpose of the Coalition is to address the new Medicare Advantage (MA) risk adjustment methodology developed by the U.S. Centers for Medicare and Medicaid Services (CMS), and being implemented 2024-2026, which undercuts the ability of physicians in the Coalition to provide the best care to their patients enrolled in Medicare Advantage. Our member physician practice models are consistent with CMS’ definition of “advanced primary care” which CMS says consists of “improving primary care financing through increased, stable revenue that moves practices away from fee-for-service payments that pay for the volume of services delivered and toward support for team-based care, coordination with specialty providers, and community-based supports.”

Philo Hall
Physicians for MA Beneficiaries
+1 202-861-1382
info@docs4seniors.org
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