The Remington Report

In the latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders survey, the experts surveyed favor sweeping changes to Medicare – reforms that would help control program costs and support broader health system reform.

To encourage such development, nearly all respondents favor expanding the power of the Secretary of Health and Human Services to put payment pilot programs on a “fast track” (95 percent) and to work with private payors and providers to establish multipayor initiatives (94 percent).

The survey also found that:

• There was strong support for creation of an independent Medicare advisory council (favored by 75 percent) with broad authority to collaborate in multi-payor initiatives (89 percent), develop, test, and implement payment reforms rapidly and flexibly (88 percent), and alter beneficiary incentives based on effectiveness of services, drugs and devices (86 percent).

• More than three-quarters (76 percent) of respondents favor reducing overpayments to Medicare Advantage plans. Payments to these plans are projected to exceed corresponding costs in traditional fee-for-service Medicare by 13 percent in 2009.

• Sixty-five percent of respondents feel that bundled payments – a single payment for all the services provided to a beneficiary for an episode of care or over a period of time – and encouraging beneficiaries to designate a medical home would be effective policies for improving care and reducing costs.

• Nearly three-quarters (74 percent) of leaders believe older adults ages 50 to 64 should be able to buy Medicare coverage before they become eligible at age 65.

• A strong majority (69 percent) favor having Medicare offer its own comprehensive benefit package option as an alternative to Medigap or Medicare Advantage coverage.

House Passes Bill Revamping Medicare Physician Payment Formula

The House of Representatives voted 243-183 to approve the Medicare Physician Payment Reform Act (HR 3961), which would permanently revamp the Medicare physician payment formula.

In the absence of congressional action, physicians face a 21 percent payment cut in 2010 under the current system.

“Today’s House vote is the first step toward preventing this cut. The AMA urges the Senate to act quickly before the cut begins on Jan. 1,” American Medical Association President J. James Rohack, MD, said in a statement issued soon after the House action.

Earlier this month, the Senate failed to advance a bill averting the physician pay cut.

• Nearly all (91 percent) healthcare opinion leaders support a requirement that Medicare providers participate in developing state, regional and national all-payor databases to aid in research, policy development, and monitoring and evaluation.

The survey also found that by a clear margin, opinion leaders do not favor strategies that shift costs to beneficiaries or reduce payments across the board. Only 42 percent support offering a high-deductible health plan and 36 percent approve of requiring Medicare beneficiaries to pay a higher share of costs. Capping federal spending was similarly unpopular (26 percent), as was reducing payments to providers (19 percent). The survey also asked respondents their opinions about specific policy options to improve coverage. Respondents strongly supported using Medicare’s leverage to negotiate pharmaceutical drug prices (81 percent) and filling in the so-called Medicare “doughnut hole” – the Medicare Part D coverage gap, through which beneficiaries are responsible for all of their covered drug costs – through some combination of increased copayments, government funding and drug price discounts (79 percent).