February 9, 2014

Medicare Bill May Help in Treating Chronic Diseases

This may be controversial and Congress does not seem to care. Until more information on the bipartisan bill becomes available, I will go with my gut instincts on this one. Medscape has a decent article covering the Congressional bill now in both the Senate and House. I had hoped for more comments to the article, but I still have my ideas.

Since the Medscape article does not chose to identify the bill numbers, all I have is this to identify – “The Better Care, Lower Cost Act.” On the surface, it sounds like a great idea, but I fear there is much that needs to be digested and exposed to the general public and this is where the controversy may lie.

The article does promote the Act and says, “The Better Care, Lower Cost Act resorts to traditional managed-care tools such as risk-adjusted capitated (large – my addition) payments to clinicians, but also promotes the use of high-tech tools, including telemedicine in rural areas, remote monitoring, and smartphone apps that help patients better manage their conditions. Healthcare providers would voluntarily form multidisciplinary teams — possibly partnered with hospitals — that would enjoy important advantages over accountable care organizations (ACOs) in rendering coordinated, cost-effective care to seniors with chronic illnesses, according to the bill's sponsors.”

Senator Wyden (D-OR) then hypes the bill stating, "Medicare reform must be built around offering better quality, more affordable care for these seniors. Fortunately, there are pioneering practices and plans that are paving the way. Medicare is now dominated by cancer, diabetes, heart disease, and other chronic conditions."

The lawmakers then cite data from the Centers of Medicare and Medicaid Services showing, “that 68% of Medicare beneficiaries have more than one chronic illness, and that this group accounts for 93% of Medicare spending. They also point out that 98% of what they call costly hospitalizations involve such beneficiaries. Keeping the chronically ill healthy enough to avoid a trip to the hospital is the Holy Grail of Medicare cost-cutters. Accordingly, the bill calls quality and cost-containment 'interdependent goals.'" Bold is my emphasis.

To accomplish this, multidisciplinary clinical teams will be certified as qualified Better Care Programs (BCPs) and will receive large payments for Medicare beneficiaries with multiple chronic illnesses that are risk adjusted for health status. BCPs will be different from Accountable Care Organizations (ACOs).

The key difference between the ACO and the BCP will be that BCPs are free to target and enroll the sickest Medicare patients. This will allow them to specialize in such patients and their chronic illnesses. The Congressional bill sponsors go to great lengths to say that BCPs will outperform ACOs to the benefit of physicians and patients alike.

A BCP must develop a care plan for each patient that, when appropriate, will include the use of digital technology — telemedicine, remote patient monitoring, smartphone apps — "that promote(s) patient engagement and self-care while maintaining patient safety." The care plan itself must be easily integrated into electronic health record systems.”

All this sounds great and uses all the correct terminology possibly to confuse the general public. I admit that I am skeptical and wonder if one comment to the article might not be correct when he says, “How long will it be before these teams are designated "death panels"'?

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