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April 2015

Medicare Testing, Testing, Testing – For Financial as Well as Healthcare Reforms

Washington Watch

 

Medicare is making a major change in how it pays doctors and hospitals – moving toward quality of care and away from the fee-for-service model.

 

This shift, from “volume to value,” as Health and Human Services Secretary Sylvia Burwell described it recently, has been slowly evolving since 2010 and is being phased in over the course of a decade.

 

The idea of rewarding doctors, nurses, and hospitals that achieve better outcomes for patients rather than those that just do more, is seen by experts as a crucial shift to improving the quality of care that patients receive, while also restraining costs at a time when millions of baby boomers are beginning to enter the nation’s primary insurance program for the elderly.

 

Medicare, which serves more than 50 million seniors and disabled Americans, is the nation’s biggest purchaser of medical services. In 2014, the program paid caregivers $362 billion. But while Medicare is viewed as among the most efficient federal government programs, it, nonetheless, has always had problems with waste, fraud, abuse and runaway costs.

 

Since 2010, the Obama administration has been experimenting with ways to change the system and make it more efficient. But it is hard to transform the way doctors and hospitals get paid. Since its inception in 1965, Medicare has paid providers on a fee-for-service basis in which doctors, hospitals and other medical providers are paid for each case or service without regard to how the patient fares. That results in medical folks providing more care and medical services, whether or not they are needed.

 

Now, Medicare wants to move to a performance-based system of payments with the hope of getting 50 percent of Medicare payments to fall under that new concept by 2018. The goal is also to get hospitals to 90 percent by 2018. “Not everyone is going to be able to move at the speed we would like, but we want everyone to be moving,” Burwell said.

 

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The Mad Dash for Eggs

The Raven Lunatic

 

Since forever, the Lions Club in my little hometown has hosted an Easter egg hunt. The Lions Club is a strange bunch, err, pride, with eccentric fraternal rituals.

 

My father — who once held a group office called the Tail-Twister — sometimes returned from meetings with his tie cut in half. He had been “fined” for something as silly as his beloved Chicago Cubs winning a game. Dad and the other members often paid the price for sins real or imagined. Fines and fundraisers enabled the club to raise money for their various charities and host the annual Easter egg hunt.

 

My memory book reflects a different time — an era when schoolteachers wore ties and a time when ties were inexpensive enough to slice in half.

 

On a spring morning in 1965, the wild men of the Lions Club hid multi-colored plastic eggs in the field behind the elementary school. Several hundred children — these were future baby boomers — lined up in age groups, tightly clutching yellow, lavender, and green braided Easter baskets. Anticipation hung over the crowd and parents held children back from the mad dash to find eggs.

 

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