IOM recommends phased-in Medicare P4P system
In a just-released report, the Institute of Medicine urged the Department of Health and Human Services to gradually replace the current fee-for-service Medicare program with a new pay-for-performance system for reimbursing participating health care providers, concluding that the current Medicare system provides "few disincentives for overuse, underuse or misuse of care, and does not reward efficiency." In the next three to five years, the authors urge Congress to reduce base Medicare payments for all health care providers and use the money to fund rewards for strong performance. HBQI will provide in-depth analysis of this potentially industry-changing report in our next issue.
CMS announces preventive care project
The Centers for Medicare & Medicaid Services (CMS) has issued a solicitation to implement a health promotion and disease prevention program through the Medicare Senior Risk Reduction Demonstration. The program enhances CMS' focus on prevention of chronic disease in the Medicare population.
The program aims to determine whether health risk reduction programs that have been developed, tested, and shown to be effective in the private sector can be tailored to the Medicare program. According to CMS, 82% of seniors have one chronic condition, and about 50% have two or more. Seniors with these conditions have better outcomes with fewer costly complications when they are diagnosed early and when they take lifestyle steps that are proven to improve their health.
In addition to the demonstration project, Medicare has instituted "Welcome to Medicare" visits for new Medicare enrollees that provide education and counseling about important preventive services as well as screening tests, shots, and appropriate referrals. Other preventive benefits Medicare offers include: cardiovascular screening blood tests, diabetes screening, counseling to quit smoking, and glaucoma screening for Hispanic Americans.
CMS will select up to five existing health promotion, disease prevention, and risk reduction organizations to participate in this three-year demonstration. Final award decisions should be made by spring 2007. For more information, go to: www.cms.hhs.gov
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