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June 30, 2012 at 08:00 PM
Everyone wants to put the consumer in charge of lowering health care spending.
That raises a question: If the current fee-for-service (FFS) physician reimbursement system is so dysfunctional that the Centers for Medicare & Medicaid Services (CMS)has a hard time making the system work for Medicare, how do we create a reimbursement system that gives consumers a fighting chance?
Today, consumers can barely find out after they’ve had an office visit what kind of care the office thinks it has provided, let alone what the care will cost in total, or what the patient will pay for care out-of-pocket.
The Senate Finance Committee recently organized a hearing on Medicare physician payment policy, to get ideas from private insurers on how CMS could fix the traditional Medicare FFS payment system.
Peter Edwards of Humana Inc., Louisville, Ky., talked, for example, about setting up a program that required physicians and hospitals to work together to manage care, measure performance, and try to qualify for incentives for improving outcomes and controlling costs.
The program lowered the number of inpatient hospital days per 1,000 patients by 29%, and it lowered the number of emergency room visits per 1,000 patients by 46%, Edwards said. The program also increased the percentage of patients with diabetes who’d had the recommended A1c test by 6.1%.
Similarly, Lonny Reisman of Aetna Inc., Hartford, said his company found an incentive program helped decrease the pilot-program patient acute hospital admission rate by 45% when compared with the rate for control-group patients.
Unfortunately, most people with high-deductible health insurance and health savings accounts (HSAs) have no ability to get their providers to work together and adopt sensible incentive systems. The only incentive the providers have is to skin the patients alive.
Pre-deductible HSA holders who are trying to dicker with doctors and hospitals are like open-pocketed lambs wandering timidly through a pasture full of FFS wolves.
Hiring a lawyer or a professional patient advocacy service to manage $100 to $5,000 in medical bills per year makes no sense for the patient or the lawyer.
