Md. Medi­care model works

Baltimore Sun - - FROM PAGE ONE - Nel­son Sa­ba­tini and Donna Kinzer, Bal­ti­more The writ­ers are, re­spec­tively, chair­man and ex­ec­u­tive direc­tor of the Mary­land Health Ser­vices Cost Re­view Com­mis­sion.

The re­cent com­men­tary, “Mary­land’s Medi­care ex­per­i­ment needs to end” (Aug. 31), got it wrong. Mary­land’s all-payer model for health care de­liv­ery im­prove­ment is on the right track. In Jan­uary of 2014, Mary­land part­nered with the fed­eral gov­ern­ment to trans­form health care in the state, em­pha­siz­ing higher qual­ity of care that pro­vides more value for our dol­lars. Since then, there have been life-chang­ing im­prove­ments in the qual­ity of health care pro­vided to Mary­lan­ders. Hospi­tal-ac­quired in­fec­tions and con­di­tions are down nearly 30 per­cent. Hospi­tal read­mis­sions, which in­crease the cost of care, are drop­ping sig­nif­i­cantly. Mary­land hos­pi­tals are deeply en­gaged with their com­mu­ni­ties and lo­cal physi­cians to pro­vide ef­fec­tive and ef­fi­cient health care that meets the needs of pa­tients. Hospi­tal pay­ment demon­stra­tions that have been in place for years at Mary­land’s ru­ral hos­pi­tals — and which are the foun­da­tion for early value-based pay­ment mod­els be­ing im­ple­mented across the state to­day — have shown suc­cess through im­proved care for pa­tients and a sta­bi­liza­tion of re­sources for hos­pi­tals.

In other states, Medi­care and Med­i­caid pay­ments to hos­pi­tals are sub­stan­tially be­low mar­ket price. As a re­sult, pri­vate pa­tients out­side Mary­land fre­quently pay, in what amounts to a hid­den tax, more than 75 per­cent above Medi­care prices. With the aging of the pop­u­la­tion, the sit­u­a­tion gets worse. As the gray­ing of Amer­ica ac­cel­er­ates, more of the cost of hospi­tal care na­tion­ally will be shifted to em­ploy­ers and in­di­vid­u­als with in­sur­ance cov­er­age to make up for low Medi­care and Med­i­caid pay­ments. In con­trast, Mary­land avoids that pit­fall by en­sur­ing that all pay­ers pay the same rate for the same ser­vice at the same hospi­tal.

De­spite spi­ral­ing health care costs, the United States falls short on some com­par­a­tive qual­ity mea­sures. Con­gress re­cently passed a law that changes the way Medi­care pays physi­cians to pro­mote qual­ity of ser­vice rather than quan­tity. The all-payer model aligns with the new fed­eral strategy and is be­ing sup­ported by providers, con­sumers and pub­lic health agen­cies, all work­ing col­lab­o­ra­tively. This is why Prince­ton Univer­sity health care econ­o­mist Uwe Rein­hardt called the new agree­ment, “the bold­est pro­posal in the United States in the last half cen­tury to grab the prob­lem of cost growth by the horns.”

Mary­land is plac­ing the in­ter­ests of the pa­tient first while serv­ing as an im­por­tant model for the coun­try in tack­ling chal­lenges on a broad scale to im­prove out­comes and con­trol costs. More in­for­ma­tion on the pro­gres­sion of Mary­land’s all-payer model may found on the Health Ser­vices Cost Re­view Com­mis­sion web­site.

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