Research by Author & Topic

Publications by Robert A. Berenson on Medicare

Experts agree that the way health care is currently paid for in the United States, especially in the traditional, fee-for-service Medicare program, does not support coordinated care that is high quality and cost-efficient. To address these problems, policy-makers are taking a close look at accountable care organizations (ACOs). This policy brief explores what ACO are, how they compare to previous reform concepts such as Health Maintenance Organizations and Provider Sponsored Organizations, key design and implementation issues, and opportunities and challenges. The authors conclude that ACOs are no real game changers in the short term, but are nevertheless important to try.

Experts agree that the way health care is currently paid for in the United States, especially in the traditional, fee-for-service Medicare program, does not support coordinated care that is high quality and cost-efficient. To address these problems, policy-makers are taking a close look at accountable care organizations (ACOs). This policy brief explores what ACO are, how they compare to previous reform concepts such as Health Maintenance Organizations and Provider Sponsored Organizations, key design and implementation issues, and opportunities and challenges. The authors conclude that ACOs are no real game changers in the short term, but are nevertheless important to try.

Growing evidence demonstrates that certain approaches to financing and paying for chronic care coordination for patients are effective not only for improving patient well-being but can also reduce health care spending. However, chronic care approaches should vary for different patient populations and can be carried out effectively by diverse organizations and professionals reflecting the heterogeneity of health care delivery throughout the US. The Report considers the different populations in need of care coordination, summarizes current evidence of effectiveness, describes the various entities that can serve as focal points for coordinating care, and details the possible financing and payment options that can support these approaches.

Emotions are flaring as constituents speak their minds to members of Congress home for August recess. That's to be expected, since health care is both a personal and public issue, but let's not forget to debate the basics:

In this paper and brief, the authors discuss alternative ways that health reform could be financed. They analyze different options including several proposals for delivery system reforms and for reduction in Medicare and Medicaid payments. They estimate the cost savings that could occur due to the introduction of a public plan option. Finally, they explore a range of revenue options. The key message of the paper is that health reform can be paid for, but it is best to obtain funds from a large number of measures to spread the burden broadly.

Medicare and other insurers generally ignore the importance of established chronic illnesses in generating demands on the health care system and escalating costs, Institute Fellow Robert Berenson told the House Ways and Means Committee. At the same time, delivery system reforms are likely to fail unless immediate steps are taken to address the likely collapse of the primary care physician workforce in many parts of the country. He also underscored the need for a public plan -- patterned on Medicare but separate from it -- as an option for those seeking care.

In testimony before the Senate Finance Committee, Robert Berenson, M.D. explores possible reasons that integrated care organizations that include multispecialty group practices have not become a major feature of the U.S. health system despite prominent success stories. These organizations are often penalized financially for undertaking activities that reduce costs because the benefits of efficiency are not internalized to the organization. Berenson makes the case that current payment incentives embedded in Medicare and private payer approaches promote behavior that may not benefit patients, such as rewarding preventable hospitalizations and producing a mismatch between the services patients need and those that fee schedules encourage.

This paper demonstrates that while fees for physician evaluation and management increased over the first ten years of the Medicare Fee Schedule, the quantity of imaging services and non-major procedures increased even more, making the share of program spending on evaluation and management services in 2002 the same as it was in 1992. Two factors explained the differential spending growth across types of services: the introduction of new services and the process for reviewing and revising fees. The authors argue that differences in expenditure growth across service types affect Medicare's costs and should be considered in the program's spending control policies.

Senior fellow Robert Berenson, testifying before the House Ways and Means Health Subcommittee on physician payment reform options in Medicare, argued that long-term approaches need to include bundled payments as an alternative to traditional fee-for-service payments, especially for primary care physicians caring for patients with chronic conditions. Because these reforms are operationally challenging and will require demonstrations of effectiveness, Berenson also suggested reforms to the existing resource-based relative value scale (the basis for the Medicare Fee Schedule) that could be implemented immediately.

Dr. Robert A. Berenson, senior fellow in Health Policy at the Urban Institute, has considerable frontline experience. As director of the federal Center for Health Plans and Providers and acting deputy administrator at the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services), Dr. Berenson oversaw policy and operational matters. He co-founded and served as the first medical director of the National Capital Preferred Provider Organization. A board-certified internist, Dr. Berenson practiced for 12 years in a Washington, D.C. group practice.