Beyond the Band-Aid
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