A Route to Quality Medicare Reform – Insight by CMS’ Donald Berwick

It is often instructive to review the thinking of health care decision-makers as a tool to acquire insight on the direction of health care policy. In this regard, Dr. Donald Berwick, the administrator of the Centers for Medicare & Medicaid Services (“CMS”), recently authored an Op-Ed in the Wall Street Journal outlining his view of Medicare reform. In light of the fluidity of the debate on the direction of the federal health care program, we, at The Health Law Partners, have summarized the central principles in Dr. Berwick’s piece. While Dr. Berwick’s perspective is, by no means, devoid of the partisanship that has become so endemic in the health care debate, his article nonetheless demonstrates that the Administration intends to pursue the reform path enacted with the passage of the Patient Protection and Affordable Care Act (“PPACA”) in 2010. It is noteworthy that, subsequent to the publication of this article, Dr. Berwick has acknowledged that the negative reception of the proposed ACO rules by the provider community inevitably will result in modifications to those rules.

Medicare reform may be a crucial building block toward a brighter economic future for the country because, among other benefits, successful reform could reduce the country’s deficit and debt. The task, however, requires balancing the growing costs of Medicare with the enormous financial burden medical costs impose on families. A plan proposed by Republicans in Congress would shift the costs of healthcare to seniors and the disabled. The plan would eliminate guaranteed Medicare benefits, limit the choice of doctors and hospitals, and burden the average senior with $6,400 of insurance costs. Although Medicare spending might be reduced as a result, the overall cost of healthcare would continue to climb under this plan.

In the alternative, the Medicare system could follow the example set by other fields (e.g., the computer industry) and focus on lowering costs and improving efficiency. The groundwork for such an approach was laid out by the PPACA. Up to $1 billion will be invested by the Partnership for Patients to aid healthcare providers in improving the safety of care. This partnership will not only elevate the quality of health care delivery, but will reduce Medicare costs by an estimated $50 million. In another effort, CMS recently introduced a Proposed Rule for Accountable Care Organizations (“ACOs”). Under this rule, ACOs will coordinate patient care and facilitate better communication among providers to reduce duplicate tests and procedures which should result in decreased healthcare costs. According to Dr. Berwick, improving the quality of healthcare may prove to be the best route to successful Medicare reform and a brighter economic future for the country.

For more information about ACOs or the ever-evolving healthcare landscape, please contact Carey F. Kalmowitz, Esq., Adrienne Dresevic, Esq. or Esq. at (248) 996-8510 or (212) 734-0128, or Daniel B. Brown, Esq. at (770) 804-6475, or visit the HLP website.