Can Medical Management Succeed Within A Fee-For-Service Environment?

Brian Klepper

The column immediately below is an important discussion by Douglas Elmendorf, the Director of the CBO – actually it was prepared by Lyle Nelson of CBO’s Health and Human Services Division, but it has Mr. Elmendorf’s imprimatur – which recently released an issue brief concluding that major cost control approaches had not produced savings in Medicare. This of course elicited a cascade of pro/con medical management commentary.

Most important is this sentence near the bottom.

Demonstrations aimed at reducing spending and increasing quality of care face significant challenges in overcoming the incentives inherent in Medicare’s fee-for-service payment system, which rewards providers for delivering more care but does not pay them for coordinating with other providers, and the nation’s decentralized health care delivery system, which does not facilitate communication or coordination among providers.

Continue reading “Can Medical Management Succeed Within A Fee-For-Service Environment?”

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”

A Litmus Test for Elected Officials

Brian Klepper and David C. Kibbe

Six months ago, who could have imagined that a large percentage of rank-and-file Americans would support the Occupy Wall Street (OWS) against special interests’ rigging of the American dream? So why not go to the next step? Why not pointedly ask political candidates, “Will you take money from lobbyists?” and “If elected, what will you do to stop special interest influence?”

Most Americans are deeply disturbed by this issue. In a recent Time Magazine poll of people familiar with the OWS protests, 86 percent thought that “Wall Street and its lobbyists have too much influence in Washington.” Gallup found that 68 percent of Americans think corporations should have less political influence.

These trends didn’t just happen. They resulted from special interests’ vigilant attention to legislative possibility, lubricated by the exchange of money for votes. Influence peddling is now so accepted in American politics that the Center for Responsive Politics (CRP) has established a lobbying data base, Open Secrets. But making lobbying contributions transparent hasn’t slowed the torrent of money that re-shapes law and wealth distribution.

Since 1952, the percentage of gross domestic product (GDP) represented by corporate taxes has plummeted from 6.1 to 1.0 percent, while the percentage represented by employment taxes has skyrocketed from 1.8 to 6.3 percent. Meanwhile, a just released Congressional Budget Office study confirmed that the top 1 percent of earners more than doubled their share of the nation’s after tax income over the last 30 years.

CRP’s numbers show that 13,000 lobbyists contributed $3.5 billion in Congress in 2010.  Considering that Congress influences the flow and distribution of a $15 trillion national economy, these investments promote unfair advantages extremely cost-effectively. Politicians from both parties fund their campaigns with the money, shrug off the system’s financial conflicts, and apparently avoid thinking too hard about the consequences.

The intensifying ability of the powerful to buy America’s lawmakers’ votes is the greatest threat to the America that most of us grew up believing in. It is why the rich have gotten much richer, why large, profitable corporations pay no taxes, why health care costs have continued to explode, and why Americans’ social mobility is at an historic low. America has many difficult problems, but lobbying and the way we finance elections are among the deepest, facilitating many others.

Voters can facilitate rapid change by holding their representatives accountable. Asking our political candidates who they think they’re working for would be a simple but powerful way to bring America back into balance.

Brian Klepper, PhD is a health care analyst and the Chief Development Officer for WeCare TLC Onsite Clinic. David C. Kibbe, MD, MBA is Senior Advisor to the American Academy of Family Physicians and an industry advisor on health information technologies.