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03/04/2021

Dr. Amol Navathe Discusses Medicare Fee for Service Policy Reforms (March 4th)

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(As explained on the podcast home page, this is the third of eight interviews concerning federal healthcare policy reform.  This discussion with Dr. Amol Navathe was conducted in late December.  As you will hear this podcast like all others is introduced by ProMedica's CEO, Randy Oostra.  This series was produced in an effort to interest or persuade federal healthcare officials to pursue substantive healthcare policy reform.)    

Medicare is projected to grow from 62 to 80 million Americans by 2030.   Largely because of the so called age wave, Medicare spending in sum is projected to double to $1.28 trillion by 2029.  Among other current policy problems, the Part A hospital trust fund is projected to be insolvent in three years.  Part B , or physician payments, intended under 2015 MACRA legislation to move eligible Fee for Service (FFS) clinicians into financial at-risk models, remains unproven, largely due to the fact only less than one in five clinicians participate.  Part B and Part D drug spending growth continues to plague Medicare program largely because Medicare, unlike the VA, is prohibited from exercising its purchasing power.   Medicare FFS is plagued by numerous other coverage problems including, for example, no long term care policy, no hearing, oral, vision and non-medical social support coverage.  In addition, CMS' Innovation Center's (CMMI) demonstrations have proven to be at best marginally successful and post-acute FFS care suffers numerous quality and reimbursement problems, for example, SNFs continue to over-prescribe anti-psychotics while 2018 marked the 19th consecutive year freestanding skilled nursing facility profit margins were in the double digits. 

During this interview Dr. Navathe begins by commenting on the Medicare program in context of the ongoing COVID-19 pandemic.  The discussion moves on to discussing policies to expand Medicare coverage, provides comment on the FFS Medicare Shared Savings Program, discusses the inherent problems with FFS payments and policy recommendations he and his colleagues outline in their December Medicare's "next decade" paper (cited below).   He concludes by commenting on post acute, particularly related to skilled nursing, under FFS Medicare.    

Dr. Amol Navathe is an Assistant Professor of Medical Ethics and Health Policy, Co-Director of the Healthcare Transformation Institute and Associate Director of the Center for Health Incentives and Behavioral Economics, all at the University of Pennsylvania.  He is also presently a Commissioner of the Medicare Payment Advisory Amol-Navathe-expert-2020 Commission (MedPAC).  He founded the academic journal, Health Care: The Journal of Delivery Science and Innovation, serving as its Co-Editor-in-Chief, as well as Founding Director of the Foundation for Healthcare Innovation.  His work on health care cost and quality improvement has been published in numerous leading journals, including ScienceNew England Journal of Medicine (NEJM)Journal of the American Medical Association (JAMA)Health AffairsHealth Services ResearchHealthcare, and other leading academic journals.  Dr. Navathe completed his medical training at the Perelman School of Medicine and his post-graduate medical training at the Brigham and Women’s Hospital at Harvard Medical School.  He obtained his PhD in Health Care Management and Economics from The Wharton School at the University of Pennsylvania.

Dr. Navathe's writings can be found at: https://ldi.upenn.edu/expert/amol-s-navathe-md-phd.

His recent article December noted during this essay, "Medicare Payment Reform's Next Decade: A Strategic Plan for the Center for Medicare and  Medicaid Innovation," is at: https://www.healthaffairs.org/do/10.1377/hblog20201216.672904/full/

To read this interview's transcript or to post a comment or question, please go to: https://commissiononhealthcare.org/

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