NEW ORLEANS – The American College of Physicians has issued a policy paper containing at least a dozen recommendations to help reform the Medicare program, including support for having wealthier beneficiaries pay higher premiums and for giving the federal government the ability to negotiate drug prices.
The time to act is now, as the Medicare Trust Fund is due to run out of money in 2024, said ACP President Dr. Virginia Hood at the organization’s annual meeting. But the ACP will not advocate for any reform that would threaten beneficiaries’ access to, or quality of, care, she said.
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Mr. Robert Doherty and Dr. Virginia Hood
"Difficult choices must be made to ensure the program’s solvency, but not at the expense of patients’ health," said Dr. Hood at a press briefing.
Robert Doherty, the ACP’s senior vice president of governmental affairs and public policy, said that Medicare had become a political football. "Republicans and Democrats alike are engaging in a war of words about Medicare, trying to scare voters into believing that the other party will destroy the program," he said at the briefing.
But neither party is facing up to the facts, said Mr. Doherty. Given rising health costs, an aging population, and increased cost-shifting to beneficiaries, the program "can’t continue as it is," he said. "Change is coming, change is necessary," Mr. Doherty said.
He and Dr. Hood said that the ACP’s recommendations for reform could help find cost savings, improve value, and protect access to care.
The ACP recommended finding ways to accelerate adoption of the patient-centered medical home concept. But it expressed concern about proposals to transform Medicare from a defined benefit to a defined contribution program. Also known as "premium support," this concept has been advanced by Rep. Paul Ryan (R-Wisc.) and has the backing of many of his GOP colleagues in the House of Representatives.
But, said Dr. Hood, "too little is known today about the impact of a Medicare premium support program on patient access to care." She added, "It’s concerning that with such little information that risky decisions would be made to transition away from the current guaranteed benefit structure."
Instead, the ACP proposes testing such a system. The College also said that the Medicare eligibility age should not be raised unless affordable, comprehensive insurance is made available to those who would now have to wait.
"Advancing the Medicare eligibility age could result in tens of millions of seniors having no access to affordable coverage from age 65 to 67, adding to the ranks of the uninsured," Mr. Doherty said.
The organization recommended that Congress instead give Medicare the authority to redesign benefits, coverage, and cost-sharing so that high-value services are rewarded and lower-value services – which might be not only inappropriate but also harmful – be given less coverage or lower reimbursement.
The ACP waded into somewhat controversial waters by urging Medicare to cover advance planning for patients with terminal illnesses. Payment for the voluntary discussions was included in the Affordable Care Act, but after Republicans said that such counseling might lead to rationing of care – or "death panels" – the Obama administration retracted a rule defining the benefit.
"Voluntary advance care planning should be covered and reimbursed by Medicare to encourage patient-physician engagement and ensure that patients are informed of their palliative and hospice care options," Mr. Doherty said.
Finally, the ACP urged an overhaul of the authority of the Independent Payment Advisory Board. Congress should have the right to approve or disapprove of the IPAB’s recommendations "by a simple majority," according to the policy paper.
Overall, "I do believe that the politicians have to show some leadership," said Mr. Doherty. Both parties need to talk responsibly "about the challenges to sustaining Medicare," and not just talk of "ending Medicare as we know it," he added. Because, he said, "Medicare as we know it is not sustainable. It’s going to have to change."