Medicare’s center seeks to rebalance quality, cost

Ricardo Alonso-Zaldivar
Associated Press

Washington — They work for the government and even their closest relatives have no idea what they do. It’s not because they’re spies or nuclear scientists, but because their jobs are so arcane: trying to reinvent Medicare to improve it, and maybe save taxpayers money.

In a sprawling, nondescript office park near Baltimore, some 360 people at the Center for Medicare & Medicaid Innovation are trying to change the health care system, using the government’s premier insurance program as leverage. If they prevail, the U.S. may no longer have the worst of both worlds: unsustainable spending and unenviable results.

“I want Medicare to exist not just for my mother, but for me and my kids,” said the director, Patrick Conway, 41, a pediatrician who also serves as Medicare’s chief medical officer.

The center is in its sixth year, and its influence is starting to be felt in areas from joint replacement surgery to cancer treatment and front-line primary care.

The idea is to use Medicare payments to create financial incentives for doctors and hospitals to work together, helping patients avoid costly hospitalization whenever possible.

That might mean paying a primary-care practice to hire a clinical coordinator who keeps tabs on patients with chronic illnesses. It could mean holding hospitals accountable for the overall cost and quality of joint replacement surgery, to encourage attention to rehabilitation.

Successful experiments can be adopted as permanent policy without seeking approval from Congress.

Among the center’s more than 60 experiments:

■A “Comprehensive Primary Care Plus” initiative that will involve 5,000 medical practices. They will get upfront payments to coordinate care.

■A change in the way Medicare pays for drugs administered in a doctor’s office, including chemotherapy. Medicare says it wants to reduce incentives for doctors to prescribe the most expensive drugs. Cancer doctors are opposing the proposal, which is still open for public comment.

■A program started this month that holds hospitals in 67 major metro areas accountable for costs and quality for hip and knee replacements, the most common inpatient procedure for Medicare patients.