The Department of Health and Human Services (HHS) recently announced it will expand Value Based Payment (VBP) programs that currently account for 20 percent of Medicare payments to 30 percent by 2016 and 50 percent by 2018. While VBP is supposed to improve quality and lower costs by paying for the value and/or quality of services, rather than the volume of services, multiple studies, including some by HHS, show that VBP programs have not worked. In practice they place tremendous burdens on physicians and distort the physician-patient relationship. This flawed experiment will impact all Americans since Medicare is a benchmark for all U.S. health insurance.
Scott Becker, JD, CPA, publisher of Becker’s Hospital Review and chairman of the healthcare department at McGuireWoods, recognizes the serious outcomes the overhaul may have. “I think if this happens it will have a draconian effect on all small and mid-size hospitals, health systems and providers.” he says. “The largest providers, who can absorb the changes and take on population health, will fare fine. The small and mid-size providers will face further harm from such substantial changes in payment methods. They are already struggling to survive. Actions like this heavily favor the larger systems and are grist for more consolidation.”
Concerning HHS’ plan, Mr. Becker also says, “This may in part be a political salve aimed at getting more providers interested in a single-payer system — i.e. Medicare for all. Most mid-size and small providers would anticipate serious negative consequences from the approach set forth by CMS and might view a single-payer system as a good alternative to this. It reminds me of the old adage about hitting someone over the head. If you hit them for long enough, they say thank you for stopping here. This plan is another shot across the bow at smaller and mid-size providers of all types. They may just be thankful to stop being hit.”
“Measurement fatigue is a real problem in hospitals,” said Scott Wallace, a visiting professor at Dartmouth’s Geisel School of Medicine. “But, to me, the only metric that matters is, did you get better?”
As of last year, 33 federal programs asked providers to submit data on 1,675 quality measures, according to a government count. State, local and private health plans use hundreds more.
This year, many of the federal pay-for-performance programs carry financial penalties. Hospitals and doctors stand to lose millions in Medicare payments for missing filing deadlines or improvement benchmarks in programs that track hospital-acquired infections, readmissions and electronic-record use.
In all, about 80% of traditional Medicare spending is already tied to such pay-for-performance programs. HHS Secretary Sylvia Burwell said Monday the agency wants that to increase to 90% by 2018. She also set a goal of having 50% of Medicare spending in alternative payment models, in which providers are accountable for quality and the cost of care for groups of patients.
Overall, ACOs have been a dismal failure, VBP has had mixed results, and hospital readmission reduction programs appear to have no impact whatsoever. Yet HHS is calling for the expansion of these programs to an ambitious 90 percent of the health care sector over the next four years.
Surprisingly, despite the Medicare Advantage program’s widespread popularity and measurable success for both patients and taxpayers, Congress has repeatedly gone after this vital program with cuts that threaten its integrity and long term sustainability. Ultimately, bolstering Medicare Advantage in order to support innovative care coordination, quality patient outcomes and lower healthcare costs is a vital step for patients everywhere.
North Carolina senior citizens who choose private Medicare policies are seeing an unusual level of turmoil this year, with more than 57,000 notified their plans won’t be offered in 2015 and others seeing rates more than triple.
The upheaval involves Medicare Advantage, a program that lets people 65 and older choose private policies instead of federal health coverage. About 475,000 in North Carolina have those policies, including about 35,000 each in Mecklenburg and Wake counties.
No other state had so many people lose their current Medicare Advantage plans, according to a national tally by the Kaiser Family Foundation, a nonprofit group that tracks health trends. New York was second with just over 55,000 enrolled in canceled plans.
In last night’s U.S. Senate debate in New Hampshire between incumbent Jeanne Shaheen D. and challenger Scott Brown R., Shaheen uttered a flat-out, bald-faced lie: that Obamacare doesn’t cut Medicare spending to pay for its expansion of coverage to the uninsured. It’s a talking point that a number of Democratic Senate candidates—and their enablers in the lefty blogosphere—have been clinging to. And it’s embarrassingly dishonest.