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With Little Hope for Reform, What Can Congress and CMS Do?

Posted Dec 02 2008 3:08am
After today’s market meltdown, the Disease Management Care Blog once again pondered the moribund prognosis for any new money being approved by Congress for health care reform in the near future. Main Street is clearly balking over a bailout for Wall Street. Given the bad news for their 401Ks or home values, who thinks the folks on Main Street will be willing to dig into their pockets for their uninsured neighbors, underpaid Lexus-driving physicians or overfilled hospitals?

That doesn’t mean Congress and CMS won’t search for something, anything that will give their constituents the impression that they’re concerned – deeply concerned – about healthcare quality or cost savings. Here are four process-rich areas that will give the Feds the cover they need in mainstream FFS Medicare. The DMCB fully expects these concerns to move to center stage, pushing disease management, population-based care strategies, new provider reimbursement or consumerism off to the side for the foreseeable future.

Attacking fraud. A perennial bipartisan favorite that is a never ending source of blustering indignation. Given the whack-a-mole complexity of the Medicare regulations, enterprising criminals will always exploit a loophole. In exchange, the Feds get to always exploit the appearance of accomplishing stuff.

Exposing administrative incompetence. While Medicare is a huge bureaucracy, there are simply not enough people to monitor inappropriate utilization, especially when CMS relies on the threat of a retrospective audit to get its way. That doesn’t mean there isn’t political advantage to be gained by finding examples like this. A closely related area is high cost radiology.

Not paying for errors (and paying for quality). No, not all mishaps are unavoidable and not all quality is measurable, but that’s not the point. It tastes great and is less costly.

Pursuing physician self-referrals. The rules that govern ‘safe harbors’ between physicians and imaging facilities are a mind-numbing morass. Perfectly suited for our political process, which can use untold months pulling it all apart and then putting it back together again.
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