Health Care

What if MedPAC Rules the World?

by Tim Foley

categories: Comparative Effectiveness Research, Doctors And Nurses, Medicare And Medicaid

Published June 03, 2009 @ 08:19PM PT

President Obama today embraced the notion of giving the Medicare Payment Advisory Commission (MedPAC), the commission that advises Congress already on Medicare reforms, the power to make its recommendations reality.  The president embraced the idea of bringing MedPAC’s recommendations each year into a single up-or-down vote in Congress that cannot be filibustered.  Similar to the base closing commissions, doing this would shift the power for making decisions out of the political sphere and into the sphere of men and women intimately familiar with how our health care system works.  If we're seriously thinking of giving them this power, it begs one big question:  what would MedPAC do if they ruled the world?

Well, luckily MedPAC’s recommendations are all documented – the ones Congress follows and the ones Congress ignores.  Based on MedPAC’s statement to the Senate Finance Committee from April, here are some of the changes they recommend right away:

• Use the payment system to create incentives for efficiency.  This includes setting Medicare payments to Medicare Advantage plans to 100% of the cost of a beneficiary in regular Medicare, instead of the 114% they’re gobbling up now for not terribly different outcomes.  This has become an annual recommendation from MedPAC.  Although both the President and most members of Congress have spoken out against these overpayments in Medicare Advantage, no one has done anything yet.
• Increase payment for primary care providers by “improving the accuracy” of payment for specialized care.  That means taking an ailment that’s not terribly severe but is currently being billed at super-high rates as though it were a difficult procedure, and decreasing the payments for it.  It's one of many ways to curb the excesses of our fee for service system while simultaneously making the investments in primary care that we know are so desperately needed.  This would have the added effect of discouraging doctors and hospitals who’d be tempted to only do these easy but lucrative procedures.
• Create a “quality incentive payment policy” that applies to everyone from doctors to dialysis facilities, from hospitals to Medicare Advantages plans where part of the payment is based on hitting measurable standards for quality of care.
• Require doctors using Medicare to report back on what resources they use in their treatments, compare doctors treating the same ailments, and facilitate discussions with those who use the most and those who use the least.  Note:  there’s no money involved in this one – it’s just creating dialogue and learning opportunities that could improve care for everyone.
• Fund more comparative effectiveness research to generate more “credible, empirically based information” so that doctors and patients could “make informed decisions about alternative services for diagnosing and treating most common clinical conditions.”  This also doesn’t have any money attached to it, but would give more information to doctors and patients to make better decisions and have more productive visits.  It’s also likely to bring costs down and decrease overtreatment.

And I’m only on page 4.

A refrain I hear too often is that health care is so complicated -- particularly the health care delivery system -- that we don’t know where to even start fixing it.  Baloney.  One thing that will strike you if you read the statement all the way through is that MedPAC has been making these same recommendations for years in multiple reports.  Missing from the discussion is that the VA system uses a lot of the same techniques, which explains why their outcomes and costs are better even than Medicare.

We have the experts already.  They’re making great recommendations.  Some of them just involve communications and research – they don’t even involve money.  But because Congress is bogged down in getting perpetually re-elected, they’re not implementing them.  Medicare is a huge opportunity to start turning our health care system around – we just have to start listening.

(Photo credit:  wauter de tuinkabouter on Flickr.)