April 10, 2012
10:10 am
Today, I saw an argument in support of the Independent Payment Advisory Board (IPAB) – the 15-member board of political appointees with unprecedented power to reduce Medicare expenditures – that was so off the mark one would think it came from some sort of fringe website. In fact, it was found on CBS News’s Marketwatch site.
CBS provided webspace for a consulting actuary to argue that there is really no difference between IPAB and private insurers. IPAB will, he said, “assess whether certain procedures will be denied reimbursement, either due to ineffectiveness or excessive costs,” the same as private health insurers. IPAB members may be unelected, but, he argues, private insurance claims adjusters aren’t elected either.
“It’s just a reality that any insurance program, whether commercial or governmental, will deny some claims, states this CBS News-hosted editorial.
We won’t even get into some of the obvious differences between IPAB and private coverage, such as the fact that employers can take their business to different insurers. Or the fact that private insurers have appeals mechanisms, whereas IPAB decisions aren’t even subject to judicial review.
But that’s not even the biggest problem with this pro-IPAB argument. IPAB isn’t structured to cut costs by denied payment for ineffective procedures. It’s not about that at all.
As the Congressional Budget Office has made quite clear, the law creating IPAB explicitly forbids the board from rationing care, changing Medicare benefits or increasing beneficiary cost-sharing. According to CBO, the board will, for all practical purposes, be limited to cutting healthcare provider payments to meet its cost-cutting targets.
That’s not distinguishing one treatment or therapy from another based on cost and effectiveness. That’s simply paying physicians less to treat Medicare patients. And, in so doing, IPAB threatens to widen the payment level gap between Medicare and, you got it, private insurers. It will result in care for Medicare beneficiaries that is less accessible, not more cost-effective.
There is a legitimate debate to be had over whether IPAB is a wise public policy choice. To have that debate, though, we need to be on the same platform in terms of understanding what this board will actually do.
April 04, 2012
9:37 am
When you examine the rising costs in our healthcare system, an important starting point is the care required by the so-called dual eligibles, those Americans who are eligible for both Medicare and Medicaid. There are nearly 10 million individuals nationwide who fall into this category and they utilize a disproportionate share of healthcare services because of a high propensity for chronic disease and need for acute care.
Dual eligibles account for 27 percent of Medicare’s spending, although they represent only 16 percent of beneficiaries. That gap is even wider in Medicaid. According to a Wall Street Journal article last year, one reason costs are so high for this patient group is imperfect coordination between Medicare and Medicaid which is contributing to “hundreds of thousands of hospitalizations that could be avoided.”
A new report released this week shows that progress can be made in providing better, more cost-effective care to the dual eligible population. Avalere Health, a highly-regarded research and analysis firm specializing in health policy, has studied an integrated care model developed by SCAN Health Plan, a health insurer serving 130,000 Medicare Advantage beneficiaries in California and Arizona. (SCAN is also a member of the Healthcare Leadership Council.)
The Avalere study found that SCAN’s team-oriented case management approach for dual eligible patients, utilizing individually-tailored care plans, has resulted in hospital readmission rates that are 25 percent lower than traditional fee-for-service Medicare. SCAN also outperformed conventional Medicare by 14 percent in prevention indicators, maintaining patient wellness and keeping them out of the hospital.
As Avalere senior vice president Bonnie Washington put it, “Better coordinated care for low-income elderly patients is a critical imperative for federal and state governments. This study shows that well-developed care management models can result in measurable differences in quality, hospitalization and rehospitalization – and cost savings – for a vulnerable population in need of close care coordination.”
March 19, 2012
9:35 am
In this morning’s editorial, “This Cost-Cutting Reform Deserves a Chance,” the Washington Post paints opposition to the Independent Payment Advisory Board as largely political, or parochial, in nature. Republicans, the Post argues, want to sink one of President Obama’s initiatives before it can get off the ground, while some Democrats take issue with a non-elected board carrying out responsibilities that belong to Congress.
In making these points, the Post editorial goes off the rails early by focusing too heavily on inside-the-Beltway political banter. In fact, opposition to IPAB extends well beyond conventional White House-v-GOP partisan skirmishing. As of today, over 400 patient, healthcare, employer, veteran and disability organizations from all 50 states have signed a letter to Congress urging an immediate repeal of IPAB.
That kind of strong grassroots sentiment transcends partisan gamesmanship.
That’s not to say the Post editorial is entirely offbase. Actually, the opinion piece is right on the mark in saying that the Medicare status quo cannot stand and that Washington politicians have been negligent in not pursuing substantive change to address the program’s serious financial problems.
The newspaper is dead wrong, though, in asserting that IPAB represents a workable solution to this problem. The editorial pulls out what have become, by now familiar canards – that IPAB will be made up of healthcare experts, that the law creating it specifically forbids any kind of healthcare rationing. The simple fact is, though, that IPAB’s structure, in which changes must be made immediately in order to get program spending below an arbitrary level, will limit the board’s realistic options to cutting payments for healthcare services.
In some policy circles, chopping Medicare reimbursement levels is referred to as bringing greater efficiency to the program. In the real world, though, it means fewer physicians seeing Medicare patients and less beneficiary access to new healthcare innovations. The law may say that IPAB can’t recommend rationing, but reduced access to care is an inevitable result.
March 08, 2012
3:32 pm
We’re all concerned about how our healthcare workforces will keep up with an increasing patient population. Not only is Medicare growing at the rate of 7,500 new beneficiaries per day, but the Affordable Care Act will lead to millions more Americans having health coverage when fully implemented.
We’re seeing one answer in the form of technology that is helping to reduce hospital readmissions and enable health facilities to evaluate patient conditions and needs without requiring them to come to the doctor’s office.
This week, the Geisinger Health Plan and AMC Health announced the results of a two-year evaluation of a telemonitoring program developed by AMC. Geisinger found that home telemonitoring of patients with congestive heart failure reduced 30-day hospital readmission rates by more than 40 percent.
Here’s how the system works. Patients receive scheduled calls from an interactive voice response system. The patients report their symptoms, with those responses immediately stored in their electronic health record and evaluated. A determination is made whether the patient needs a follow-up with a nurse or a case manager. 96 percent of the Geisinger case managers said the system was allowing them to monitor heart failure patients more effectively.
This also bolsters our argument that there are better ways to address healthcare’s cost issues than simply axing dollars out of the system and consequently reducing patient access and care quality. There are technological solutions, as shown in this innovative work by AMC Health and Geisinger, that can make the system more cost-effective while providing even better care to patients.
March 02, 2012
2:34 pm
Following the House Energy and Commerce health subcommittee’s 17-5 bipartisan vote on Wednesday to repeal the Independent Payment Advisory Board (IPAB), there has been some important commentary on the issue worth spotlighting.
The National Minority Quality Forum pointed out that IPAB – the 15-member appointed board that will be empowered to cut Medicare spending – could endanger necessary investments in healthcare research and delivery.
A seniors’ organization, RetireSafe, made it clear that IPAB will do tremendous “collateral damage to Medicare beneficiaries.”
Former Congressional Budget Office Director Douglas Holtz-Eakin co-authored an op-ed in Real Clear Politics, pointing out that IPAB will cause more healthcare providers to cease accepting Medicare patients.
We’ll have more on this issue in the very near future. The House Ways and Means health subcommittee will have a hearing on the IPAB issue on Tuesday, March 6 at 10 a.m. We will be planning to live-tweet that hearing at @HealthInFocus.
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