Medicare, consumers face challenges when trying to make choices based on value

Jan 20 2010

News outlets report on concerns about Medicare costs, problems with fraud in health care around the world, and the difficulties consumers face when trying to find value in their health services.

Jacksonville Business Journal reports on concerns about proposals to base Medicare pay on rewarding quality and notes that variation in hospital performance often occurs because of the amount of charity cases, Medicaid and uninsured patients. "Rewarding high-quality, efficient hospitals with more Medicare dollars may be one of the most effective cost-control measures in health care reform legislation, which explains why moving to such a system is included in both the House and Senate bills. But the prospect of a shift toward paying for value has raised familiar questions about how it is measured, and concerns over who would be on the losing end if the new formula were to become law. At the center of the debate are the vast regional disparities in Medicare spending, and what are legitimate causes for the variations that may be unrelated to a provider's cost and efficiency" (Morrison, 1/19).

MarketWatch reports on Medicare costs and retirement: "Health care is one of the biggest costs to plan for in retirement, even with the federal Medicare program providing basic coverage to Americans age 65 and over. That's because Medicare beneficiaries can face substantial out-of-pocket costs, and the program doesn't cover long-term-care needs beyond a brief transition period." MarketWatch offers advice to "retirement-focused investors, hurt by the market's collapse and skeptical of a rebound" (Gerencher, 1/19).

The Olympian reports on several Democratic members of Congress from Washington -- Sen. Maria Cantwell,  Rep. Norm Dicks and Rep. Jay Inslee -- who are pushing for proposed fixes to Medicare reimbursement: "Lawmakers have told congressional leaders they won't support a health care bill unless it overhauls a complex Medicare reimbursement formula that for years has shortchanged doctors and hospitals in Washington state, which provide medical care to more than 780,000 seniors. The changes should make it easier for Medicare patients in Washington to find and keep doctors. It may also help attract additional doctors to Washington state" (Blumenthal, 1/18).

The Houston Chronicle reports that the price for common medical tests such as an MRI or CT scan vary significantly in Houston: "Patients — and the companies that subsidize their health insurance plans — can save thousands of dollars if they know which in-network hospitals, outpatient clients or lab offer the lowest prices. But patients don't typically have access to that pricing information in advance, or even know that prices vary. Insurance contracts are confidential, and individual bills are determined by billing codes few patients understand. Consumers can compare prices when they're shopping for a car or buying groceries, but they don't have that transparency when buying health care services, said Christopher Fisher, chief innovation officer of BenefitSpecialists, which designs benefit programs for Houston-area employers. Pricing information available from insurance companies varies" (Sixel, 1/18).