Be­yond the Band-Aid

Modern Healthcare - - Opinions Letters -

As Don­ald Ber­wick be­gins his ten­ure as CMS ad­min­is­tra­tor, find­ing a cure for the fes­ter­ing sore that is the Medi­care re­im­burse­ment sys­tem for physi­cians should be a top pri­or­ity.

In June, Congress slapped yet an­other Band-Aid (the 10th since 2003) on the prob­lem by avert­ing for six months a planned 21% re­duc­tion in physi­cian fees. This is­sue con­tin­ues to be a sig­nif­i­cant chal­lenge for the provider com­mu­nity. A great num­ber of doc­tors are con­tem­plat­ing not serv­ing Medi­care pa­tients in the near fu­ture—po­ten­tially an is­sue in com­mu­ni­ties such as Akron, Ohio, with large num­bers of res­i­dents who are 65 and older.

The es­sen­tial flaw in the re­im­burse­ment sys­tem is the fee-for-ser­vice model. Medi­care re­im­burses physi­cians at a set rate for each ser­vice. Though lim­it­ing the re­im­burse­ment for each ser­vice, Medi­care places no limit on the num­ber of ser­vices pro­vided—and few con­trols on qual­ity of care. As a re­sult, Medi­care of­ten pays for in­ef­fec­tive and re­dun­dant treat­ments, lead­ing to pa­tients not re­ceiv­ing op­ti­mal care and pos­si­bly be­ing read­mit­ted to the hos­pi­tal within 30 days.

At Summa Health Sys­tem, we sup­port Medi­care’s ef­forts to change the way physi­cians are paid. In­stead of be­ing paid per pro­ce­dure, health­care providers should be paid based on the qual­ity of care pro­vided and re­warded with a bonus for im­prove­ments in pa­tient health.

An­other step to­ward an im­proved re­im­burse­ment sys­tem would be to re­duce frag­men­ta­tion and re­dun­dancy of ser­vices by ap­point­ing a pri­mary-care provider as the co­or­di­na­tor of care for each pa­tient, with re­spon­si­bil­ity for mak­ing sure that the pa­tient re­ceives the right care at the right time.

Summa, with its hos­pi­tal, health plan and physi­cian com­po­nents, has been vol­un­tar­ily mov­ing to­ward an ac­count­able cul­ture that pro­vides the right care at the right time for years. We are eval­u­at­ing our busi­ness model to en­sure we will be able to pro­vide bet­ter ser­vices and sup­port to pa­tients as changes in provider re­im­burse­ment un­fold in the months ahead.

We are ea­ger to work with Dr. Ber­wick and his staff and our peers across the coun­try to de­velop a sus­tain­able cure for physi­cian re­im­burse­ment—one that delivers real sav­ings while im­prov­ing health out­comes for our pa­tients. Un­less we act quickly, the lame-duck Congress will just slap an­other Band-Aid on the Medi­care physi­cian re­im­burse­ment is­sue in Novem­ber.

T. Clif­ford Deveny Sys­tem vice pres­i­dent of physi­cian align­ment Pres­i­dent of Summa Physi­cians Summa Health Sys­tem

Akron, Ohio


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