Health bills would shift Medicare money to Mayo and other 'high-value' hospitals
By Alec MacGillis
Washington Post Staff Writer
January 6, 2010
As House and Senate lawmakers start to reconcile their health-care bills with an eye to final passage, a little-noticed provision is already prompting celebration from a small group of influential hospitals that stand to gain millions in Medicare dollars.
Language in both the House and Senate bills would reward hospitals for efficiency in their Medicare spending, a dramatic change in the formula for parceling out the public dollars, which can account for as much as half of a hospital's budget. That could prove to be a windfall for some hospitals but a significant loss of funding for others, mostly those in big cities and the South.
A revised Medicare formula represents a major lobbying victory for a coalition of hospitals based in the upper Midwest, led by the Mayo Clinic. Their leaders sent a letter to House members in July demanding Medicare reform, as well as objecting to a government-run insurance plan, or "public option." Even the smallest in the group mobilized lobbyists and sent their leaders to Capitol Hill to press their case.
Mayo leaders met with White House officials several times in recent months, convincing them that "paying for value" was key to slowing the growth in health-care costs. Throughout, President Obama has praised Mayo and "high-value" care.
But those on the losing end are criticizing the provision as a brazen money grab. They predict that, instead of saving taxpayer money, it will simply take funding from areas with more poverty and racial minorities and send it to more homogenous communities that tend to have fewer health problems.
Hospitals now have little incentive to be parsimonious, because Medicare revenue is based on the number of procedures performed at a facility. But supporters say a value index -- by rewarding hospitals that spend less per patient -- would provide an incentive to limit procedures.
But opponents say Congress has bought a flawed sales pitch. They point out that the Midwestern hospitals spend less in part because they serve fewer low-income patients and racial minorities, who have higher rates of diabetes, high blood pressure and other costly conditions.
Opponents cite a new report from MedPAC, the Medicare advisory commission, which found that the spending gap between the Midwestern towns and urban cities such as Boston and New York shrinks when other factors are taken into account, including patients' health status and the fact that teaching hospitals get higher payments and thus appear to be spending more per patient.
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