Alice Rivlin, Ph.D., director of the Engelberg Center for Health Care Reform at the Brookings Institution and cochair of the delivery system reform initiative at the Bipartisan Policy Center, offered a number of potential cost-saving reforms, including income-adjusting premiums, accelerating of payment reform, rewarding seniors for choosing generic drugs, more competitive bidding, and accelerating the time frame for higher payments to providers participating in alternative payment mechanisms highlighted in the legislation to 2018 and offering those incentives to all Medicare providers.
“They would move to make Medicare a more efficient program,” Dr. Rivlin, founding director of the Congressional Budget Office, said.
Dr. Rivlin also suggested that strengthening accountable care organizations (ACOs) would help with finding savings offsets, including setting longer-term savings goals rather than resetting baselines every year or eliminating historical or “after-the-fact” attribution of beneficiaries to ACOs.
“The long-term promise of these models won’t be realized if unrealistic short-term pressures for savings make it unlikely that many providers can succeed,” she said. “These are all fixable problems that can be addressed as part of SGR reform.”
Better care coordination also could save Medicare money and contribute to SGR reform funding, according to Marilyn Moon, Ph.D., a fellow at the American Institutes for Research.
Dr. Moon said that there should be incentives that emphasize performing the right care at the right place and at the right time. To that end, she said the notion of bundled payments needs to be carefully examined because of the influence the entity in charge of payments might have.
For example, if a hospital is the lead organization in charge of distributing bundled payments in a coordinated care system, it might be inclined to keep patients in house rather than send them to a more appropriate setting.
There are “a lot of things that need to be worked out,” she said, adding that the SGR legislation could be a good vehicle for it.
On Jan. 22, the Health Subcommittee will hear testimony on SGR reform from a panel of representatives of physician organizations.
AGA has advocated for years that legislation is needed to reform the SGR. While AGA is disappointed that repealing the SGR had become such a politicized issue in terms of identifying pay-fors, we continue to call on Congress to keep the momentum going and not to lose progress on an issue that is so critical to organized medicine and patients. AGA and the entire physician community urges Congress to enact SGR reform legislation before the temporary physician patch expires in March.
