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Medicare Fix Remains Elusive

Margaret Dick Tocknell, for HealthLeaders Media, August 1, 2012

Private sector (Aetna, Blue Cross Blue Shield of Massachusetts, Humana, CareFirst BlueCross BlueShield, and Hill Physicians Medical Group) recommendations:

  • A holistic view of payment that integrates physician and institutional payment is necessary to counter fragmentation of care.
  • Any proposals to modify Medicare payment policy should be sufficiently flexible to allow for practice variations.
  • Payments to primary care physicians should recognize the role they play in developing and monitoring care plans for their sickest patients and reinforce the central role of primary care in helping members manage their health risks.

Physicians' (American Medical Association, American Academy of Family Physicians, Louisiana State University Health Science Center, Henry Ford Health System, and New Mexico Oncology Hematology Consultants) recommendations:

  • New models of care coordination and payment such as medical homes and bundled payments hold promise
  • No single payment system should replace the SGR formula, instead a blended payment system that combines FFS, care management fees, and quality improvement payments might be better.
  • For the treatment of chronic illnesses physician payment and incentives should reflect that outcomes are long term.
  • The Medicare payment system should be nimble enough to reflect changes in scientific understanding and physician practice standards.
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