Geriatric Dentistry in the 21st Century: Environment and Opportunity

The aging of the baby boomers in the 21st century is creating unprecedented numbers of vulnerable older adults. The increase in people keeping their teeth and their increasingly complex conditions all point to more people with more complex needs. Although these demographic shifts are providing unparalleled challenges for our health care system, they also bring new opportunities to develop and implement innovative systems for reaching and maintaining the oral health of older Americans.

How will provider-focused payment reform impact geographic variation in Medicare spending?

OBJECTIVES

The Institute of Medicine has recently argued against a value index as a mechanism to address geographic variation in spending and instead promoted payment reform targeted at individual providers. It is unknown whether such provider-focused payment reform reduces geographic variation in spending.

STUDY DESIGN

We estimated the potential impact of 3 Medicare provider-focused payment policies-pay-for-performance, bundled payment, and accountable care organizations-on geographic variation in Medicare spending across Hospital Referral Regions (HRRs). We compared geographic variation in spending, measured using the coefficient of variation (CV) across HRRs, between the baseline case and a simulation of each of the 3 policies.

METHODS

Policy simulation based on 2008 national Medicare data combined with other publicly available data.

RESULTS

Compared with the baseline (CV, 0.171), neither pay-for-performance nor accountable care organizations would change geographic variation in spending (CV, 0.171), while bundled payment would modestly reduce geographic variation (CV, 0.165).

CONCLUSIONS

In our models, the bundled payment for inpatient and post acute care services in Medicare would modestly reduce geographic variation in spending, but neither accountable care organizations nor pay-for-performance appear to have an impact.

Medicare Payment Reform: Aligning Incentives for Better Care

The Affordable Care Act (ACA) has provided the Medicare program with an array of tools to improve the quality of care that beneficiaries receive and to increase the efficiency with which that care is provided. Notably, the ACA has created the Center for Medicare and Medicaid Innovation, which is developing and testing promising new models to improve the quality of care provided to Medicare beneficiaries while reducing spending. These new models are part of an effort by the U.S. Department of Health and Human Services to increase the proportion of traditional Medicare payments tied to quality or value to 85 percent by 2016 and 90 percent by 2018. This issue brief, one in a series on Medicare's past, present, and future, explores the evolution of Medicare payment policy, the potential of value-based payment to improve care for beneficiaries and achieve savings, and strategies for accelerating its adoption.

Achieving interoperability for accountable care

Based on findings of a recent survey, accountable care organizations should keep eight points in mind as they seek to establish interoperability among their provider constituents: Create a shared governance structure to make IT decisions. Conduct a readiness assessment and gap analysis. Reconfigure the technology infrastructure and processes to support new value-based care delivery protocols. Consider targeting programs around high-risk groups. Develop real-time data-sharing systems. Ensure privacy and security policies and procedures are in place. Assess and address workforce issues expeditiously. Participate in broader interoperability efforts.