Matthew Holt

Medicare should pay less & differently

Easy to say. Rita Redberg from UCSF points out in the NY Times that Medicare pays for loads of procedures that we know are a waste of money. After all the COURAGE trial a while back showed that stents were a waste of money, and we put in more stents now than when the data were released. This shouldn’t be much of a surprise–we ignore the evidence all the time in making health care decisions. Brian Klepper in his wonderful but probably ineffective crusade to abolish the RUC shows that CMS (and therefore Medicare’s) payment methodologies are fundamentally flawed–yet we can’t fix them either. So it’s easy to say Medicare should pay less and pay differently but the political will is just not there yet. It’s lucky the Chinese are so generous.

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1 reply »

  1. I agree that the payment methodologies are flawed, but I don’t know that they should pay LESS. I worked with disabled patients on getting their custom power wheelchairs and other equipment covered by Medicare, and there were times when even though they CLEARLY needed the equipment, Medicare would deny it. Guidelines were clear, but they didn’t always cover every patient who needed equipment. From a provider standpoint, it’s difficult to see patients going without the equipment they need (or having to cough up thousands of dollars out of pocket.)