Gem of the Week: Overhauling the Medicare Payment Model

Opals on Black/<a href="http://www.flickr.com/photos/opals-on-black/4798525308/lightbox/">Flickr</a>

For indispensable reporting on the coronavirus crisis and more, subscribe to Mother Jones' newsletters.


In this blog post I highlight an illuminating or groundbreaking news article or report on the environment or health from the past 5 days. This week’s gem goes to… the National Academy of Science’s Institute of Medicine for revealing deep weaknesses in the way Medicare determines how much to pay doctors and hospitals for covered expenses. The report also outlined ways to fix these weaknesses.

For example, as found in the NAS report, Medicare uses geographical market areas to help determine how much a kidney transplant will cost a hospital to perform. However, Medicare divides the US into only 89 geographic markets, and some of those markets are an entire state or a large city. So even though an independent hospital in rural Nebraska incurs more costs to provide an organ transplant, it would be reimbursed the same as a better-funded, corporate-owned hospital in downtown Omaha. The authors recommend revising how these geographical areas are determined, and integrating them other parts of the Medicare payment model.

Another large flaw the report found was the wage index Medicare uses to help determine how much it should pay doctors and staff for procedures. Instead of using survey data from the Centers for Medicare and Medicaid Services, the report’s authors recommend using the Bureau of Labor Statistics’s data because it’s independent and more accurate.

The report is just phase I in a two-part investigation: the final report will be released in 2012. Amid discussions of cutting Medicare entitlements and aging Baby Boomers, the report’s recommendations are vital information. Currently Medicare covers 47 million seniors and 8 million people with permanent disabilities. With so many subscribers, making payments more accurate could go a long way toward cutting waste (where it occurs), and making sure all hospitals and staff are fairly compensated Medicare services.

Thank you!

We didn't know what to expect when we told you we needed to raise $400,000 before our fiscal year closed on June 30, and we're thrilled to report that our incredible community of readers contributed some $415,000 to help us keep charging as hard as we can during this crazy year.

You just sent an incredible message: that quality journalism doesn't have to answer to advertisers, billionaires, or hedge funds; that newsrooms can eke out an existence thanks primarily to the generosity of its readers. That's so powerful. Especially during what's been called a "media extinction event" when those looking to make a profit from the news pull back, the Mother Jones community steps in.

The months and years ahead won't be easy. Far from it. But there's no one we'd rather face the big challenges with than you, our committed and passionate readers, and our team of fearless reporters who show up every day.

Thank you!

We didn't know what to expect when we told you we needed to raise $400,000 before our fiscal year closed on June 30, and we're thrilled to report that our incredible community of readers contributed some $415,000 to help us keep charging as hard as we can during this crazy year.

You just sent an incredible message: that quality journalism doesn't have to answer to advertisers, billionaires, or hedge funds; that newsrooms can eke out an existence thanks primarily to the generosity of its readers. That's so powerful. Especially during what's been called a "media extinction event" when those looking to make a profit from the news pull back, the Mother Jones community steps in.

The months and years ahead won't be easy. Far from it. But there's no one we'd rather face the big challenges with than you, our committed and passionate readers, and our team of fearless reporters who show up every day.

We Recommend

Latest

Sign up for our newsletters

Subscribe and we'll send Mother Jones straight to your inbox.

Get our award-winning magazine

Save big on a full year of investigations, ideas, and insights.

Subscribe

Support our journalism

Help Mother Jones' reporters dig deep with a tax-deductible donation.

Donate

We have a new comment system! We are now using Coral, from Vox Media, for comments on all new articles. We'd love your feedback.