Research by Author & Topic

Publications by Robert A. Berenson on Elderly

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.

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.

Statement of Robert A. Berenson, M.D. before a hearing of the House Ways and Means Committee's Subcommittee on Health. Berenson addresses the Medicare Chronic Care Improvement Program and the challenges of better serving the growing number of Medicare beneficiaries with multiple and complex chronic conditions, such as chronic obstructive pulmonary disease, congestive heart failure, diabetes mellitus, and other diseases.

While Medicare spending varies widely across the country, increased local spending apparently does not produce differences in quality, access, or even patient satisfaction. Yet policy analysts tend to minimize the importance that as much as 30% of Medicare spending in particular high-spending areas might be excessive and unnecessary. Under most visions of the future of Medicare, there is an imperative to transform the traditional Medicare program from a claims payer to a strategic purchaser, able to adopt a broad array of approaches and use a comprehensive set of tools, some of which are used by private plans, but in a more transparent and accountable way, consistent with Medicare's role as a broad-based social health insurance program.