November 17, 2014
9:57 am
There are not high expectations for this lame duck session of Congress. We may see passage of a bill to authorize the Keystone XL pipeline and there will have to be action on a spending bill to keep government operating as well as funding measures related to the fights against Ebola and the Islamic State. But, when an election sees one party take over control of one or both houses of Congress, the new victors are usually content to put issues on hold until January when they have greater leverage over the outcomes.
Before the waning days of the 113th Congress elapse, however, there is one more critical item that lawmakers should include on their to-do list.
It’s high time to reform the Medicare payment system for physicians and other healthcare professionals.
Sixteen times since 2003, Congress has passed temporary fixes to prevent healthcare providers from having to absorb a significant reduction in their Medicare reimbursements. This patchwork approach isn’t fair to physicians, patients or taxpayers. Physicians should not have to wait year after year to find out if Medicare will provide a fair payment for treating beneficiaries. Patients don’t benefit from a system that doesn’t encourage healthcare professionals to provide better, evidence-based care at sustainable costs. And taxpayers have had to pay substantially more for these short-term patches than they would have if a sensible, permanent payment system had been implemented in the first place.
There’s no reason this indefensible situation should continue. In fact, it shouldn’t even be kicked over to the next Congress.
Legislation has been developed in both the House and Senate that would not only permanently fix the Medicare physician payment formula, but would also establish a structure to encourage coordinated care and reward healthcare providers for elevating the quality and cost-efficiency of patient care. This legislation has support from both Republicans and Democrats.
Further, there is widespread support in the healthcare and patient communities to act now instead of later.
The new Congress will have plenty on its plate next year. Fixing the Medicare payment formula should become a 2014 achievement, not a 2015 challenge.
October 27, 2014
2:46 pm
The Healthcare Leadership Council is very pleased to be supporting a conference taking place this Thursday, October 30 called “Mind the Gap: Improving Quality Measurement in Accountable Care Systems.” It’s co-sponsored by the National Pharmaceutical Council, National Health Council and the Pharmacy Quality Alliance.
One thing that is invariably true of all of our Healthcare Leadership Council members and so many successful organizations is that metrics matter. There is no such thing as being theoretically successful. If you can’t or don’t measure it – and measure it effectively, accurately and comprehensively – it doesn’t exist.
That’s the focus of this conference, looking at new healthcare payment and delivery systems like accountable care organizations. We have long maintained that ACOs and similar structures must achieve both cost-efficiency and improved clinical effectiveness (and, with it, improved patient outcomes). To ensure those two objectives are being met, high-quality measurement tools are imperative.
Experts on October 30 will look at the gaps in today’s measurement systems and whether all health conditions, those that affect millions and those that impact comparably fewer, are being assessed with the same rigor and detail. The conference is open to the public and you can register to attend here.
October 22, 2014
5:02 pm
(We have made the point often in this space that, even with the private sector’s successes in containing healthcare costs and reducing Medicare per-capita spending to historic lows, the sheer magnitude of baby boomers reaching 65 and reaching Medicare eligibility necessitates significant changes to the program. Moving away from a fee-for-service model that incentivizes volume rather than value is essential. As Mark Bertolini, CEO of Aetna (a Healthcare Leadership Council member) points out in this Forbes op-ed column, innovative approaches to Medicare payment and healthcare delivery can achieve better patient health and improved system sustainability.)
By Mark T. Bertolini
The Medicare Part A trust fund will be exhausted by 2030. As 11,000 baby boomers become eligible for Medicare daily, Medicare spending is projected to exceed $1 trillion in 2020. We can’t change the numbers that define our population but, we can apply new math to them.
Focus first on helping the chronically ill
The sickest 5 percent of fee-for-service Medicare patients with chronic conditions drive more than 40 percent of the total cost of health care in the program. We should use the lessons learned in Medicare Advantage and other proven innovations. Encourage Medicare Part A and B enrollees with multiple chronic conditions to participate in new integrated care programs with top-notch physicians to ensure high-quality service. Pay managed care organizations rates that guarantee savings for taxpayers out of the gate.
Use the successes and learnings of this approach to phase out the Medicare fee-for-service payment model
The fee-for-service model has doctors getting paid by the number of procedures they do or tests they run, rather than on how well their patients do. We need to move to a system that pays for quality over quantity.
These two changes alone will mean lower cost coupled with better integrated, quality care for the members of our families that need that care the most.
While the Congressional Budget Office recently reported that estimated costs of Medicare and Medicaid have dropped, our country’s coffers are still being drained by a too-costly health care system. This was reconfirmed in July, when the Boards of Trustees of the Federal Hospital insurance and Federal Supplementary Medical Insurance Trust Funds projected that Medicare costs will grow from their current level of 3.5 percent of the gross domestic product (GDP) to at least 5.3 percent of the GDP in 2035.
Consider this: As baby boomers become Medicare eligible, the number of beneficiaries will grow from 50.7 million in 2012 to 81 million in 2030—a 60 percent increase in less than 20 years. Add to this that the tax base is shrinking: Baby boomers are retiring, leaving the country with a much smaller workforce paying a much higher Medicare tax burden. With average life expectancy projected to reach 81.5 years by 2030, on average those seniors will use Medicare benefits for three times as long as when Medicare was enacted in 1965. Chronic conditions among Medicare beneficiaries also are on the rise, making them a sicker and more expensive population than existed in 1965.
The current fee-for-service payment model unintentionally incentivizes the wrong kinds of behaviors—spending less time with patients, or having more tests and procedures. There is little reward for finding more efficient ways to make people better or for keeping them healthy in the first place.
Bringing innovative collaboration to traditional Medicare
Many programs that have been so effective for caring for Medicare Advantage’s sickest beneficiaries, including enhanced home-based care, care coordination and medication review, are not always covered under traditional Medicare. Our experience in Medicare Advantage shows the promise of these models. For several years, we have worked with health care providers to establish reimbursement models based on risk-sharing that encourages higher-quality performance. Aetna Aetna’s Medicare Advantage Provider Collaboration program, and its work to create accountable care organizations (ACOs), are examples of cooperative arrangements that are improving care quality and health outcomes while also reducing costs. In many instances, these programs have resulted in fewer inpatient hospital days, fewer hospital admissions and fewer readmissions for patients, which can reduce health care costs by as much as 30 percent.
Bringing innovative provider collaborations and managed care approaches to traditional Medicare is a winning proposition for everyone. Patients could get a full team of experts providing customized and focused attention, and be rewarded with incentives for adhering to treatment. Doctors could get greater support, information and resources to help their patients get and stay healthy. Managed care companies could serve a broader Medicare population, as long as they meet the required quality and outcomes results. Taxpayers could get a lower-cost, better-quality healthcare system.
In the past, we have shied away from making significant changes to Medicare, since the issues seemed to be so far down the road. That is no longer the case. Our Medicare spending has a tremendous impact on our economy now, and that will only increase over the next decade. Our population is aging too quickly and our nation’s Medicare costs are growing too rapidly for us to be timid. We need to take dramatic action now, and revolutionize how we approach the problem. The numbers can work if we are ready to adopt a new model. We can achieve a result that includes both healthier seniors and a lower tax burden.
CATEGORIES: Access,
Access to Coverage for the Uninsured,
Adherence,
Evidence-Based Medicine,
Health,
Health Literacy and Disparities,
Health Reform,
Healthcare Costs and Value,
Medicare,
Protecting Innovation,
Wellness and Chronic Care Management |
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August 08, 2014
11:16 am
Earlier this year, the Centers for Medicare and Medicaid Services (CMS) issued proposed regulations that would have made significant, sweeping changes in the Medicare Part D prescription drug program. Among other aspects, the proposed rule would have placed new limitations on the number of Part D plans that plan sponsors could offer in a particular region.
In a logical world, policymakers would have first asked seniors if they felt the Part D program was inflicting too many plan choices upon them. They didn’t, so the Healthcare Leadership Council (through our Medicare Today initiative) did.
We recently released our annual nationwide survey of U.S seniors evaluating their perspectives regarding their prescription drug coverage. As has been the case in past years, satisfaction with Part D remains high, with almost 90 percent saying they’re pleased with their coverage and find it affordable.
More interesting, though, in context with the earlier CMS proposed rulemaking is the survey’s finding that three of every four seniors value having a wide choice of plans from which to choose and expressed concern with any changes that would limit those choices.
Ever since the inception of Medicare Part D, those who take a more patronizing view toward older Americans have asserted that they would be confused by having a number of plan choices before them. This survey makes it abundantly clear that is not the case.
CMS pulled back on its efforts to make such drastic changes to the Medicare prescription drug program. Before any further rulemaking takes place, federal regulators would do well to take into consideration what beneficiaries actually want.
June 10, 2014
1:36 pm
The Healthcare Leadership Council has long maintained that the nation can’t make its way toward a high-quality, cost-effective, sustainable healthcare system simply through arbitrary cuts in healthcare expenditures and controlling prices through government fiat. The importance of targeted research to better understand how to improve the efficacy of healthcare delivery and achieve a higher level of population health can’t be overstated.
That’s why we’re keeping a close eye on the comparative effective research being undertaken by the Patient-Centered Outcomes Research Institute. An important tool in this observation is the annual survey of healthcare stakeholders conducted by the National Pharmaceutical Council (NPC) health policy research organization. NPC has just released the results of its fourth annual survey of insurers, government leaders, employers and others who have a strong interest in the progress of comparative effectiveness research. Some of the facets of the survey we found most interesting include:
• A large majority – 84 percent – feel this research has had very little impact on healthcare decisionmaking over the past year, but are confident it will have a greater effect in the next three to five years.
• Stakeholders see a public-private partnership in the way healthcare research is conducted. According to the survey, they believe academia and the pharmaceutical industry will conduct most of the actual research in the years to come, but PCORI and the National Institutes of Health will be the leading players in funding and monitoring research.
• More stakeholders are saying that research priorities are adequately addressing the real-world choices faced by patients and providers – 37 percent now, up from 22 percent last year.
We believe comparative effectiveness research can be a valuable tool, if it is used to provide the different sectors of the healthcare community with the kind of information that can improve clinical effectiveness for all patients and healthcare consumers. The NPC survey provides an important measuring stick on this evolving linkage between data and healthcare practice.
