Medicare experiment shows initial promise

Accountable care organizations, an Affordable Care Act model that rewards providers who produce better quality at lower cost, are showing promise in Wisconsin and Iowa. Meanwhile, a top Medicare adviser outlines other needed changes.

Milwaukee Journal-Sentinel: Medicare Experiment Rewards Better Health At A Lower Cost
David Krueger regularly saw the waste and inefficiency in the health care system while working as an emergency physician. It might be as simple as patients who came to an emergency department because they could not get in to see their primary care doctors. Those doctors' schedules were full because they were seeing patients with relatively minor problems that could be handled with a phone call or an email. But the doctors saw the patients in person because that's the only way they would get paid. Krueger now is in a position to help make the health system work a bit better. The hard work is just beginning, but the initial efforts show some promise (Boulton, 9/20).

Des Moines Register: Iowa Hospitals' ACOs Earn $5.6 Medicare Rewards
Two Iowa hospitals have started seeing federal rewards for their efforts to keep patients healthy instead of just treating them when they're sick. Medicare has agreed to pay Mercy $4.4 million for the performance of its Accountable Care Organization, the hospital announced this week. Medicare also awarded $1.2 million to Trinity Regional Medical Center in Fort Dodge for its ACO, which was the first of its kind in Iowa, a spokeswoman said. Accountable Care Organizations involve extensive efforts to track how patients fare and to head off health problems before they become severe and expensive. For example, ACO's carefully monitor patients with chronic conditions, such as diabetes or congestive heart failure, and encourage them to come in for regular checkups and maintenance treatment. The organizations also employ "health coaches" to help patients stay on track (Leys, 9/19).

The Tennessean: Big Changes Needed For Medicare, Expert Says
Medicare must change, and that will be painful. That was the condensed version of the message from Mark Miller, executive director of Congress' Medicare Payment Advisory Commission, when he spoke to members of the Nashville Health Care Council on Friday. ... Miller's talk was loaded with information about the difficulty of managing Medicare, but a couple of points shone through. First, the commission, known as MedPAC, strongly believes Congress must fix the Sustainable Growth Rate formula. The SGR is supposed to tell the government how to determine reimbursement rates for Medicare -; but it doesn't work. "The SGR kind of brings the Congress to its knees on an annual basis," Miller said (DuBois, 9/21).

And a reminder that Medicare's annual enrollment period is coming --

The Wall Street Journal: Medicare's Annual Enrollment Period Approaches
Got Medicare? Two recent developments may help you figure out what type of coverage to elect during this fall's open-enrollment period, and how to navigate the backlogged system for appealing Medicare claim denials (Tergesen, 9/20).