Fix Medicare to keep the promise to seniors

BEFORE the federal government embarks on a major effort to provide universal health care, it needs to take a hard look at the programs it already manages. It is common knowledge that Medicare is in trouble.

Federal funding for Medicare will run out in eight years, a recent analysis showed. The reality is many seniors find it difficult to access care right now because physicians are losing money on every Medicare patient they serve.

The Everett Clinic, which cares for more than 28,000 Medicare patients, just completed an independent review of our Medicare finances. The results are sobering.

Under the original Medicare fee-for-service model, we lose $464 per patient each year. In 2009, the Everett Clinic will lose approximately $11.7 million treating Medicare patients. With anticipated growth in the Medicare population, it is estimated that the loss will grow to $70 million in the next five years.

The Everett Clinic also contracts with several Medicare Advantage plans. We lose money from these plans as well — approximately $340 per patient per year. However, we believe managed Medicare Advantage programs are a good option for Medicare patients because they encourage preventive care and support disease-management programs, which are especially important for Medicare patients.

To compensate for losses on Medicare, physicians are forced to increase the fees charged to other patients. This amounts to a hidden health-care tax. Given the current health-care market, it is increasingly difficult to shift costs to compensate for the shortcomings of the Medicare program.

To get Medicare on solid financial footing and ensure that seniors can continue to receive care, Medicare must be restructured. The focus must shift from the quantity of care delivered to the quality of care. Policymakers must act quickly and decisively to preserve the promise of health care for seniors.

• First, there needs to be transparency in Medicare. The public needs to know the truth. As currently structured, Medicare is fatally flawed. There is adequate money in the system today to care for Medicare patients. The money is just not being spent efficiently.

• Second, Medicare's entire approach to care needs to be revamped. Unfortunately, Medicare is disease-focused, not prevention-based. Health-care providers are rewarded for treating illnesses, not preventing them. This must change. Patients need more preventive care to help minimize expensive emergency, hospital or nursing-home care. Increased prevention will save lives and money.

• Third, Medicare should insist upon and reward chronic-disease management. Managing the care of patients with chronic illnesses (such as diabetes and congestive heart failure) improves patients' quality of life, reduces hospitalizations and decreases the cost of care. Enrollment in these programs should be mandatory for all Medicare patients affected by these diseases and Medicare should cover the cost of this care.

• Fourth, care coordination must become the standard of care. As one of 10 participants selected nationwide for a Medicare demonstration project, The Everett Clinic has successfully shown that by coordinating care (providing the right care at the right time), health-care costs are reduced and the quality of care is improved.

Medicare should insist on coordinated care and provide the incentives to ensure it happens. Too much time and money are wasted on duplicate and unnecessary procedures. Efficient, effective health care is delivered when primary-care physicians and specialists are encouraged to consult with each other and coordinate treatment plans. Yet, under most Medicare plans, physicians are not reimbursed for providing this coordinated care. At The Everett Clinic we do it anyway, because coordinating care improves quality.

One approach to fix Medicare is to have Medicare contract directly with physicians and link funding to quality measures and outcomes. With electronic medical records, it is possible to effectively coordinate care, increase prevention and track results. A multidisciplinary team providing high-contact, coordinated care can help patients stay healthy. Under this approach, rather than waiting for patients to call with a problem, patients are contacted regularly to discuss their health status and wellness strategies. The focus is truly on preventing disease.

The demands on Medicare are increasing but the dollars to pay for it are not. It is imperative that Medicare deliver more value to patients. Limited Medicare dollars should go directly to delivering efficient and effective patient-centered care, instead of overhead and paperwork.

Medicare must be transformed before more seniors are denied care, and before enacting other health-care reform. Pledging to provide health-care coverage but not providing access to care is a broken promise with profound consequences for the health of seniors and the financial health of our country.