Is Medicare “innovation” in the delivery and payment of health care headed in the right direction?

Medicare is on a quest to raise the quality of health care and save money. Both are worthy and necessary goals, but is one new program after the other the way to go about it? Can any of these efforts produce significant positive results when they seem to dictate to the medical profession, are mired in tons of paperwork and regulation and often are voluntary with inadequate incentives for participation? Are the various efforts even coordinated?

Here is the latest example. If you were a physician, would you participate? What does it mean for your income? Do bundled payments work in an Accountable Care Organization?

The Centers for Medicare and Medicaid Innovation today announced the Bundled Payments for Care Improvement Initiative to help improve care for patients while they are in the hospital and after they are discharged. Doctors, hospitals, and other health care providers can now apply to participate in this new program that will align payments for services delivered across an episode of care, such as heart bypass or hip replacement, rather than paying for services separately.  Bundled payments will give doctors and hospitals new incentives to coordinate care, improve the quality of care and save money for Medicare.

We need these types of changes, but we also need less not more bureaucracy and most of all we need more and stronger incentives for both health care providers and patients to want to participate. Perhaps rather than focusing on the behemoth of traditional Medicare the effort should be to strengthen managed care plans within Medicare Part C and provide strong incentives for beneficiaries to join such plans.

Managed care is not the enemy, it is where all this is headed.

This quest for cost savings is similar to employers embracing wellness programs with no idea what is and is not working, or what a wellness program is for that matter and yet claiming great success even as they cut benefits, shift costs to employees and raise employee premiums to deal with rising health care costs.