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Health care reform debate centers around Medicare delivery problems
Government officials and health care experts participated in a round table discussion on health care delivery system reform at a Senate Finance Committee hearing on Tuesday.
The meeting was the first of three discussions to be hosted by the committee on health care reform.
While Medicare is not the sole contributor to the health care delivery system problem, Medicare Payment Advisory Commission Chairman Glenn M. Hackbarth, JD, said that discussions like the one this week can pave the way for larger system reform. He highlighted previous recommendations that the commission has made to improve the Medicare program, such as linking payments to quality and encouraging public reporting of financial relationships, but noted that greater, fundamental reform is needed.
Greater accountability
Hackbarth also said the commission is investigating other payment systems that cross provider settings and focus on accountability. For example, the commission recommended a medical home pilot program, bundling payments around a hospitalization episode and changing readmission payments to move Medicare in this direction.
“The process of reform should begin as soon as possible; reform will take many years, and Medicare’s financial sustainability is deteriorating,” Hackbarth said.
“That deterioration can be traced in part to the dysfunctional delivery system that the current payment systems have helped to create. Those payment systems must be fundamentally reformed, and the recommendations we have made are a first step on that path. They are, however, only a first step; they fall far short of being a ‘solution’ for Medicare’s long-term challenges,” he said.
Provider payment reform
Mark B. McClellan, MD, PhD, director of the Engelberg Center for Health Care Reform at The Brookings Institution in Washington, focused on reforming provider payment. He noted that using the Accountable Care Organization (ACO) model would shift the focus of payments from volume to value without causing major changes to current payments and practices.
The model emphasizes local accountability and allows for ACOs to receive shared savings for spending below expenditure benchmarks in addition to their usual payments, he said.
Lewis Morris, chief counsel for the Office of Inspector General, Department of Health and Human Services, said that combating fraud, waste and abuse is crucial to any heath care reform strategy, which should adhere to the following principles:
- scrutinize potential providers and suppliers before their enrollment;
- create reasonable payment methodologies that respond to marketplace changes;
- help providers and suppliers adopt practices that foster program compliance;
- monitor programs for waste, fraud and abuse; and,
- quickly respond to fraud, adequately punish to deter others and rectify program weaknesses.
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