Senators Focus on Coordinated Care in Battle Against Chronic Illness

Medicare still has significant room for improvement in incentivizing care coordination for individuals with multiple chronic conditions, lawmakers concluded at a Senate Finance Committee hearing today. In a hearing focused on the challenges of treating patients with chronic conditions, Chairman Ron Wyden (D-OR) announced that the Finance Committee will begin a months-long effort “to find bipartisan solutions to meet the challenges of chronic disease.” Sen. Orrin Hatch (R-UT), ranking member on the Committee, added that the Medicare Payment Advisory Commission (MedPAC) “has long said that fee-for-service Medicare creates silos – incentivizing providers to deliver more care, not necessarily higher quality, coordinated care.” And after hearing testimony from patients, caregivers, providers, and health plans, senators responded in a bipartisan chorus that improved care coordination is the Holy Grail in improving outcomes for patients suffering from chronic illness.

Witnesses at today’s hearing testified that Medicare’s fee-for-service (FFS) payment model has created disincentives to coordinating care for beneficiaries with chronic conditions. Dr. William Bornstein, Chief Quality and Medical Officer at Emory Healthcare in Atlanta, discussed how the FFS model makes it more profitable to prescribe and complete procedures than to coordinate care. Bornstein also said hospitals and other providers lack mechanisms to receive reimbursement for the extra costs of coordinating care. Stephanie Dempsey, a patient with multiple chronic conditions including coronary artery disease, said that having a dedicated care-coordinator would be a “life changing” proposition. And Mary Margaret Lehmann, the caregiver of her husband, an Alzheimer’s patient, added that having someone coordinate care between multiple specialists could help circumvent avoidable medical errors such as prescribing incompatible medications.

Members on both sides of the aisle highlighted care coordination as the most important step in reducing the impact of chronic illness. Sen. Johnny Isakson (R-GA) lamented the fact that coordination of care is not reimbursed by FFF, and said that it is one of the few ways to improve quality while lowering costs. He added that, particularly for Alzheimer’s patients, a care coordinator can help limit the number of doctor’s visits, which can “significantly aggravate” patients in later stages of disease management. Sen. Michael Bennett (D-CO) discussed care coordination for children with chronic conditions, saying that he was worked extensively with Sen. Chuck Grassley (R-IA) to “encourage hospitals to work in closer coordination.” Sen. Mark Warner (D-VA) added that Congress should work to allow plans to be recognized across state lines as a means to increase coordinated care.

If you are interested in a comprehensive summary of today's hearing, please contact Shea McCarthy (smccarthy@thornrun.com).