Gem of the Week: Overhauling the Medicare Payment Model

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In this blog post I highlight an illuminating or groundbreaking news article or report on the environment or health from the past 5 days. This week’s gem goes to… the National Academy of Science’s Institute of Medicine for revealing deep weaknesses in the way Medicare determines how much to pay doctors and hospitals for covered expenses. The report also outlined ways to fix these weaknesses.

For example, as found in the NAS report, Medicare uses geographical market areas to help determine how much a kidney transplant will cost a hospital to perform. However, Medicare divides the US into only 89 geographic markets, and some of those markets are an entire state or a large city. So even though an independent hospital in rural Nebraska incurs more costs to provide an organ transplant, it would be reimbursed the same as a better-funded, corporate-owned hospital in downtown Omaha. The authors recommend revising how these geographical areas are determined, and integrating them other parts of the Medicare payment model.

Another large flaw the report found was the wage index Medicare uses to help determine how much it should pay doctors and staff for procedures. Instead of using survey data from the Centers for Medicare and Medicaid Services, the report’s authors recommend using the Bureau of Labor Statistics’s data because it’s independent and more accurate.

The report is just phase I in a two-part investigation: the final report will be released in 2012. Amid discussions of cutting Medicare entitlements and aging Baby Boomers, the report’s recommendations are vital information. Currently Medicare covers 47 million seniors and 8 million people with permanent disabilities. With so many subscribers, making payments more accurate could go a long way toward cutting waste (where it occurs), and making sure all hospitals and staff are fairly compensated Medicare services.

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WE'LL BE BLUNT

It is astonishingly hard keeping a newsroom afloat these days, and we need to raise $253,000 in online donations quickly, by October 7.

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Readers also told us to just give it to you straight when we need to ask for your support, and seeing how matter-of-factly explaining our inner workings, our challenges and finances, can bring more of you in has been a real silver lining. So our online membership lead, Brian, lays it all out for you in his personal, insider account (that literally puts his skin in the game!) of how urgent things are right now.

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Getting just 10 percent of the people who care enough about our work to be reading this blurb to part with a few bucks would be utterly transformative for us, and that's very much what we need to keep charging hard in this financially uncertain, high-stakes year.

If you can right now, please support the journalism you get from Mother Jones with a donation at whatever amount works for you. And please do it now, before you move on to whatever you're about to do next and think maybe you'll get to it later, because every gift matters and we really need to see a strong response if we're going to raise the $253,000 we need in less than three weeks.

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