WHY WERE "POS" (POINT OF SERVICE) PLANS MISNOMERED AS "PFFS" PLANS, AND DID THIS FAULTY NOMENCLATURE CONTRIBUTE TO CONGRESSIONAL LEGISLATION TO ...

... TERMINATE THIS TYPE OF PLAN FROM THE PORTFOLIO OF MEDICARE ADVANTAGE PLANS?

Presumably, it is either CMS or the legislation creating Medicare Advantage Plans or both, which can be held accountable for the misnomering of what should have been called a POS (Point Of Service) Plan as a PFFS (Private Fee For Service) Plan. What cannot be denied is that the Congress, since 2006, has undermined the Medicare Advantage Plan industry, and that in the summer of 2008 struck a severe blow against the industry by scheduling the termination of PFFS plans effective at the close of 2010.

In the health insurance industry there are three now traditional models: POS, PPO, and HMO. For reasons that remain mysterious to this writer, CMS [presumably] chose not to use the standard health insurance terminology and misnomered the POS type plan as a PFFS plan. As Bill Shakespeare said (that famous thespian, author of poetry and plays, who died in 1616 AD - not the tennis player), "What's in a name? A rose by any other name would smell as sweet!" Thus spoke Juliet of "Romeo and Juliet" - and we know exactly what happened soon after these words were spoken!

There's much in a name, as evidenced by the role in the current healthcare debate that is displayed by criticism of the PFFS (Private Fee For Service) model of payment to medical providers as responsible for a great deal of the outlandish cost of medical care. Whether or not this is a true does not matter to this article, except to the extent that there may be negative spill-over and a poisoning of attitudes towards Medicare PFFS plans based solely and inappropriately on the faulty nomenclature. In point of fact our entire American system of health care payments is based on the PFFS reimbursement system and all Health Insurance Plans including all Medicare Advantage Plans are in one way or another paid according to the PFFS medical reimbursement mode.

Are you confused? Remember, the PFFS reimbursement model to health providers is NOT synonymous with the misnomered "PFFS Medicare Advantage Plan". One has to wonder, how such a blunder of nomenclature could occur and be institutionalized by CMS [or was it Congress?], the regulatory body responsible for that industry. Then again, CMS is the same body that is responsible for a seemingly harmless, but, profoundly faulty TV advertisement by the Government, misinforming the Medicare Beneficiary that Medicare Prescription Drug Plans could be reviewed and even switched during "Open Enrollment"; in point of fact, while this is true during the AEP (Annual Enrollment Period occurring November 15 - December 31), this is not true during the OEP (Open Enrollment Period occurring January 1 - March 31). So, having misinformed the public, will CMS (Centers for Medicare and Medicaid Services) [why not "CMMS'?] grant an SEP (Special Enrollment Period) to last the entire OEP this 2010 to allow Medicare Prescription Drug Plans to be switched per it's own word, however mistakenly advertised?

Anyhooooooo... returning to the subject of this article.... It should be clear that a Point Of Service Plan should be called a Point of Service Plan, not a PFFS plan. Properly labeled in the first place, perhaps they would not be facing extinction at the end of 2010. Perhaps as well there is a clue here as to how such a Plan can be given new life as a "POS - Network Plan". [This will be the focus of my next article.]