Experts Favor Medicare Reforms to Control Costs,
Foster Health Care Innovations
Opinion leaders voice support in survey for an
independent Medicare advisory council with broad authority; allowing HHS
to negotiate drug prices
Question:
“Members of Congress and the Administration have discussed the
creation of an independent Medicare advisory council with
authority to make payment and benefit design decisions within
parameters established by Congress and subject to review by the
President and Congress. Please indicate the degree to which you
favor or oppose the creation of an independent Medicare advisory
council.”
Nov. 3, 2009 - A vast majority of leaders in health
care and health policy believe Medicare has been successful in providing
access to care and stable coverage to the elderly and disabled
individuals; however only a small percentage think the program has
realized its potential to achieve other important goals, like using its
leverage as the country's largest purchaser of services to control costs
and promote a high performance health system.
In the latest Commonwealth Fund/Modern Healthcare
Health Care Opinion Leaders survey, the experts surveyed favor
sweeping changes to Medicare - reforms that would help control program
costs and support broader health system reform.
Because of Medicare's unique position as the
nation's largest insurance program, it can be an important testing
ground for cost and quality innovations.
To encourage such development, nearly all
respondents favor expanding the power of the Secretary of Health and
Human Services to put payment pilot programs on a "fast track" (95%) and
to work with private payers and providers to establish multipayer
initiatives (94%).
Similarly, there was strong support for creation of
an independent Medicare advisory council (favored by 75%) with broad
authority to collaborate in multi-payer initiatives (89%), develop,
test, and implement payment reforms rapidly and flexibly (88%), and
alter beneficiary incentives based on effectiveness of services, drugs,
and devices (86%).
The survey asked respondents their opinions about
specific policy options to improve coverage. Respondents strongly
supported using Medicare's leverage to negotiate pharmaceutical drug
prices (81%) and filling in the so-called Medicare "doughnut hole" - the
Medicare Part D coverage gap, through which beneficiaries are
responsible for all of their covered drug costs - through some
combination of increased copayments, government funding, and drug price
discounts (79%).
There was also strong support (83%) for eliminating
the two-year waiting period currently required of 1.8 million disabled
beneficiaries before they become eligible for benefits. Delaying
coverage for them can have dire consequences—both financial and
physical.
"While these responses confirm that Medicare has
been a tremendous success in fulfilling its basic mission," said Karen
Davis, president of The Commonwealth Fund, "they also indicate that it
is important for Medicare to take the lead in developing innovative
approaches to improving health system performance."
Other findings from the survey include:
● More than three-quarters (76%) of
respondents favor reducing overpayments to Medicare Advantage plans.
Payments to these plans are projected to exceed corresponding costs in
traditional fee-for-service Medicare by 13 percent in 2009.
● Sixty-five percent of respondents feel that
bundled payments—a single payment for all the services provided to a
beneficiary for an episode of care or over a period of time—and
encouraging beneficiaries to designate a medical home would be effective
policies for improving care and reducing costs.
● Nearly three-quarters (74%) of leaders
believe older adults ages 50 to 64 should be able to buy Medicare
coverage before they become eligible at age 65.
● A strong majority (69%) favor having
Medicare offer its own comprehensive benefit package option as an
alternative to Medigap or Medicare Advantage coverage.
● Nearly all (91%) health care opinion leaders
support a requirement that Medicare providers participate in developing
state, regional, and national all-payer databases to aid in research,
policy development, and monitoring and evaluation.
● By a clear margin, opinion leaders do not
favor strategies that shift costs to beneficiaries or reduce payments
across the board. Only 42 percent support offering a high-deductible
health plan and 36 percent approve of requiring Medicare beneficiaries
to pay a higher share of costs. Capping federal spending was similarly
unpopular (26%), as was reducing payments to providers (19%).
The survey is the 20th in a series from The
Commonwealth Fund, and the 12th conducted in partnership with the
publication Modern Healthcare. Commentaries on the survey results by
former Medicare administrators
Bruce Vladeck, Ph.D., a senior adviser at Nexera, a subsidiary of
the Greater New York Hospital Association, and
Gail Wilensky, Ph.D., a senior fellow at Project HOPE, appear in the
November 2 issue of Modern Healthcare. The commentaries are also posted
on the Fund's Web site, along with a Commission data brief discussing
the survey findings.
Methodology
The Commonwealth Fund/Modern HealthCare Health Care
Opinion Leaders Survey was conducted online within the United States by
Harris Interactive on behalf of The Commonwealth Fund between September
9, 2009 and October 13, 2009 among 1,467 opinion leaders in health
policy and innovators in health care delivery and finance. The final
sample included 215 respondents from various industries, for a response
rate of 16.0 percent. The complete methodology is available on The
Commonwealth Fund Web site.
Also issues other policy updates adjusting pay for
hospital outpatient care, home health care