Lieberman Consulting, Bethesda, MD, USA.
Health Aff (Millwood). 2013 Jul;32(7):1258-64. doi: 10.1377/hlthaff.2012.0337.
Medicare needs fundamental reform to achieve fiscal sustainability, improve value and quality, and preserve beneficiaries' access to physicians. Physician fees will fall by one-quarter in 2014 under current law, and the dire federal budget outlook virtually precludes increasing Medicare spending. There is a growing consensus among policy makers that reforming fee-for-service payment, which has long served as the backbone of Medicare, is unavoidable. Accountable care organizations (ACOs) provide a new payment alternative but currently have limited tools to control cost growth or engage and reward beneficiaries and providers. To fundamentally reform Medicare, this article proposes an enhanced version of ACOs that would eliminate the scheduled physician fee cuts, allow fees to increase with inflation, and enhance ACOs' ability to manage care. In exchange, the proposal would require modest reductions in overall Medicare spending and require ACOs to accept increased accountability and financial risk. It would cause per beneficiary Medicare spending by 2023 to fall 4.2 percent below current Congressional Budget Office projections and help the program achieve fiscal sustainability.
医疗保险需要进行根本性改革，以实现财政可持续性、提高价值和质量，并维护受益人的医生就诊渠道。根据现行法律，2014 年医生的费用将下降四分之一，而严峻的联邦预算前景几乎排除了增加医疗保险支出的可能性。政策制定者越来越达成共识，认为改革长期以来一直是医疗保险支柱的按服务收费支付方式是不可避免的。责任医疗组织（ACO）提供了一种新的支付选择，但目前控制成本增长或吸引和奖励受益人和提供者的工具有限。为了从根本上改革医疗保险，本文提出了一个改进版的 ACO，该版本将取消预定的医生费用削减，允许费用随通胀而增加，并增强 ACO 管理护理的能力。作为交换，该提案将要求适度减少医疗保险的总体支出，并要求 ACO 承担更多的责任和财务风险。到 2023 年，它将导致每位受益人的医疗保险支出比国会预算办公室的预测低 4.2%，并帮助该计划实现财政可持续性。
