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>>  5.1 Electronic Medical Records
  • Health Information Technology: Prioritize electronic sharing of information among providers in the next stage of the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs. Read More >>
  • Bring accountability and transparency to graduate medical education. Read More >>
  • Enhance "meaningful use" of electronic medical records by establishing registries that track experience with medical devices or other high-tech procedures (such as the registry for total joint replacement maintained by Kaiser Permanente). Developing a national approach, rather than relying on private systems, would provide information about the safety of devices and other technologies as well as their comparative benefits for patients and doctors. [page 28]
  • Support behavioral health homes by providing community mental health centers and other behavioral health providers access to "meaningful use" incentive payments for adopting qualifying health IT systems. [page 30] [Medicare, Medicaid]
  • Leverage the "meaningful use" program and the health information technology (IT) roadmap (developed by the National Coordinator for Health IT and the Centers for Medicare & Medicaid Services [CMS]) to provide guidance on analysis and reporting of quality measurements on high-priority health conditions (e.g. criteria for electronic health record technologies, clinical decision support, benchmarking and feedback systems, and public reporting); establish requirements and a timeline by which health IT capabilities are in place for all providers that do business with Medicaid and Medicare. [page 21] [Medicare, Medicaid] Read More >>
>>  5.2 Primary Care Workforce
  • Graduate Medical Education (GME): Reduce the indirect medical education (IME) percentage add-on to inpatient hospital admissions from 5.5 percent to 3.5 percent. Read More >>
  • Address outdated licensing barriers, including inappropriate scope-of-practice laws and restrictions on telemedicine, for more effective and efficient care. [pages 31-32]
  • Expand use of nonphysician providers. The federal government should provide bonus payments to states that meet scope-of-practice standards delineated by the Institute of Medicine. In addition, Medicare and Medicaid payments to nonphysician providers should allow them to practice to the full extent permitted under state law. [page 21] [Medicare, Medicaid]
  • Eliminate the sustainable growth rate (SGR) formula and move from fee-for-service (FFS) payment toward pay-for-value. Read More >>
  • Modify scholarship and medical loan forgiveness programs to address the most acute workforce needs, including provider shortages in primary care specialties and in medically underserved geographic areas. [page 22] Read More >>
>>  5.3 Prevention and Wellness
  • Invest the Prevention and Public Health Fund in demonstration programs to help identify the most cost-effective prevention strategies. [pages 92-93] Read More >>
  • Implement a standard program for person-focused Medicaid that includes support for capitated Medicaid managed care organizations, as well as state-directed reforms that focus on particular components of care. Read More >>
  • Implement the Medicare Better Health Rewards Program that provides small monetary incentives for Medicare beneficiaries to set and achieve health goals. Read More >>
>>  5.4 Fraud, Waste, and Abuse
  • Implement the Medicaid and Children's Health Insurance Program (CHIP) Payment and Access Commission's recommendations to strengthen Medicaid program integrity. [pages 102-103] [Medicaid]
  • Expand Medicare and Medicaid's ban on physician self-referrals by closing loopholes for in-office imaging, pathology laboratories, and radiation therapy (exception should apply to physicians who use alternatives to fee-for-service payment). Read More >>
  • Expand Medicare payment penalties for high rates of potentially avoidable health care–acquired complications and readmissions. Read More >>
  • Validate physician orders for high-cost and high-fraud services. [page 27] [Medicare]
>>  5.5 Administrative Simplification
  • Implement a standard program for person-focused Medicaid that includes support for capitated Medicaid managed care organizations, as well as state-directed reforms that focus on particular components of care. Read More >>
  • Simplify administration for all payers and providers. Read More >>
  • Simplify and require more uniform administrative policies and procedures across public and private plans to reduce provider and plan administrative costs and complexity. [page 29] [Medicare, Medicaid, Private Payers, FEHBP] Read More >>
  • Establish a single, multi-payer, common provider credentialing system to reduce unnecessary administrative costs. [page 39] [Medicare, Medicaid, Private Payers, FEHBP]
  • Reduce administrative overhead: Health plans, providers, and vendors should adopt and use the same health information technology standards to conduct electronic transactions related to eligibility determinations, claims status updates, claims payments, and electronic fund transfers. [page 23][Medicare, Medicaid, Private Payers, FEHBP] Read More >>
>>  5.6 Medical Malpractice
  • The Institute of Medicine should convene a panel of providers, consumers, and quality-measurement groups to determine whether evidence-based quality measures could be used as a basis for provider defense in medical liability cases and, if so, to provide guidance on a process for the adoption of appropriate measures through a quality-certification organization. Read More >>
  • Encourage states to develop more efficient medical liability systems, including "safe harbor" and "rebuttable presumption" laws based on quality and safety performance, and tort law alternatives. [page 32]
  • Reform the malpractice system to include provisions for fair compensation for injury and medical costs, with policies to encourage disclosure of errors. Read More >>
  • Expand federal support for disclosure-and-offer programs that are currently part of an HHS medical liability reform and patient safety initiative at four major health systems. Read More >>
  • To avoid spending scarce justice system resources on less meritorious cases, modify current medical malpractice laws and procedures to require a "certificate of merit" process, whereby independent medical experts evaluate the merits of claims prior to filing; such a process should be required to consider whether the care provided was consistent with evidence-based care guidelines and best practices. [page 24] Read More >>
  • Institute a statute of limitations for malpractice claims. [page 23] Read More >>
>>  5.7 Raising the Eligibility Age for Medicare
  • Gradually increase the Medicare eligibility age; beginning in 2017, increase eligibility age by one month per year until it reaches age 66, and then by two months per year until it reaches the Social Security normal retirement age; lock Medicare eligibility age to the Social Security retirement age thereafter. Read More >>
>>  5.8 Comparative Effectiveness
  • Invest the Prevention and Public Health Fund in demonstration programs to help identify the most cost-effective prevention strategies. [pages 92-93] Read More >>
  • Provide better information on the benefits, safety, and cost of alternative high-cost medical treatment choices or technologies to inform decisions by patients and providers. [page 28] Read More >>
  • Implement the Medicare Payment Advisory Commission's recommendation to empower the U.S. Secretary of Health and Human Services to vary cost-sharing based on evidence of a particular treatment's effectiveness. Lift curbs on tiered cost-sharing in MA. Read More >>
  • Use comparative evidence to set reimbursement rates at the time of coverage. Read More >>
Source: Katie Horton, J.D., M.P.H., R.N., Mary-Beth Malcarney, J.D., M.P.H., and Naomi Seiler J.D., George Washington University Department of Health Policy.