Higher Quality Care for Medicare Beneficiaries

The President believes that Medicare’s most important goal is to provide enable our Nation’s seniors and disabled Americans with to get the high-quality, error-free health care they deserve. Physicians and other health care providers unquestionably share this goal. Unfortunately, because of benefit limitations, and inefficient and complex regulations and payment rules, the Medicare program today is not creating creates an environment for medical practice that encourages and supports high-quality care that can improve health and reduce costs provides few incentives to deliver quality care that patients need in the most efficient manner possible. Failures to provide recommended treatments, as well as frequent medical errors with serious consequences for seniors, collectively, potentially account for a large share of Medicare expenses and present an a tremendous opportunity for making Medicare beneficiaries and taxpayers better offfor improving the health of people in Medicare.

There are many examples of Medicare’s failures to provide high-quality care in Medicare:

• A recent study published in the prestigious Journal of the American Medical Association found that treatment of Medicare patients with heart attacks varies widely. For example, while it is recommended that patients take aspirin within 24 hours after their heart attack, the proportion of patients who actually received this treatment ranged from 75 percent in one area of the country to 97 percent in another area.

• A recent study showed that only 69 percent of Medicare beneficiaries with diabetes received recommended eye exams to determine if treatment was needed to prevent blindness. And only 71 percent of beneficiaries with diabetes received a test to determine whether their blood sugar was in control to determine if their medications needed adjusting to prevent the many complications of diabetes.
• Less than half of Medicare beneficiaries in the government plan received pneumonia vaccinations. According to the Centers for Disease Control and Prevention, the respiratory illnesses of pneumonia and influenza represent the sixth leading causes of death in the United States. The incidence of pneumonia increases with age, and approximately 90 percent of deaths occur among seniors. About 600,000 seniors are hospitalized each year with pneumonia, and they also have more than 500,000 emergency department visits.

• Only about 55 percent of women in the government plan who were less than 70 years old received the annual mammogram that has long been recommended as a critical part of early breast cancer detection. One out of eight women will develop breast cancer over her lifetime. When detected early, the chance that breast cancer can be cured is much higher – the vast majority of patients with the disease can survive it.

Some quality problems may be greater in rural areas. For example, hospitalization rates are higher in rural areas for some chronic conditions, like angina and chronic pulmonary disease, that can usually be treated effectively outside the hospital. Rural beneficiaries are also less likely to get mammograms and recommended follow-up visits after a hospitalization.

The problems of benefit gaps, lack of coverage options, outdated management practices, and excessively complex administrative burdens undoubtedly contribute to these results. There is also increasing evidence that a range of private sector and public-private initiatives can help providers deliver better and safer care. For example, many hospitals and other health care institutions have launched collaborative efforts to use information related to quality, giving providers and patients more useful information while reducing the burden of data collection. Some health insurance systems have implemented payment incentives to encourage and reward better performance. Many of these initiatives may be particularly challenging for rural providers. For example, investments in new information systems or hiring specialized personnel may be very difficult for rural facilities with limited scopes of service and small patient volumes.

The President will work to improve the quality of care based on the following principle:

Principle #8: Medicare should encourage high-quality health care for all seniors.

All Medicare beneficiaries deserve high-quality, error-free care. To assure that beneficiaries get the most from Medicare’s improved benefits and coverage options:

• Medicare should support efforts by plans and providers to improve care through more collaborative programs that use protected data on quality and safety. Medicare should help seniors get better care through improved information on quality.
• Medicare should support efforts by plans and providers to improve care through more collaborative programs that use protected data on quality and safety. Medicare should help seniors get better care through improved information on quality.

• Medicare’s payment system in the government plan should take steps toward rewarding better performance and encouraging investments that improve quality of care without increasing budgetary costs. Medicare’s risk adjustment system for private plans should reward health plans for providing appropriate care and reducing complications for chronically ill, high-cost patients without creating costly reporting burdens.

Medicare’s payment system in the government plan should take steps toward rewarding better performance and encouraging investments that improve quality of care without increasing budgetary costs. Medicare’s risk adjustment system for private plans should reward health plans for providing appropriate care and reducing complications for chronically ill, high-cost patients without creating costly reporting burdens.

• Medicare should address the additional challenges facing rural health care providers in delivering high-quality care.

Medicare should address the additional challenges facing rural health care providers in delivering high-quality care.

• Medicare’s process for covering new technologies should be streamlined so that valuable new technologies can be incorporated into the program in a more rapid, fair, and fiscally responsible manner.