The statute also gives the Center wide-ranging authority to alter the Medicare and Medicaid programs without further congressional action. It is supposed to be testing new ways to pay providers of medical services. Changes that are found through pilot programs to reduce costs without harming quality, or found to be budget neutral while improving quality, can be implemented nationwide through regulatory fiat. The agencys broad mandate reveals the mind-set of ObamaCares authors. The premise is that the federal government is best positioned to lead an effort in innovation in medical delivery, despite all evidence to the contrary. The history of Medicares payment systems over four decades is one of politicized decision-making by regulators, protection of incumbent providers, and roadblocks to new medical technologies and new ways of doing business, such as using information technology to consult with patients, or employing non-physician clinics for routine patient care. Its the opposite of an environment conducive to innovation. Consequently, inefficiency is rampant in Medicares traditional fee-for-service program. Ironically, the Center for Medicare and Medicaid Innovation is now trying to promote initiatives, such as accountable-care organizations and bundled payments, that are the same tools already in use in Medicares private-plan option, called Medicare Advantage. Medicare Advantage plans have the flexibility to test new payment methods and models of care, and have been doing so since the Medicare HMO program (Medicare Advantages predecessor) began in 1982. These plans pioneered benefits like clinical care management, necessary to properly care for the sickest Medicare enrollees. Medicare Advantage plans also routinely cut costs by using clinical and claims data to screen out the most costly and lowest-quality providers of services in a community. According to the Medicare Payment Advisory Commission, Medicare Advantages HMOs provided patients with covered services for 92% of the cost of the traditional fee-for-service program in 2013. Nearly 30% of Medicare beneficiaries are now enrolled in Medicare Advantage plans, and new entrants are enrolling at an even higher rate. Rather than build on this progress, ObamaCare cuts payments to Medicare Advantage plans by more than $150 billion over a decade—and relies instead on the Center for Medicare and Medicaid Innovation to prop-up the more costly fee-for-service program with government-led innovation. Whats likely to transpire isnt innovation but price controls on medical procedures to give fee-for-service a chance to compete against more efficient Medicare Advantage plans. The agencys authority is broad enough to allow across-the-board cuts in payments to hospitals and physicians, and lower reimbursements for pharmaceuticals and related products as well, all in the name of innovation. The Congressional Budget Office certainly expects this to happen. It says that legislation to repeal the agencys $10 billion in funding would increase the deficit because its cost-cutting agenda is expected to produce more than $10 billion in savings from reimbursement cuts. Its one more indicator that budgetary scorekeeping in health care is hopelessly biased in favor of irrational governmental controls. Innovation in health-care delivery is necessary and can happen with reforms promoting deregulation and more intensive competition. What we dont need is more bureaucratic micromanagement cloaked under the mantle of innovation. Which is why Congress should do away not just with the Independent Payment Advisory Board, but with the Center for Medicare and Medicaid Innovation as well.
Posted on: Thu, 24 Apr 2014 14:59:13 +0000
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