Wyden Outlines New Medicare Reforms

Stresses Focus on Cost Driver - Chronic Care

Washington, D.C. – U.S. Sen. Ron Wyden today outlined new Medicare reforms aimed at reducing costs by focusing on the needs of the millions of seniors suffering from chronic conditions.

“Chronic disease needs to be Medicare’s primary focus,” Wyden said during a keynote speech at the National Accountable Care Organizations (ACO) Summit. “Providers should be encouraged to seek out beneficiaries who are in need of chronic disease prevention, management and treatment and work to manage patients’ conditions before more acute, expensive care is required.”

The text of Wyden’s speech can be found here.

Spending associated with beneficiaries suffering from chronic conditions is disproportional and has been on the rise since the program began. According to Centers for Medicare and Medicaid Services, 68 percent of Medicare beneficiaries suffered from two or more chronic conditions, and accounted for 93 percent of Medicare spending, or about $487 billion annually. Additionally, 98 percent of hospital readmissions involved beneficiaries with multiple chronic conditions.

Wyden said that he will be working on a bipartisan basis with colleagues to develop policy that would refocus Medicare on patients with chronic conditions, and identified areas to start with.

First, Wyden said the so-called “attribution rule” created under the Affordable Care Act is barring providers from seeking out and specifically targeting the chronically ill seniors who would benefit most from coordinated chronic care. The rule was created out of fear that providers would try to shed risk by avoiding the sickest patients.  

Wyden said Congress should modify the attribution language so that it continues to protect seniors, but it should encourage those with a passion for treating chronic disease to focus and specialize in this kind of care management.

Another challenge, Wyden said, is ensuring that coordinated chronic care providers exist throughout the country. He said that ACOs, for example, are not being established where there is the greatest need for coordinated chronic care for a variety of reasons. He also said Medicare reimbursement should be reconfigured to target areas with the highest incidence of chronic illness, and reward practitioners, in those areas, who improve care and hold down costs.

“The Medicare guarantee should not depend on where you live,” Wyden said.

Wyden also mentioned the need to make individual care plans the rule, rather than the exception, for seniors with more than one chronic condition, and urged making innovative incentives available to encourage seniors to be as healthy as possible.

Wyden pointed to a number of examples of where this kind of care is being successfully undertaken, and said reforms are needed to encourage emulation of these models of care.