|
MEDICARE IN 2009: “A Big Ugly Year” JCHA HEALTHLINE-NEWS, November 2008 The future of Medicare is not very pretty, according to predictions made from former CMS administrators during a CMS Administrator Roundtable, held in Washington D.C. on September 23, 2008. In an article that appeared in Health Plan Week, Steve Davis[1], the managing editor of the publication reported that former CMS Administrator Tom Scully predicts 2009 will be a “big, ugly year” for Medicare in general and Medicare Advantage plans in particular. “There hasn’t been a major Medicare (reform) law in several years, and some people think it can’t happen,” Scully told attendees. “But it can happen, and it likely will happen next year almost for sure.” He also added that this type of bill will most likely target rates paid to Medicare Advantage insurers. Davis reported that Nancy Ann DeParle, who left CMS (then known as the Health Care Financing Administration or HFCA) in 2000 also agreed that a bill is forthcoming, especially with the turmoil on Wall Street and the growing national debt. “And if I am correct, health plans need to get ready”, she warned. Insurers that sell Medicare Advantage plans need to provide CMS with a rationale for the price differential between Medicare Advantage and traditional Medicare fee-for-service (FFS). “I could actually argue in favor of paying (MA insurers) more under Medicare if they are really doing something to manage care and are showing results”, she said. Davis also cited comments by former HFCA Administrator, Gail Wilensky, Ph.D. told attendees that the key problem under the existing Medicare FFS model, is that the quality of care physicians provide has no effect on their level of reimbursement. “Nothing they do, good or bad, impacts their fees,” she said. “It is a broken part of part of Medicare that urgently needs to get fixed.” She went on to explain that one of the problems with FFS Medicare is that when you pay physicians a fixed dollar amount for an office visit, you are not paying them to do chronic care management. And the Medicare Advantage insurers haven’t yet demonstrated they can improve the health of enrollees. “Medicare Advantage insurers have the ability to lead the way and demonstrate to policymakers, beneficiaries and taxpayers that they are providing real value. That is the challenge for plans in the year ahead.” However, she cautioned against trying to make too many changes to the system at once. “I would advocate a more moderate approach over the next 10 years”, Wilensky said. “The fundamental problem with Medicare is price fixing…Hospitals and doctors get paid the same whether they do a good job or a bad job,” Scully contended. Wilensky agreed and said Medicare has traditionally focused on controlling the price of health care services rather than controlling spending. Submitted by: Barbara Noon, RN, MSN, MBA, Principal, Ethos Partners Healthcare Consulting [1] Reprinted from HEALTH PLAN WEEK, the industry’s leading source of business, financial and regulatory news of health plans, PPOs and POS plans. Featured story October 14,2008 by Steve Davis, Managing Editor, (sdavis@aispub.com). |
