MEDICARE:
CMS Has A Lot Of Work To Do To Whip Medicare Into Shape
Published on Sat Jun 03, 2006
Medicare can't keep up with rapid technological advances, MedPAC says.
Providers must become more accountable for the quality of the care they provide--and Medicare must take the reigns, the influential Medicare Payment Advisory Commission (MedPAC) says.
In MedPAC's "Report to Congress: Increasing the Value of Medicare," which it released on June 15, the advisory body had some strong suggestions for the Centers for Medicare & Medicaid Services (CMS). The report cited improving accountability, care coordination and pricing accuracy among the top concerns regarding Medicare. The commission also acknowledged the biggest change in Medicare in recent years as being the advent of Part D and private plans' involvement in the Medicare program.
"Providers must be held accountable for the quality of care they provide and the resources consumed in providing that care," MedPAC charges. Pay-for-performance programs are the first step, and measuring physician resource use is the second, the report says.
But making individual physicians more accountable for providing high-quality care is not enough, the report points out. Care coordination is the real key to improving the Medicare program's value. "Overall care for a beneficiary may be sub-optimal if providers do not coordinate across settings or assist beneficiaries in managing their conditions between visits," MedPAC notes.
To integrate care coordination into fee-for-service Medicare for chronically ill benes, MedPAC used two models. The first model used group practices to deliver care coordination, and the second used "stand-alone care management organizations."
"In both models, organizations would be required to have information technology and care manager capacities and would agree initially to cost savings as a condition of payment," the report says. Medicare's Information Flow Is Running Too Dry, Report Claims In addition to care quality initiatives and P4P, MedPAC's report included a laundry list of information-delivery improvements for CMS. "Medicare policymakers and administrators need better information to formulate policies and to create tools to give useful information to beneficiaries and providers," MedPAC says. Despite this somewhat vague idea, the commission went on to list quite specific follow-up recommendations, including:
1. CMS should develop and test measures related to fall prevention and wound care in home health agencies and add them to the home health measure set.
2. CMS needs to collect better information about benes' outpatient therapy needs and their outcomes. "Specifically, CMS will need to develop patient assessment tools that report risk factor information and outcomes measures," MedPAC explains. "This would help evaluate alternative payment methods that could increase the value of the therapy services Medicare purchases."
3. Medicare needs to keep up with technological advances, the commission says. "A pressing issue for Medicare is that technology diffuses rapidly without sufficient analysis or guidelines that target its use to the patients who will benefit the most." Another major problem that [...]
