How to stay informed as Medicare changes

Major changes are coming to the way seniors receive certain common Medicare services.

And while the changes are designed to improve care and eliminate duplicative costs, consumers need to keep a close eye on how they unfold, advocates say.

In a proposed rule more than 900 pages long and set for publication in the Federal Register in early August, the Centers for Medicare & Medicaid Services lays out a framework for paying health care providers to better coordinate certain medical procedures

They’ll get a set fee, or a bundled payment, to care for patients. The federal program will begin a five-year test of the new payment models next year in randomly selected geographic markets. It’s expected to save the program $170 million over the five years.

“Now is a great time to be talking to your doctor about how your care is being delivered now and how that might change in the future,” said Stacy Sanders, the federal policy director for the Medicare Rights Center.

Bundled payments are only one part of the overall push in health care toward more value-based pay.

“On the one hand, all these payment reform systems offer the promise of higher-value care and better coordination at lower cost but we need to be vigilant about how incentives might encourage providers to potentially skimp on care,” said David Lipschutz, the managing attorney for the Center for Medicare Advocacy.

There are quality measures built into these programs to address that concern, experts noted, but there are a few things patients should do:

Speak up

It’s important to fill out those pesky patient satisfaction surveys regardless of whether you had a good or bad health care experience, notes Josh Seidman, a senior vice president at Avalere Health and the head of the firm’s Center for Payment & Delivery Innovation.

“It’s very important that patients express their candid opinion about their experience of care because that is how they are going to make sure the concerns won’t happen again,” he said. Likewise, praising excellent care creates a positive reinforcement mechanism that can incentivize physicians in a good way, he said.

Be skeptical

While these measures are designed to improve patient outcomes, there’s always a danger of “teaching to the test,” Lipschutz said, or organizations finding ways to artificially create the outcomes called for in the rules.

“You always have to stay vigilant about discussing why certain plans and procedures are being recommended,” he said.

Be aware

Understand how your local medical community works. Do you see a physician who works in a small private practice, or one employed by a large hospital? These arrangements can make a difference in whether you’ll be part of these bundled payment arrangement trials or other value-based payment programs in the future, for better or worse.

On the plus side, the new incentives should substantially reduce the confusion and hand-off issues that often accompany a procedure like a hip replacement, said Blair Childs, the senior vice president of public affairs for Premier Inc., an alliance of 3,600 hospitals and other providers that focuses on health care innovation.

“You hear a lot of talk about patients being lost in the handoffs between physicians and post-acute care facilities. Now we’re talking about designing care much more centered around the patient,” he said.

This story was originally published August 1, 2016 at 2:52 PM with the headline "How to stay informed as Medicare changes."