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Groups explore Medicare savings, quality ideas

The Supercommittee that will decide on how to slash the federal budget in part by cutting costs from Medicare might consider recommending that the Centers for Medicare & Medicaid Services pay the lowest price for functionally equivalent medications instead of accepting more expensive brand drugs.

This was among the proposals offered by Dr. Robert Berenson, a senior fellow at the Urban Institute and vice chair of the Medicare Payment Advisory Commission, and others at an Oct. 19 panel on Medicare savings ideas for the Supercommittee. The meeting was sponsored by Health Affairs, American Board of Internal Medicine Foundation, the California HealthCare Foundation and the Foundation for Informed Medical Decision Making.

Participants proposed that Medicare be allowed to make more effective coverage decisions that will contribute to better health outcomes for beneficiaries, discourage routine unnecessary services that increase costs without benefit to patients and encourage more shared decision-making among physicians and patients, especially about care at the end of life.

The congressional Joint Select Committee on Deficit Reduction is charged with finding ways to decrease the federal budget deficit by at least $1.2 trillion over the next 10 years. Measures that could save money in Medicare would also improve patient care. The Supercommittee must vote on a plan by Nov. 23.

CMS needs more employees and established processes to carry out its programs effectively, such as to support compliance with decisions on coverage, Berenson said.

"Providers like Medicare because they don't ask questions and pay on time," he said. For example, he cited claims research that showed that 20 percent more patients than was necessary according to Medicare clinical guidelines received implantable defibrillators to give a jolt of electricity when the heart is in arrhythmia. The medical devices can reportedly cost between $50,000 and $100,000 to implant.

The American College of Physicians (ACP) supports value-based purchasing and value-based benefit design for patients so they have a stake in changing behavior. The value of care and use of comparative effectiveness should be considered in pricing and reimbursement, said Dr. Steven Weinberger, ACP CEO.

"Sometimes it is difficult to effect change just through education. It is worthwhile to incentivize both physicians and patients to avoid low value care," he said.

Some of the most routine procedures are performed unnecessarily and by establishing sensible protocols could lessen their use and improve their effectiveness, said Dr. Nancy Morioka-Douglas, medical professor at Stanford University. 

Following the recommendations on the top five procedures in primary care could improve care and would also save almost $7 billion annually, according to a study that estimated the costs of the Top 5 Lists developed by the National Physicians Alliance Good Stewardship Project. Morioka-Douglas is a project participant.

Of the total, $5.8 billion alone would be saved by prescribing low-cost generic statins when initiating cholesterol-lowering treatment rather than high-cost, brand name drugs.

Patients might also produce savings for Medicare if tools for shared decision-making were widely available, such as for discussions between a physician and patient about end of life preferences.

For example, a video can more accurately inform patients about interventions than just describing them verbally, said Dr. Angelo Volandes, who practices at Massachusetts General Hospital. He has tested the use of videos with a number of patients who have advanced conditions.

"When they are informed, they are more interested in comfort at the end of life than aggressive interventions. We are a visually literate society. Medicine needs these tools," he said.
 

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