Mark McClellan, M.D., the current administrator of the CMS and one of the possible candidates to be the next HHS secretary, told 200 health lawyers at the American Bar Association's Washington Healthcare Summit that President Bush's re-election offers the best opportunity in decades to improve healthcare.
McClellan said initiatives to reward providers for improving quality and adopting healthcare technology, the expanded Medicare Advantage (PPO) Plans and the prescription drug benefit scheduled to take effect in 2006 should also restrain the growth of healthcare costs.
HHS on Monday announced the 26 Medicare Advantage Plan regions and 34 regular Medicare regions for prescription drug plans. He said HHS in early 2005 will announce a federal-employee type plan that will offer subsidies for employers and unions already providing drug coverage.
He said Medicare will move from a disease treatment insurance plan to a preventive and personalized care plan starting in January 2005, with the agency for the first time paying for diabetes, colorectal cancer and heart disease screening tests and comprehensive physicals, all aimed at the early detection and prevention of disease.
"Historically, most Medicare money has gone to the treatment of disease. This is the time to make the shift," McClellan said. He said that fragmented approach has not served beneficiaries well and said coordinating care is a more efficient way of delivery healthcare.
He said Medicare will select from a large number of bidders to provide services to beneficiaries with chronic conditions, noting that a pilot program will treat 300,000 beneficiaries in 10 regions starting in 2005. The plans covering those beneficiaries will be paid according to improvements in clinical outcomes, patient satisfaction and ability to save money.
"The most successful pilots will go national," he said. He said better information systems are needed to reduce the 9 million annual adverse drug events, many of which are preventable. He said Medicare hopes to persuade physicians to move to an electronic prescribing system, a component of last year's Medicare reform and prescription drug law.
The former Food and Drug Administration administrator said by 2006 he hopes to introduce demonstration projects on physician payments with both large and small physician group practices, paying more when beneficiaries with chronic conditions get better and when those doctors adopt information technology systems. He also hopes to lead efforts to change the Stark and antikickback laws to allow hospitals to help support their physicians' efforts to adopt electronic medical records and e-prescription systems. "We want to see doctors tied into hospitals," he said.
McClellan said hospitals can also benefit from some of the quality initiatives, such as an effort to prevent postsurgical infections and the Premier project grading hospitals on a set of quality outcomes.
He said that by mid-2005 he expects to have a set of hospital patient satisfaction measurements to introduce. "We want Medicare to get more for its money," he said. "We want to reward, rather than punish, providers delivering quality healthcare."