Lessons from Medicare’s Demonstration Projects on Disease Management, Care Coordination, and Value-Based Payment

Douglas Elmendorf

Posted 1/18/12 on the Congressional Budget Office Director’s Blog

In the past two decades, Medicare’s administrators have conducted demonstrations to test two broad approaches to enhancing the quality of health care and improving the efficiency of health care delivery in Medicare’s fee-for-service program.

Disease management and care coordination demonstrations have sought to improve the quality of care of beneficiaries with chronic illnesses and those whose health care is expected to be particularly costly. Value-based payment demonstrations have given health care providers financial incentives to improve the quality and efficiency of care rather than payments based strictly on the volume and intensity of services delivered.

Continue reading “Lessons from Medicare’s Demonstration Projects on Disease Management, Care Coordination, and Value-Based Payment”

AMA: Pay Docs For Care Coordination

Merrill Goozner

Posted 10/10/11 on Gooz News

The little-known American Medical Association committee that recommends physician pay scales to Medicare’s fee-for-service program today asked the agency to reimburse physicians for coordinating care for their chronically-ill patients. In a letter to administrator Donald Berwick, the Relative Value Scale Update Committee (better known as the RUC) recommended the Center for Medicare and Medicaid Services pay for phone calls, counseling sessions and other services that help their patients wend their way through the complicated health care system.

Good idea, and long overdue. But what I didn’t see in the letter from RUC committee chairwoman Barbara Levy was any reference for how to pay for these new services. How about a reduction in the “relative value” of back surgery or conducting angioplasty on patients complaining of persistent chest pains? These are among the most expensive and overused procedures in medicine, incentivized by the extraordinarily high fees earned by the surgeons who do them. These surgeons often earn two or three times what primary care physicians earn.

Continue reading “AMA: Pay Docs For Care Coordination”