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Medicare’s Dumping a Program That Works

Last update on: Feb 02 2017

Though the federal government’s various medical payment programs are regimented and uniform, they do allow various pilot or test programs. The pilot programs start small and sometimes expand when they really work. Yet, here’s a report that Medicare is phasing out a pilot program that has fantastic results.

The program is directed at people with one or more chronic diseases. These are the people that consume most medical spending. Unlike most other programs, this one works. The government gives a vague reason for phasing out the program, and people outside the government disagree with the explanation. It’s a long article, but well worth reading.

But Health Quality Partners, with its emphasis on continuous nurse-to-patient contact, did work. Of the 15 programs, four improved patient outcomes without increasing costs. Only HQP improved patient outcomes while cutting costs. So Medicare extended it again and again — now it’s the only program still running under the demo. But Medicare has notified Coburn that it intends to end HQP’s funding in June.

Medicare’s official explanation is carefully bureaucratic. “The authority that CMS had to conduct this specific demonstration, which predated the health care law, did not allow us to make the program permanent and limited our ability to expand it further,” says Emma Sandoe, a spokeswoman for the Centers on Medicare and Medicaid Services. “As we design new models and demonstrations, we are integrating lessons from this experience into those designs.”

Every expert I spoke to — as well as a plain reading of the law — disagrees. If they wanted to make HQP permanent, or scale it up in a big way, Medicare has the power to do so. Then there’s this: “Thanks to the health care law, we can now test new, innovative models for delivering health care and expanding models that show promise,” Sandoe continues. “With this new authority, we can take best practices to scale and provide more incentives to deliver high-quality health care at lower costs.”



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