Many healthcare leaders are outspoken about the issues within the Medicare and Medicaid systems, but what can be done to fix them?
Becker's connected with two physicians to explore the biggest issues with the Medicare system and what can be done to address them.
Note: These responses have been edited lightly for length and clarity.
Question: What are the biggest issues with the Medicare/Medicaid system, and how would you change Medicare?
Agnes Hurtuk, MD. Assistant Professor and Ambulatory Medical Director of ENT at Loyola Medicine (Chicago). One of the current challenges of the Medicare system is its payment structure, increasing administrative burdens, and escalating out-of-pocket costs for patients. Medicare payments have not kept up with inflation, the costs of labor and supply, as well as the administrative costs within healthcare. This is increasingly forcing clinical practices to consolidate, close, and/or not offer services to Medicare patients, leading to shortage of physicians in some areas, creating obstacles in timely access of care, ultimately affecting quality of care and outcomes within communities.
One of the biggest challenges from a patient's perspective are the increasing Medicare out-of-pocket expenses, premiums and copays, as well as the increasing cost of prescription drugs that are being passed on to the patients due to increasing deductibles, coverage limits or lack of coverage. Patients may be delaying seeking care due to cost concerns or may not be able to afford the recommended medications due to limited Medicare coverage, thus affecting the quality of care and ultimately leading to poorer outcomes.
Additional measures are necessary to provide a reform that both patients and physicians need to receive and provide timely, safe, and quality care that Medicare patients deserve. I would propose strategies aimed at streamlining the process of caring for patients by decreasing the administrative burden, such as the preauthorizations, investing in programs and innovations that have been shown to improve quality of care, efficiency, and value within healthcare. I would also propose reforming the Medicare payment system structure and rates, to create financial stability for all practice types, from solo independent practices to multispecialty medical groups, to hospital-based groups and academic medical centers.
As an otolaryngology physician, I sincerely believe that with any Medicare reform it is important to consider the quality of care that the patients receive as the most important factor. I am a proponent of value-based innovations, such as incorporation of artificial intelligence into clinical operations to improve efficiency, safety and quality and reduce costs. It is also important to focus on value-based innovations, such as novel devices in the clinical settings that for example allow for in-office procedures to be performed, eliminating the need for surgeries and anesthesia which may have been required in the past.
Such value-based innovations have the potential to improve efficiency of care while maintaining or improving quality, and at the same time have the potential to save resources within the overall healthcare system.
It is important for stakeholders such as CMS, industry leaders, healthcare systems and professional associations such as the American Academy of Otolaryngology and the American College of Surgeons to work collaboratively to innovate and incorporate evidence and value-based innovations into clinical and administrative healthcare operations so that we can continue to strive to provider the highest quality care to our patients and communities.
Shalini Modi, MD. Associate Director of Heart and Vascular Service Line and Service Chief of Cardiology at Henry Ford Health West Bloomfield (Mich.) Hospital. The current system as it exists lacks patient accountability. Patients can go to multiple providers, health systems, be non-adherent to therapies, yet the providers are held accountable, not to mention the yearly Medicare cuts to providers. In addition, Medicare launches new incentive programs to providers not realizing the administrative burdens that it poses on practices in the name value and quality.
Patients' access to office notes and diagnostics causes insurmountable anxiety to patients, which is then directed towards the providers, causing hours of office staff and provider time in answering inbox messages. Has this really shifted the paradigm in providing better and cheaper healthcare? Absolutely not. Yet the practices suffer through this ordeal every single day.