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AARP On the Fence About Care Coordination Roles
Just in case this particular item hasn’t yet reached the top of your own to read pile, let me bring to your attention recent testimony to the Senate Finance Committee on Medicare Payment of Physician Services.
The testimony was presented on March 1 by Byron Thames, MD, an AARP Board member. With over 35 million members, AARP is the leading nonprofit, nonpartisan membership organization for people age 50 and over in the United States.
Here are my take-away points from Dr. Thames testimony:
- AARP recognizes that addressing care coordination is a critical issue in health care payment reform
- AARP is on the fence about who should do care coordination
- AARP could have an influential role in payment reform
AARP Recognizes that Addressing Care Coordination is a Critical Issue in Health Care Payment Reform
Dr. Thames suggested four key areas of focus:
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:
- encouraging widespread adoption of health information technology;
- expanding the use of comparative effectiveness research;
- utilizing performance measurement including physician resource use; and
- enhancing care coordination [emphasis added].
the Medicare program could improve the efficiency of health care delivery by increasing the use of primary care services and encouraging coordination of care. Coordination of care is important for individuals with multiple chronic conditions and especially as individuals move across care settings. AARP believes that Medicare’s payment methods should be changed to create incentives in the fee-for-service system to better coordinate care so that beneficiaries receive the best care possible. Treatment of chronic illnesses accounts for the majority of health care expenditures, including those of the Medicare program, yet the traditional Medicare system is not designed to prevent complications.
AARP is On the Fence About Who Should Do Care Coordination
On the one hand, AARP had nice things to say about primary care doctors role in care coordination:
AARP believes that physicians are central to the delivery of health care, and that Medicare’s payment system should encourage quality and affordable care. national comparisons conducted by Dartmouth researchers indicate that communities with more robust primary care provide lower cost, higher quality care. It is clear that the mix of physicians in a community has a direct impact on quality and cost. Moreover, patients report more care coordination problems the more specialists they see.
On the other hand, AARP qualified its support and cautioned that physician payment increases should not come at the expense of Medicare beneficiaries:
AARP believes physicians who treat Medicare patients should be paid fairly. But as we have learned from our members, the program must be affordable for beneficiaries as well. Determining how to balance these two needs is a complex, yet critical, policy problem that must be solved for the Medicare program to remain strong for future generations. Each time the SGR [sustainable growth rate] is overridden, the price tag beneficiaries pay in the long run increases.
AARP also acknowledged some of the innovative Medicare pilot/demonstration projects underway relating to care coordination. These projects are lead by disease management companies, health plans, physicians, and others:
Recently enacted Medicare legislation has expanded the number and type of Medicare demonstration projects to examine the impact of various strategies for improving the coordination of care for beneficiaries with chronic conditions in traditional Medicare, such as the Medicare Health Support demonstration, the Physician Group Practice demonstration, and the new Medical Home demonstration.
And just to make sure that nobody felt left out
In addition, other practitioners, such as nurse practitioners, physician assistants, and advanced practice nurses, might help fill this growing gap of primary care and needed care coordination.
My take here is that AARP clearly is not (yet) taking a position on who should do care coordination. They recognize that there are many options and that all the evidence is not in.
AARP Could Have an Influential Role in Health Care Payment Reform
Sitting on the fence with 35 million members in your pocket is a highly influential position to be in. It will be interesting to see how this plays out. Your thoughts?
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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!
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.
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!