A REPORT ISSUED in mid-June by the Medicare Payment Advisory Commission supports increasing the role of primary care and the use of incentives and punishments to increase the efficiency and quality of care.
MedPAC's "Report to Congress: Reforming the Delivery System" supports several initiatives now under way or being tested by Medicare.
MedPAC suggests that care coordination and holding providers accountable for the quality and cost of care are the best hopes for improving care delivery nationwide and reforming the Medicare program.
"Fundamental reforms in payment and delivery systems are needed to improve quality, coordinate care and reduce cost growth," said a statement from the panel, an independent Congressional advisory body that provides policy analysis and advice on the Medicare program and other aspects of the country's healthcare system.
"To increase value for beneficiaries and taxpayers, the Medicare program must overcome the limitations and incentives for volume growth in its current payment systems," the report continued.
The panel's recommendations for primary care support the notion of having primary care physicians better coordinate patient care.
MedPAC recommended two initiatives for promoting primary care, first asking for a budget-neutral adjustment that increases fee schedule payments for primary care services furnished by clinicians focused on delivering primary care. Such increased payments will be tested in a medical home demonstration project planned by the Centers for Medicare & Medicaid Services.
The commission also recommends a medical home pilot program in Medicare that would include monthly per-beneficiary payments to qualifying medical practices. Beneficiaries would not incur cost sharing for the medical home fees and would retain the right to see specialists and other practitioners.
Medicare should take a more active role in holding providers accountable for resource use in hospitalizations, a significant determinant of a patient's final hospital bill. MedPAC specifically suggests that hospitals and physicians receive confidential reports about resource use from the hospital stay and the 30 days after discharge, as well as readmission rates. Such information should be publicly disclosed after two years.
Also, MedPAC wants to pressure hospitals to improve care during inpatient stays by reducing payments to hospitals with relatively high readmission rates for select conditions. Conversely, hospitals and physicians should be able to share in savings from providing care more efficiently.
The commission also recommends that CMS conduct a voluntary pilot program to test bundled payments for some conditions to cover all services involved in a hospitalization.
The report also looks at revisions in the payment system for skilled nursing facilities, the benefits of creating a comparative effectiveness entity, the study of potential conflicts of interest related to physicians' financial relationships with drug and device manufacturers and the need to adjust the hospice payment system.