Medicare lacks the information and resources to aggressively enforce its own policies affecting medical judgments, even if those decisions are inconsistent with scientific evidence, according to researchers at the University of Minnesota.
By law, Medicare must pay only for items or services deemed reasonable and necessary, and it has developed sophisticated, evidence-based coverage policies to evaluate when procedures should be covered. At the same time, the Medicare contractors that process the claims for payment are directed to apply these policies. Yet that goal is not achieved because Medicare lacks the tools to make evidence-based medicine work.
Policymakers assume that Medicares coverage policies change physician behavior. Our research shows they dont, said Susan Bartlett Foote, the principal investigator and professor in the School of Public Healths Division of Health Policy and Management. Implementing coverage policies offers a promising way to reduce geographic variations and manage diffusion of technology. Unfortunately, despite Medicares great strides in the area of evidence development, we are falling short on the implementation side. The study was funded by the Robert Wood Johnson Foundation's Changes in Health Care Financing and Organization initiative, and it appears in the November/December issue of Health Affairs. -- by Cinda Becker
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