Giving them credit: a way to reduce Medicare cuts

The dream of providers' getting budgetary credit for health system savings that their efforts produce is alive on Capitol Hill, but it may be on life support until after the election.

The seemingly esoteric budget question could have very real effects. For instance, crediting providers for achieving some spending reductions—for example, by reducing hospital-acquired infection rates—could reduce the need for the 2% across-the-board Medicare cuts next year.

It's a long-sought change in congressional health budget cost estimating or “scoring,” which advocates of the 2010 healthcare overhaul failed to obtain (and which could have significantly improved the projected costs of that legislation). But Sen. Ben Cardin (D-Md.), a member of the committee with primary jurisdiction over Medicare, is continuing to push for the change as part of a bipartisan group of senators searching for common ground on long-term federal debt reduction.

“I use hospital infection rates because there we have pretty strong evidence as to how we can reduce—by a substantial amount—costs that were built into the baseline that have never been scored, by using protocols that will reduce hospital infection rates,” Cardin said in an interview last week.

The ultimate goal is to achieve bipartisan consensus on using such provider accomplishments in projecting reductions in federal spending and thereby reduce the need for aggressive cuts in the federal healthcare programs as part of a “grand bargain” to rein in massive projected deficits, Cardin said.

But if a grand debt deal does not materialize, Cardin said, senators still could apply such provider savings to reducing the need for the coming 2% cut.

“There's many of us who don't really want to see across-the-board provider cuts, we don't want to see beneficiaries have to pay more, so this an area that we think gives us the greatest chance of bringing down the projected Medicare costs in a way that rewards providers for the right care and doesn't cost beneficiaries more money,” he said.

It's a change that likely would attract a lot of support from provider advocacy groups.

So how's it looking?

“I'm trying to get discussion on it now but it's a long shot at this stage,” Cardin said.

Follow Rich Daly on Twitter @MHRDaly.



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