Medicare payment innovations in the ACA: research insights for policy
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Research insights
- Contributor(s):
- Merlis, Mark. AcademyHealth.
- Publication:
- [Washington, D.C.] : AcademyHealth, [2011]
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Insurance, Health, Reimbursement Medicare -- economics Advisory Committees Cost Control Pilot Projects Quality of Health Care Reimbursement Mechanisms Humans United States United States. Centers for Medicare & Medicaid Services (U.S.)
- Genre(s):
- Technical Report
- Abstract:
- The Patient Protection and Affordable Care Act (ACA) includes changes in Medicare provider payment rules that were expected to reduce spending by over $222 billion in the years 2010-2019. Growth in payment rates will continue to be constrained in later years, and the new Independent Payment Advisory Board could recommend further payment cuts if Medicare spending growth exceeds specified targets. The Budget Control Act--the debt ceiling agreement reached in August 2011--includes a trigger mechanism that could lead to automatic Medicare spending reductions of up to 2 percent for each year through 2021. These also would be achieved through cuts in provider payment rates. While the ACA and the Budget Control Act are designed to steadily squeeze down provider payments, the ACA also offers an alternative route to savings: it provides for widespread experimentation with innovative payment methods--such as bundled payments and pay-for-performance--that are intended to provide incentives for providers to furnish more coordinated and cost-effective care. If these new approaches work, they could offer a more attractive way of controlling costs than arbitrary fee limits. The ACA payment changes raise urgent questions for policymakers. How far can we squeeze provider payments without jeopardizing access and quality or raising costs for other payers? Which new payment mechanisms can actually produce savings over the long term? And, more fundamentally, how are we going to collect and assess the data that would let us know on a timely basis whether payment cuts have gone too far, or that one new payment method is better than another?
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- NLM Unique ID:
- 101589998 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101589998