KHN: Kaiser Health News

If you could make one change to Medicare, what would it be? Ask three former directors of the program and you’ll get plenty of ideas.

Bruce Vladeck, who was head of what was then known as the Health Care Financing Administration, or HCFA, for former President Bill Clinton, wants more market-based competition and less pricing set by Congress.

“I would like to move all of Medicare drug purchasing, whether through Part D or Part B, all of [durable medical equipment] and related services – almost everything other than hospitals, docs and managed care plans — to a real market-based purchasing model,” he said.  Give the  administrator of the Centers for Medicare & Medicaid Services the authority to negotiate prices “starting with the federal supply schedule for the 20 or 25 percent of Medicare outlays that are creating windfalls for various producers that we don’t talk about so much because it’s only 20 or 25 percent of outlays,” he said.

Gail Wilensky, who ran HCFA for President George H.W. Bush, would urge lawmakers to adopt a competitively bid premium support model that includes the current traditional fee-for-service plan and the payments beneficiaries receive would vary by income and health risk.

Mark McClellan, who ran CMS for George W. Bush, wants to see Medicare make more progress on reducing the growth of costs.  The program, which serves 50 million elderly and disabled Americans, “is nowhere near done with those kinds of steps, nowhere near the private sector” on cost control.   “Reducing overall spending growth while still insuring access to care and improvements in innovation” are key, he said.

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Reforming Medicare – from changing the way doctors are paid to streamlining patient care – could benefit from a grassroots approach, according to experts and physicians at a policy summit held by National Journal Live in Washington, D.C., Tuesday.

“We need to focus more on responding to and joining local initiatives,” said Len Nichols, director of George Mason University’s Center for Health Policy Research and Ethics. As an example, he pointed to an initiative in Rochester, N.Y., that brought local doctors and hospitals together to successfully reduce hospital readmissions.

The panelists agreed that solutions to address the system’s inefficiencies should begin at the ground level with physicians, community members and patients, who could provide valuable feedback and ideas when designing new approaches to quality care and cost control.

“What the ACA has done is to set up an environment where there is support for new innovation,” said Gail Wilensky, an economist who previously directed the Medicare and Medicaid programs.

With much of the health law going into effect in 2014, the U.S. will likely see increased coverage, insurance marketplaces and an expanded Medicaid program.

But Wilensky said the health law’s limited role in changing payment models and encouraging patient engagement in the health system operations could prove to be a “fatal flaw” in what should be an overhaul of the system. “These are huge constraints in how and how fast Medicare can move,” she said.

Dr.  Edward Murphy, a professor of medicine at the Virginia Tech Carilion School of Medicine, said physicians’ attachment to the status quo was slowing down efforts to move to a system that rewards better health outcomes and lowers consumer costs. He said doctors need to adopt fundamental new practices.

“To get a broadwave movement of change across the country, it seems to me, we need a cultural shift,” he said.

This story comes from our partner .

Health insurance plans now have to cover the full cost of breast pumps for nursing mothers. This is the result of a provision in the Affordable Care Act (aka Obamacare), and the new rule took effect for many people at the start of this year.

It’s led to a boom in the sale of the pumps, which can cost hundreds of dollars.

Yummy Mummy, a little boutique on New York’s Upper East Side, has suddenly become a health care provider/online superstore. The company has been hiring like crazy, and just opened an online call center and a warehouse in Illinois. Yummy Mummy even hired somebody to talk to customers’ health insurance companies.

And new moms now seem more likely to splurge on fancy new breast pumps. Caroline Shany, a Yummy Mummy customer, spent her own money to buy a breast pump for her first baby. She may buy another one now because insurance will pick up the tab.

“Why not?” she says.

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Most Americans want quick action to reduce the deficit, but almost six in 10 oppose cutting Medicare spending to achieve that goal, according to a new poll released today.

Lawmakers should examine other alternatives, including requiring drug makers to give the government “a better deal” on medications for low-income seniors (85 percent) and making higher-income seniors pay more for coverage (59 percent), according to the survey conducted by the Kaiser Family Foundation, the Robert Wood Johnson Foundation and the Harvard School of Public Health. (KHN is an editorially independent program of the Kaiser Family Foundation.)

More than seven in 10 Democrats, independents and Republicans say that if the President Barack Obama and Congress made the “right changes,” they could reduce the deficit without making major cuts to Medicare.  Just over half (51 percent) oppose raising the Medicare eligibility age from 65 to 67, an idea discussed by both parties on Capitol Hill, and 85 percent oppose requiring all seniors to pay higher Medicare premiums.

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A pilot program introduced by the U.S. Centers for Medicare and Medicaid Services to boost quality of care for seniors by developing community approaches to health problems could play a key role in bringing down costs, according to a new report in the Journal of the American Medical Association.

Quality Improvement Organizations, or QIOs, are private groups in each state and U.S. territory that contract with the government for three years to improve health services for Medicare patients. They are comprised of health care providers and other medical professionals, social services workers and other community members.

In Tuesday’s report, researchers found a 5.7 percent average reduction in 30-day hospital readmissions across 14 economically and demographically diverse communities over a two-year period. The number of patients admitted to the hospital within 30 days of a prior admission is one possible measure of efficiency, since the cost and burden of readmission can be preventable.

One in five Medicare patients returns to the hospital within 30 days of being discharged. The problem is an expensive one: in 2004, these readmissions cost Medicare $17.4 billion dollars.

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This story comes from our partner ‘s Shots blog.

States aren’t likely to prevent many shootings by requiring mental health professionals to report potentially violent patients, psychiatrists and psychologists say.

The approach is part of a gun control law passed in New York yesterday in response to the Newtown, Conn., shooting a month ago. But it’s unlikely to work because assessing the risk of violent behavior is difficult, error-prone and not something most mental health professionals are trained to do it, say specialists who deal with violence among the mentally ill.

“We’re not likely to catch very many potentially violent people” with laws like the one in New York, says Barry Rosenfeld, a professor of psychology at Fordham University in The Bronx.

The New York law says mental health professionals must report people they consider likely to do harm. It also gives law enforcement officials the power to take guns from these people.

Such laws “cast a very large net that will probably restrict a lot of people’s behavior unnecessarily,” Rosenfeld says. “Maybe we’ll prevent an incident or two,” he says. “But there are other ways that would be more productive.”

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