Thursday, May 12, 2011

Health Reform: Is It a Noun.... Or a Verb?

Google blogger went down May 11 and 12, erasing the original "Noun or Verb" post.  The DMCB apologizes for the inconvenience.

In its continuing war over the Sustainable Growth Rate (SGR), the American Medical Association has sent a letter to Congress recommending that new payment structures be tested over 5 years, using a series of demonstrations that test risk-adjustment and attribution.  Why not, since there has been a plethora of other demonstrations and pilots, including the "Acute Care Episode Demonstration," the "National Pilot Program on Payment Bundling," a "Gainsharing Demonstration," and the "Independence at Home Demonstration."

In the meantime, the Medicare and Medicaid Center for Innovation continues to forge ahead with its commitment to testing and dissemination of new approaches to care and reimbursement with its refurbished web site, lauding continuous change for the better.

All well and good, says the DMCB, but it has its doubts about this burgeoning emphasis on "change."

1.  It kicks the can down the road: a fundamental alteration in the Medicare benefit literally takes an act of Congress.  Since that's so hard, it's easier to park new ideas in "demonstrations" and let them languish there in a twilight zone.

2.  Too much "change management" strains resources, resulting in a distraction away from the real work of running an agency.  For example, the DMCB's physician colleagues would like to hear less about "ACOs" and more about CMS paying bills accurately the first time every time.

3.  It gives the appearance of action when in fact, very little is happening.  Demonstrations and pilots taste great but are just not filling.

4.  Finally, the DMCB is all for innovation but CMS' track record of nimbleness - being able to collect, filter, analyze data and act on it - still remains very much of an open question.  There are just too many people, stakeholders, lawyers and politicians, no matter how well-meaning everyone is.

If the AMA isn't careful, it could end up trading the loathsome SGR for something much worse: being whipsawed by a series of delayed, tentative, frothy and inaccurate payment innovations that introduce an even higher level of uncertainty into its members' Medicare reimbursements.  In other words, payment "reform" will become an unending verb, instead of what the AMA's members want, which is a final noun.

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