All three valid points. If Medicare adopts my suggestions, I am certain that it will significantly reduce the current problem with overutilisation of services and volume-dependent practices. Here are my suggestions for Medicare reform:
1) Create a fully negotiable and transparent financial/reimbursement system recognising the fact that physician practices are in fact small businesses and need to be worked with on a level playing field. This way each patient is able to select his/her physician/hospital/pharmacy, etc. based on actual costs (not “allowables”, etc.)
2) Eliminate all “automatic” trigger mechanisms which introduce and perpetuate a sense of uncertainty in medical marketplace (not knowing what a business’ cash flow is 3 months in the future is not acceptable). Even Walmart would not do business with the government if confronted with such uncertainty.
3) While considering incentives for high quality service, first have Medicare reps visit those practices/hospitals that already provide high quality care; use these as base standards to asses other practices/hospitals, etc. Avoid using criteria such as being used under current PQRI program as surrogates of high quality – they can be fudged even by non-clinical workers. If Medicare wants to learn about true quality care, it must do a more extensive review, which will involve a lot more resources than PQRI.
4) As you know, the bulk of costs occur due to chronic diseases. So Medicare must freely employ methods proven to increase efficiency and effectiveness of managing chronic diseases. Current method of reimbursing “episodic care” is utterly inappropriate. There must be policy to reimburse “continuous care” for chronic diseases. This will result in long term cost reductions.

Finally, the only area where the government can be effective, in my opinion, is to educate the general public that they cannot expect unlimited care (especially end-of-life care). Setting up legal protections for physicians to use logical judgement in making end-of-life care decisions will go a long way in reducing potentially futile care in such circumstances.

Thanks for the blogs, Mr. Leavitt.

Barbara Heise, PhD, APRN, BC
Assistant Professor
College of Nursing
Brigham Young University
Provo, Utah
801-422-6352

___Posted by: Barbara Heise, PhD, APRN, BC | July 06, 2008 at 12:44 PM

Mr Leavitts really should look deeper into the senior citizens needs to have access to quality care before he makes arguments about spending too much $$ on Medical Equip that can be purchased at a fraction of what is being charged. It is not a “Good Stuff Cheap” industry. You get what you pay for at his so called fraction of the cost. Would he want his parents to get cheaper Medical Equipment at a fraction of the cost

Posted by: bRIAN | July 09, 2008 at 11:37 AM

So what Can you say about it?