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Lawmakers Look To Medicare To Drive Health Reform

April 22, 2009

A leading Senate Democrat said on Tuesday that the Medicare program for the elderly may offer ways to encourage better care at a lower cost as a big part of reforming the U.S. healthcare system, Reuters reported.

Senate Finance Committee Chairman Max Baucus told reporters following a committee discussion with industry groups that Medicare is the big driver on ways to change the payment system.

Many in the U.S. are working toward a new system that would reward doctors and hospitals for better quality of care, rather than the current system that pays them based on the number of procedures and treatments.

Experts say Medicare accounts for one-fifth of U.S. healthcare and private insurers usually follow the government program’s payment structure.

Baucus said he was optimistic Congress would enact a healthcare overhaul and President Barack Obama has stated that revamping the $2.5 trillion healthcare system is a top priority, calling it crucial to long-term U.S. economic recovery.

Baucus said he was confident that everyone involved with the restructuring wants to address quality and reimbursements based on quality.

Democrats who control Congress hope to deliver the first of three meetings on reform to Obama by the end of the year. Baucus said the next session would focus on covering the uninsured.

Committee member Senator Jay Rockefeller said in a statement that more money was spent per person on health care in the United States than in any other nation in the world, and yet “America has some of the worst health outcomes”.

And Medicare could help lead changes, according to Glenn Steele, president of the Geisinger Health System in Danville, Pennsylvania.

Steele told the committee panel he believes “the leverage” is in Medicare.

Many analysts point to the Geisinger system as an example of how to make payment reforms to improve quality of care and lower costs.

But Medicare should focus reform efforts on patients with costly chronic conditions, who often do not receive good continuity or quality of care, Steele said.

Previous studies have shown those patients account for a huge share of Medicare’s costs, and that patients in high cost areas do not get better care than those in lower cost regions.

Medicare should be given the flexibility to innovate and test different models of payments to improve care without undermining the quality of care, Steele said.

However, he also urged lawmakers to come up with a “plan B” if the system is too slow at showing improved care with lower costs.

“Changing Medicare to provide better care coordination, especially for people with multiple chronic conditions, is crucial to system reform,” according to the AARP, an influential group that represents older Americans.

AARP said in a statement: “Many gaps in care often occur at care transitions, as individuals move from one setting to another, such as from a hospital to home. A lack of coordination and follow-up care can lead to unnecessary hospital readmissions.”

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