With Medicare’s financing unraveling, Medicare reform will need to be high on the next president’s agenda. In a new report from The Century Foundation, fellow and HealthBeat Blog editor Maggie Mahar (www.healthbeatblog.org) points out that past proposals for containing Medicare’s costs, such as putting a cap on physicians’ fees or requiring beneficiaries to pay more for their care, have not worked. She calls for a fundamental set of reforms that would not only save money but also improve the quality of care that beneficiaries receive.
You will find the report at www.tcf.org later today.
Nice review but why no mention of tort reform to help lower the expense of defensive medicine? Any estimates of the costs of devising/revising, implementing, and monitoring outcome measures, for a pay for performance system? Do any other countries have a pay for performance(quality) health care system?
“She calls for a fundamental set of reforms that would not only save money but also improve the quality of care that beneficiaries receive.”
Granted, there has to be ways to save money and improve the quality of care.
Most overlooked is the tremendous amount of fraud – hospital beds that are never delivered, scooters never driven and tests that are billed but never administered.
If we could cut the fraud out of Medicare, that would take us a long way down the road.
“She calls for a fundamental set of reforms that would not only save money but also improve the quality of care that beneficiaries receive.”
Granted, there has to be ways to save money and improve the quality of care.
Most overlooked is the tremendous amount of fraud – hospital beds that are never delivered, scooters never driven and tests that are billed but never administered.
If we could cut the fraud out of Medicare, that would take us a long way down the road.
Maggie:
Nice summary of all the points you have been making for the past few months, but…
While there is an important role in educating the public and pols about the sources of high costs and inefficiencies in the system, the reason there is little progress has to do with money and power.
This report needs to be followed up with some discussions on implementation. Those making money under the present system aren’t about to give up the gravy train without a fight, and I don’t see any group on the other side with sufficient clout to get change implemented.
The present finance meltdown shows how far things have to go before the public and the pols “notice”. I think health care is in a similar situation, the experts know what is happening, but can’t get anyone else to focus on the issues.
Dan, medicare supplement and Robert–
Thanks for your comment.
Dan– I didn’t write about tort reform because it’s not part of Medicare reform. It would in fact be illegal to try to write rules regarding malpractice suits that only apply to patients over 65.
I have, however, written about malpractice here
http://www.healthbeatblog.org/2008/05/medical-malpr-1.html.and here,http://www.healthbeatblog.org/2008/05/medical-malprac.html.
I try to clear up the many myths about malpractice–and end saying that we have to find a better way. The current system is doing too much damage.
Other countries are experimenting with various ways of paying for quality. They’re also much better at just refusing to pay for ineffective treatments–with no medical evidence to back them up.
Over the long run, paying for quality (outcomes) rather than quantity (volume) will pay for itself. Better outcomes go hand in hand with lower spending.
Note that this is not “pay for performance”–paying doctors for doing a certain list of things. This is paying all of the doctors and the hospital involved in a course of treatment a “bundled” payment, which includes a bonus if the outcome is good. This encourages collaboration rather than competition.
medicare supplement– yes, fraud is a real problem. Medicare should probably spend more on ferreting out fraud.
Robert– there is some movement already. The legislation proposing a comparative effectiveness institute is making headway in Congress.
And it’s quite certain that next year, Congress will repeal the bonus windfall for Medicare Advantage. It’s also quite likely that Congress will vote to let Medicare negotiate discounts with drugmakers.
In general, “implementation” is what my Medicare Working Group is looking at.
Finally, I think the economic meltdown is driving the point home that markets (including health care markets) need regulation.
The days of Reagan’s laissez fair economics are drawing to a close.
It will be a tough battle, and it will take years to undo the conservative agenda that has been put in place over the last 28 years, but the pendulum is swinging . ..
Dan, medicare supplement and Robert–
Thanks for your comment.
Dan– I didn’t write about tort reform because it’s not part of Medicare reform. It would in fact be illegal to try to write rules regarding malpractice suits that only apply to patients over 65.
I have, however, written about malpractice here
http://www.healthbeatblog.org/2008/05/medical-malpr-1.html.and here,http://www.healthbeatblog.org/2008/05/medical-malprac.html.
I try to clear up the many myths about malpractice–and end saying that we have to find a better way. The current system is doing too much damage.
Other countries are experimenting with various ways of paying for quality. They’re also much better at just refusing to pay for ineffective treatments–with no medical evidence to back them up.
Over the long run, paying for quality (outcomes) rather than quantity (volume) will pay for itself. Better outcomes go hand in hand with lower spending.
Note that this is not “pay for performance”–paying doctors for doing a certain list of things. This is paying all of the doctors and the hospital involved in a course of treatment a “bundled” payment, which includes a bonus if the outcome is good. This encourages collaboration rather than competition.
medicare supplement– yes, fraud is a real problem. Medicare should probably spend more on ferreting out fraud.
Robert– there is some movement already. The legislation proposing a comparative effectiveness institute is making headway in Congress.
And it’s quite certain that next year, Congress will repeal the bonus windfall for Medicare Advantage. It’s also quite likely that Congress will vote to let Medicare negotiate discounts with drugmakers.
In general, “implementation” is what my Medicare Working Group is looking at.
Finally, I think the economic meltdown is driving the point home that markets (including health care markets) need regulation.
The days of Reagan’s laissez fair economics are drawing to a close.
It will be a tough battle, and it will take years to undo the conservative agenda that has been put in place over the last 28 years, but the pendulum is swinging . ..
Multiple Medicare Supplement Quotes are available online at http://www.lowcostmedigap.com
Recent announcements by CMS make it perfectly clear that Medicare Advantage is on the way out. The savings from the reduction in wasted spending alone will save Medicare close 100 million.
Medicare Supplement Insurance is on a ressurgence.