two ways to limit medicare costs
DESCRIPTION
Medicare costs are rising a bit faster than they have during the past few years. But by reinforcing some the changes that are already occurring, we can nip this increase in the bud -- and two developments show the way.TRANSCRIPT
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6/3/2015 Two Ways to Limit Medicare Costs - Bloomberg View
http://www.bloombergview.com/articles/2015-05-14/two-ways-to-keep-a-lid-on-medicare-cost-increases 1/2
Medicarecostsarerisingabitfasterthantheyhaveduringthepastfewyears.Butbyreinforcingsomethechangesthatarealreadyoccurring,wecannipthisincreaseinthebudandtwodevelopmentsshowtheway.
First,hospitalsarestartingtomoreaggressivelyscreenskillednursingandotherfacilitiesthattreatdischargedpatients.Second,theMedicareactuariesnowhaveacknowledgedtheevidencethatit'spossibletoreducespendingbychangingtheformofpayment,andnotjustbymakingbluntcostcuts.
Policymakersandinsurancecompanieshavebeentryingtopayhealthprovidersbasedonthequalityofcareratherthanhowmuchcaretheyprovide.Oneexampleistheuseofsocalledaccountablecareorganizations,whichgivehospitalsandotherprovidersthefinancialincentiveandresponsibilitytoorchestratecomprehensivetreatmentforpatients.
Hospitalsdoseemtobelookinginsomeoftherightplacestocutwastefulspending.AnInstituteofMedicineanalysisin2013showedthatspendingonoutpatientcareistheprimaryreasonthatMedicarecostsvarysomuchfromplacetoplace.Andamorerecentanalysissuggestedthatexcessivespendingafterapatientwasdischargedactuallydidharm.Thosefacilitiesthatspentmoreonoutpatientshadworseresults,includinghighermortalityrates,thanlowercostfacilities.SkillednursingfacilitieswhereaboutafifthofMedicarepatientsgoafterleavingthehospitalwerethebiggestoffenders.
Thesefindingssuggestalotofunnecessaryspendingcanbecutafterapatientleavesthehospitalandhaveapositiveeffectoncarequality.Hospitalsareontotheproblembasedonarecentarticle
HEALTHCAREREFORM
TwoWaystoLimitMedicareCosts
ByPeterR.Orszag
MAY14, 20154:06PMEDT
aA
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6/3/2015 Two Ways to Limit Medicare Costs - Bloomberg View
http://www.bloombergview.com/articles/2015-05-14/two-ways-to-keep-a-lid-on-medicare-cost-increases 2/2
inModernHealthcare.Therearesignsthattheyarescrutinizingskillednursingfacilities,andtryingtosendpatientstoonesthatproducebetterresults.Doingsorepresentsasubstantialopportunitytoreducecostandimprovequality,theheadofBethIsraelDeaconessMedicalCentersaidrecently.Iagreewholeheartedly.
TheotherencouragingdevelopmentisthattheMedicareactuarieshavenowcertifiedthataccountablecareorganizationsaremakingheadwayinholdingdowncosts.OnesuchorganizationsavedMedicare$384millioninitsfirsttwoyearsofexistence,accordingtoMedicareactuaries.Thatisn'tahugeamount,butstrongerversionsoftheACOconcepthaveshowngreatercostreductionsinMassachusetts,especiallyastimewenton.What'simportantisn'tthefindingbutthattheactuariessaidit.SuchcertificationisrequiredfortheHealthandHumanServicesDepartmenttoexpandvariouspilotprogramsthataretestingwaysofmovingtonewpaymentsystems.
Letshopetheactuariesfindandcertifycostreductionsandqualityimprovementsfromotherpaymentmodels,followedwithaggressiveeffortsbyHHStotransformthesuccessfulpilotprogramsintonationalones.Whencombinedwitheffortsbyhospitalstoseekoutmoreefficientcare,especiallyforoutpatients,wemightbeabletobeatbackanyrenewedsurgeinMedicarecosts.
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