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ACP amendment spurs case management study

From the September 1997 ACP Observer, copyright 1997 by the American College of Physicians.

By Michael J. Werner, JD

Medicare may soon use techniques like case management to coordinate the care of patients with chronic conditions, thanks in part to a budget amendment developed and sponsored by ACP.

An amendment requiring Health and Human Services (HHS) Secretary Donna E. Shalala to study and evaluate how the private sector coordinates care for patients with chronic conditions was passed by Congress as part of the balanced budget legislation. Once that study is complete, the amendment requires HHS to develop a series of pilot projects to apply these techniques to Medicare fee-for-service enrollees.

The amendment stemmed directly from a proposal in the College's paper that outlined recommendations for Medicare reform. In the paper, "Reforming Medicare: Adapting a Successful Program to Meet New Challenges," ACP urged Congress and the Clinton administration to make fundamental changes to Medicare to help maintain quality of care and keep the program financially viable well into the next century. (The paper is on ACP Online at http://www.acponline.org/hpp/pospaper/medref.htm)

In the paper, ACP noted that services for many chronically ill beneficiaries are often fragmented because fee-for-service Medicare provides few incentives and mechanisms to coordinate care. Although Medicare managed care plans can better coordinate care, most Medicare beneficiaries remain in the fee-for-service program. Consequently, ACP urged Congress to authorize models to coordinate care in Medicare fee-for-service plans.

During a series of meetings last winter with Congressional leaders, then-ACP President Christine K. Cassel, MACP, argued that case management or a similar approach in Medicare would improve care-and save money-by helping coordinate the services provided by the many physicians and health professionals who treat the chronically ill. And ACP President William Reynolds, FACP, explained to Senate leaders that private-sector health plans, group practices and health care delivery systems have used case management and other techniques to successfully coordinate care for many years. An independent analysis commissioned by the College showed that creating a system to coordinate care could produce substantial savings for Medicare's fee-for-service programs.

The efforts of Drs. Cassel and Reynolds paid off in June, when Sens. John Chafee (R-R.I.) and John Breaux (D-La.) introduced an amendment to Medicare reform legislation authorizing pilot projects to test case management and other techniques to coordinate care in the Medicare fee-for-service program. Shortly thereafter, the Senate Finance Committee passed the amendment unanimously.

Michael J. Werner is Senior Associate for Government Relations in ACP's Washington, D.C., office.

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