Earlier this week, Medicare announced its goals for the next few years, setting the noble and patient-centric goal of having half of all Medicare spending—outside of managed care—to be paid under a value-based contract system with incentives aimed at managing quality and costs.
There are few who would call that goal anything but good for the healthcare industry. Patients have always been, and always will be, the central focus of healthcare practitioners regardless of how they are paid for their services. The issue, however, is not the goal, but the body being charged with the mission of achieving that goal.
The HHS has learned recently through its efforts in their Meaningful Use program, as well as Congress' handling of the ICD-10 delays, that painting with broad brushstrokes is exceedingly difficult in a nation this large and with issues facing the healthcare industry that are so vast and diverse that there is little room for strategies that lack nuance and flexibility. If you pull on one thread of the tapestry, five more will bunch up on the other end. Set a tight deadline for providers to be ready to integrate ICD-10, and physicians who lack finances and technology help will scream for more time.
I have to admire the chutzpah it took to make such an announcement. It's the approach NASA used to get us to the moon. When President Kennedy announced we'd put a man on the moon, NASA didn't have the foggiest clue how they were going to do it. However, the agency developed a culture by which it thrived on being given a virtually unsolvable problem, few resources and an untenable deadline.
But HHS is not NASA. It does not have a long history of success for its initiatives. Further, it must work with Congress in some areas, and the dysfunctionality of that body is poised to reach new heights as the White House enters its last year in lame-duck land with an opposition party controlling both houses of the legislature.
Moreover, Medicare is not the only organization that pays for healthcare in the United States. Insurance companies foot the bill for a very substantial part of the care for Americans under age 67, and for HHS to truly achieve its goals, the insurance companies must also be on the same page. If not, healthcare providers will be forced to commit to a difficult balancing act, working toward a value-based system for reimbursement from Medicare while largely operating on the utilization-based model they have used for decades. As much as we would like to see that landscape change, the evolution will have to be market-driven to have any lasting impact and hope for success.
While we can admire the HHS for its vision and desire to get our nation's healthcare on a value-based system, we have to remain cautious that the way they go about it. We must ask for more detail about how they are going to achieve that solution to ensure it doesn't cause an eruption of a multitude of other problems that are bound to arise. When regulators—who have yet to get a handle on something as basic as EHRs—struggle with an industry that has traditionally been resistant to massive change, it cannot follow the NASA path of making bold pronouncements and then making it up as they go along. HHS must offer a more detailed, nuanced plan for bringing Medicare into a value-based matrix, lest it risk all its other pending achievements to get there.