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Doctors Ask Lawmakers for Caution on Doctor Pay Overhaul

By Kerry Young, CQ Roll Call

April 14, 2016 -- Medicare on Wednesday reported disappointing early results from its Comprehensive Primary Care Initiative, which is designed to shape an eventual overhaul of federal payments for basic medical services for the elderly and disabled. The savings in the program's first two years failed to offset its expenses, while the quality of medical care did not improve as expected, Medicare officials reported.

"It's a cautionary note that after two years we haven't seen those goals achieved yet. There's still the prospect of further improvement" in the program's last two years, said John Ayanian, a University of Michigan researcher who studied the initial results of the program, in an interview. "But it may also signal the need for more substantial changes to primary care."

Monthly expenses fell by an average of about $11 per patient in the program, with reductions ranging from $1 to $21, according to a Mathematica Policy Research report for the Centers for Medicare and Medicaid Services (CMS). That adds up to about $91.6 million in total savings, possibly because closer contact between doctors and patients reduced the need for hospitalizations and use of skilled nursing centers. The reduced costs, though, were not enough to offset a fee averaging $18 a month per person enrolled in Medicare, the report said. The New England Journal of Medicine on Wednesday published the initial results.

The program should be viewed as a "down payment" on broader changes that Medicare officials are seeking to make in the program, said Ayanian, director of the University of Michigan's Institute for Healthcare Policy and Innovation and the author of an editorial accompanying the results. The Obama administration is moving away from the traditional fee-for-service program, which some say results in uncoordinated patient care and needless expenses, such as duplicated tests and hospitalizations.

The authors of The New England Journal of Medicine paper included Patrick Conway, the chief medical officer for CMS. Conway on Monday announced plans for another primary-care test program.

"There are a few possible reasons why these findings were not more favorable," the authors wrote, explaining that doctors may need more time to adjust to a coordinated approach to care and greater incentives may be needed to shift away from the fee-for-service approach. 

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