Managed Care - September 2008 - (Page 37)

MedPAC Proposals Echo Private Payers’ Own Concerns The Medicare Payment Advisory Commission is asking Congress to promote primary care and to hold providers accountable By Lola Butcher Contributing Editor physicians accountable for the quality and efficiency of services they provide. The MedPAC report, issued in June, goes beyond its traditional role of focusing on Medicare payments. “It’s important because where Medicare goes, the rest of the market follows,” says Peter Kongstvedt, MD, president of P.R. Kongstvedt Company. “Medicare is the only force large enough to cause wholesale change to occur in the health system in the United States.” Within the health insurance community, the MedPAC recommendations are seen as an endorsement of where private payers want to go, so A s health insurers search for ways to address unsustainable cost increases, an influential government commission is urging Medicare to step into the lead. The Medicare Payment Advisory Commission, which advises Congress regarding the Medicare program, recommends reorganizing the health care delivery system by changing the way services are purchased. Among its major goals are to promote the use of primary care and to hold hospitals and Holding hospitals accountable Three MedPAC recommendations focus on moving toward a bundled payment system that will force hospitals to improve care. MedPAC’s recent report focuses on readmission rates, and with good reason. Spending on potentially preventable readmissions is billions of dollars a year, according to MedPAC. These costs are preventable Number of potentially preventable 30-day readmissions (thousands) Heart failure Chronic obstructive pulmonary disease Pneumonia Acute myocardial infarction Coronary artery bypass graft Percutaneous transluminal coronary angioplasty Other vascular conditions Total for seven conditions Percent readmitted in all diagnosis- related groups 139,000 85,000 86,000 31,000 27,000 68,000 30,000 466,000 27% Percent readmitted within 30 days 19 17 13 19 18 15 19 Average Medicare payment for readmission $6,490 $6,491 $6,681 $6,540 $8,085 $8,342 $10,061 Total spending on potentially preventable readmissions (millions) $903 $552 $577 $199 $215 $569 $302 $3,318 27% Source: Report to the Congress: Reforming the Delivery System, Medicare Payment Advisory Commission, June 2008 SEPTEMBER 2008 / MANAGED CARE 37

Table of Contents Feed for the Digital Edition of Managed Care - September 2008

Managed Care - September 2008 Editor’s Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor Archimedes Lends Hippocrates a Hand Some Other Predictive Modeling Programs Messing With Medicare Advantage The Trouble With MAC MedPAC’s Suggestions Sound Familiar The Leader in Patient Satisfaction Formulary Files Plan Watch Tomorrow’s Medicine Ad Index Outlook

Managed Care - September 2008

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