Comments on: AARP On the Fence About Care Coordination Roles

By: Dianna The Doctor Financing Expert

Dianna The Doctor Financing Expert — Wed, 02 Jan 2008 21:40:39 +0000

I love that quote. . .

“AARP also believes Congress needs to change the incentives in Medicare’s physician payment system to promote quality and encourage efficiency. We recommend Congress focus its efforts on four key areas:”

Congress does need to change its policy in regard to Medicare. We need to support our seniors and provide for them and make it easier for them to live a healthy life!

By: Warren Todd

Warren Todd — Fri, 30 Mar 2007 19:52:46 +0000

The who or how of chronic disease coordination for the senior market will be further complicated by a gross lack of professional clinicians. With a very large percentage of the countrys family physician population rapidly approaching retirement age plus a growing nursing shortage, the who and how questions may not be relevant. As the number of chronic disease patients requiring care begins to over whelm the supply side ofcare givers in the next century the question of chronic disease coordination becomes REALLY complicated. In a purely competitive world these powerful supply/demand forces tend to drive up prices/costs. Healthcare policy makers need to start now on figuring out how chronic disease of the Medicare population is management or, better, prevented. Not to be too negative but recent announcement concerning the apparent failure of commercial-style disease management programs to reduce costs in the current Medicare Chronic Care Coordination projects adds another wrinkle. Clearly new strategies are needed, and quickly. The math is not pretty. Some of the senor trends were reported in the March 21st issue of IDMAs DM World e-Report [Nine Trends in Global Aging Present Challenges, Says U.S. Study]. In the same issue, it was suggested that some of the Lessons for Health Care Could Be Found Abroad. See http://www.DMAlliance.org for e-Report back issues.

By: Randy Williams

Randy Williams — Thu, 29 Mar 2007 14:52:32 +0000

The challenge to AARP and all other constituents who believe that care coordination is a necessary component of chronic care improvement programs is not who should do the work, but rather, who’s “ox gets goared”? AARP rightly recognizes that the SGR model of payment for physician services is outdated, and will not allow for innovative services such as care coordination without raising the out of pocket or deductibles for seniors. Before care coordination can find its rightful home in the Medicare population, regulatory barriers will need to be eliminated so that dollars SAVED by care coordination services can offset dollars spent on those services. Since care coordination, whoever performs the services, are outpatient based, they would be paid by Medicare Part B, alongside other physician services. On the other hand, costs avoided would benefit the budget of Medicare Part A. Current regulations prevent these two pools of funds from intermixing, unless specific waivers are in place. This is the case in each of the CMS demonstrations and in the Medicare Advantage and Special Needs plans. In order to drive such a regulatory change through Congress, the AARP and others would need to take on perhaps the only other lobby as strong as the AARP – the American Hospital Association!