Aging, etc.

Candice Rose

Course Correction on Medicare

Over the past couple of weeks we have heard a lot about how to rein in burgeoning Medicare costs. Most solutions focus on either cutting benefits or increasing costs to Medicare beneficiaries. But maybe there’s another approach. Why not maximize Medicare functioning and operations?

A number of factors hinder optimal functioning:

  • Over the past few decades the American health system has been transformed from private practice groups into a health industry under constant pressure to make quarterly numbers. Individual doctors may have a warm and fuzzy relationship with their patients but their corporate employer expects them to meet financial targets. The current health-care culture makes it difficult to resist the lure of overbilling.
  • We do not have an accurate picture of Medicare operations because access to Medicare databases is restricted. Last week Sens. Ron Wyden (D., Ore.) and Charles Grassley (R., Iowa) introduced the Medicare Data Access for Transparency and Accountability Act, or DATA Act. Opening the database will not only expose fraud and waste, it will reveal patterns of ineffective care. The greatest expenses billed to Medicare occur in the last two years of a patient’s life. Is the system delivering the most effective, appropriate and compassionate care during this phase?
  • Presently, service providers are reimbursed for each transaction - incentivizing doctors to order more tests and treatments regardless of whether or not the patient will benefit. A doctor recently submitted a letter to the editor of the Washington Post stating that “A major portion of the duplication, excessive testing and frequent hospitalizations that the administration is targeting, in fact, is the sole survival mechanism that these Medicare-dependent practices and hospitals rely on to stay afloat these days.” This model of provider reimbursement must change.
  • Financial ties between medical suppliers and service providers should be eliminated. Being financial rewarded for using products often leads to excessive prescribing. Recently the WSJ reported on a physician who performed multiple operations on individuals despite poor patient outcomes
  • Consumer education must become a priority. Unrealistic patient expectations about procedures and outcomes can lead to excessive utilization and demand for service which may not contribute to the patient’s quality of life. More must be done to encourage positive proactive health behaviors and maintenance of chronic conditions so that crisis care has the opportunity to diminish.

One very good thing about the Medicare system has always been its low administrative costs. Why not strive to maximize efficiency in every aspect of Medicare? Possibly older adults would achieve the highest possible level of health and functioning without overwhelming the budget. Who knows – maybe Medicare could become a model of healthcare for the entire population. Why isn’t there more discussion on this?

The author, Candice Rose, is a specialist on the topic of aging and elder care. She is currently serving as the Chairwoman of the Arlington County Commission on Aging in Virginia. You can follow her on Twitter at

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