The CMS needs to analyze its quality and outcomes rewards and penalties programs to ensure they are achieving their desired goals. Are the process measures in the value-based purchasing program the most appropriate ones for determining whether a hospital is truly offering high-quality care? Are the risk-adjustment factors in the 30-day readmissions penalty program taking into account the social conditions of the patients served by hospitals in high-poverty cities and regions?
The information is available to fine-tune these programs to incentivize behaviors that truly improve outcomes. Many systems across the country have overhauled their care delivery in ways that demonstrated better results. Coming up with incentive systems that diffuse that knowledge more broadly should rise to the top of the agency's “to do” list.
Providers should adopt higher standards for investing in or paying for cutting-edge technologies. Advertising the availability of robotic surgery at the same time the medical literature is raising questions about its efficacy and safety isn't just unseemly—it could be injurious to the bottom line. It makes no economic or medical sense for hospitals on opposite sides of town to engage in a medical arms race around technologies of dubious value.
In the same vein, pharmaceutical and medical device companies that develop next-generation pills and implants need to prove those products are better than what they seek to replace. And their prices need to reflect their actual medical value. Healthcare payers and providers can't afford $10,000-a-month cancer drugs that extend life on average for a couple of months—nor should they be pressured into paying that price by desperate patients who are in no emotional position to sort out the issues.
Political leaders in the states that failed to expand Medicaid or build their own insurance exchanges should use 2014 to decide if their stance really makes sense for their people, their healthcare providers and their local businesses. As this space noted many times over the past year, Obamacare—yes, even the president embraced its moniker—is the conservative solution to the long-festering problem of one-sixth of a nation going uninsured.
It relies on the market. It relies on private insurance with government subsidies to individuals. The relative success of the state-run exchanges versus the bungled federal rollout (now righting itself) speaks volumes about the wisdom of Obamacare's structure. The federalist approach of the nation's founding fathers can work—but only if the current crop of political leaders allows it.
Follow Merrill Goozner on Twitter: @MHgoozner