OPINION -- Legislation proposed by U.S. Senator Ron Wyden to offer global payments to primary care homes that pledge to care for Medicare clients who are chronically ill is just warmed over capitation compensation all over again. Under his legislation, teams of doctors, physician assistants, nurses and community health workers would be encouraged to work more closely to treat chronically sick Medicare patients.
It’s a conflict of interest to prepay anyone against a promise to deliver services which can vary in every regard, contrary to the patient's interest. Can you possibly imagine the corruption...."You really don't need that chemo, it is heroic! You are going to die anyway and we need to deny you these services for the benefit of the whole! In the meantime we will consider you a hostage of Medicare and our Primary Home"! As was with capitation reimbursement it is 100% about the money and who gets it.
Isn't it interesting the new promotional game is to convince the young and the healthy, they owe a subsidy to the more expensive, more highly compensated older generation...and now it is about siphoning off Medicare dollars to reallocate to someone else....if it ever gets there.
As for "costs and quality", there are your personal costs and the quality of your care which may have absolutely nothing to do with the "overall good performance" of the system as measured by rigged metrics. What we have lost and is at the heart of the distrust for government and organized medicine is that in no way do they stand for promoting your access to the "best" available care. Since most of us do not know the bad life threatening condition we are going to get at some point, it is just plain impossible to responsibly choose a health plan or provider in advance. If the goal is to improve quality, then preserve the individual's right to seek that out at the time they need it.
Stephen Gregg is a retired hospital administrator and health plan chief of staff. He can be reached at [email protected].
