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The Doctor's Prescription For Restoring Health To Medicare

The Doctor's Prescription For Restoring Health To Medicare | #HITsm | Scoop.it

An important, in-depth article in Forbes on why ACOs aren't likely to curb Medicare costs, plus valuable recommendations of what would work.

 

How does Medicare accomplish this? First Medicare must make greater use of existing capabilities to manage, in an evidence-based way, the appropriate use of prescription drugs, of expensive diagnostic imaging, and of expensive therapeutic interventions. There is a large benefits management industry in this country with a proven track record in managing these powerful but expensive components of health care. While Medicare has taken some advantage of pharmacy benefits managers (PBMs), optimal use of PBMs along with radiology benefits management and initiation of management of other expensive procedures and interventions (only as best medical evidence dictates) should be able to shave $10 billion or more off annual Medicare spending.

 

How much could this save? Estimates range from as low as 10-15% to as high as 25-30% of all healthcare expenditures. For fee-for-service Medicare this could mean from $40 to $120 billion per year.

 

Is this possible? It is already being achieved within the well-performing Medicare Advantage plans where primary care physicians are delivering quality care, gaining reimbursement of 150-200% of fee-for-service Medicare, and controlling unnecessary resource utilization.

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The Promise of Electronic Healthcare Records

The Promise of Electronic Healthcare Records | #HITsm | Scoop.it

Last week, Don Berwick completed his 17 month tenure as administrator of Medicare and Medicaid. The nation should be grateful that such a visionary was at the helm. The nation should frustrated that he was never confirmed.

 

In his parting interview with the press, he noted that 20-30% of health spending is “waste” that yields no benefit to patients.

 

Berwick listed five reasons for the enormous waste in health spending:
*Patients are overtreated
*There is not enough coordination of care
*US health care is burdened with an excessively complex administrative system
*The enormous burden of rules
*Fraud

 

Certainly regulatory reform is needed, but electronic health records can go far to addressing each of these issues.

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