On this blog, a point that I have made more than once is that
Obamacare is moving Medicare away from a fee-for-service model----a
model in which Medicare reimburses doctors for every service that they
provide to their patients, thereby incentivizing doctors to order more
services for the patients in order to make more money, whether the
patients need the services or not. Critics of this approach have
maintained that the focus of Medicare should be on health results, not
on reimbursing every service that the doctor performs.
But there
is debate about whether or not Obamacare actually moves Medicare away
from the fee-for-service model. I won't go back to every post where I
said that it does and correct myself, since that could be tedious, plus I
may say that Obamacare undermines fee-for-service in future posts,
since I have written some of the posts months in advance. But I will
post here some links that relate to the debate----one link that argues
that Obamacare does move Medicare away from fee-for-service and offers documentation for that claim, and another link that argues the opposite.
1. Stephanie Mencimer of the progressive Mother Jones argues here that Obamacare is moving Medicare away from fee-for-service. She states the following:
"[Conservative mayor of Saratoga Springs, Utah, Mia Love]
pointed to doctors who buy new equipment and then are driven to use the
equipment on as many patients as possible to pay for it. To put an end
to such practices, Love said the country needs to move away from the
fee-for-service health care model and toward a 'fee for outcomes'
system. 'If we start aligning the incentives with the outcomes we'll
start getting better health care, we'll get better services, and we’ll
get more health care available for those who need it,' she said. Love seemed unaware that Obama has already made huge strides
in doing just these things through the Affordable Care Act. The health
care reform law created and funded a host of new projects to move
Medicare away from fee-for-service practices and towards different
payment models, such as Accountable Care Organizations.
These groups of providers work to coordinate care for patients and
reduce duplication of service and unnecessary hospitalizations. If they
succeed, they can share in the savings they help create. The law also
includes pilot projects in which Medicare will reimburse health care
providers for 'episodes' of care, rather than for every service
provided, thus creating incentives for doctors and hospitals to better
coordinate care and focus on outcomes—just as Love suggested."
2. Conservative columnist John Ransom here
argues otherwise, as he refers to an article on the web site of the
American Academy of Family Physicians. This article quotes M.D. Robert
Berenson of the Urban Institute:
"From the American Academy of Family Physicians:
"The
U.S. health care system will continue to rely on a fee-for-service
payment model for at least the next eight to 10 years, making it
incumbent on policymakers to work on fixing flaws in the system for the
short term. That's the opinion of health policy expert Robert Berenson,
M.D., a senior fellow at the Urban Institute, who spoke as part of a
panel on Medicare physician payment during the Family Medicine
Congressional Conference here May 14-15.
"'It is going to
take us a while to move to something new, and I would guess there will
be parts of the country in which fee-for-service will be with us for a
very long time,' said Berenson. 'We probably will not have the
organization developed to take on new payment models and the
collaboration and integration that most of these payment models envision
in the near future.'"
Berenson appears to be arguing that Obamacare technically does
aim to move Medicare away from fee-for-service, but it will take a
while. That's what I can't stand about Obamacare: It seems to take a
while for some of its reforms to become reality.