Seminar Series – Cost Containment: Protecting Vulnerable Elderly From Profiteering and Poor Quality Care by Joan Teno, MD
615 N. Wolfe Street
US policy on cost containment centers on constraining the growth of health care cost with the additional goal of maintaining or improving the quality of care. The principle change in alternative payment models are changing payments from “fee for service” to prospective payment that rewards controlling costs and incentives to maintain or improve quality. An older alternative payment model, Medicare Advantage (MA), has grown such that in several states one in two Medicare decedents are dying under the care of MA. Given a focus on “high cost patients” and prospective payment that reverses the incentives from doing more to doing less, what are society’s obligations to ensure protection of vulnerable elderly from profiteering that results in poor quality care? One goal of quality measurements is transparency to guide consumer choice and ensure quality of care. This lecture will explore the role of quality measurement in development of concurrent care models using the example of the proposed “hospice carve in” into MA. It will further examine whether the MA Quality Bonus Plan should focus on seriously ill as a special population.