"Medicare, for the most part, pays for physical services," Reuben said. "If care is provided that doesn't fall into the category of one of those services, it isn't paid for. So, coordination of special services is not reimbursed."
The partial success of the program indicates that "a new model is achievable" under Medicare, Reuben said, "but the time is ripe for a thorough re-evaluation of how Medicare pays for services. It really needs to be freshened up. We can have fee for service, but we have places where we must fill in the gaps, and one of the big gaps is coordination of care."
Counsell said he and his colleagues are going through data collected in the program to determine whether it makes sense financially. "Armed with some further information and a cost analysis, we are looking at how much the program cost and how much was saved and who benefits the most," he said.
Elements of the program could be adapted for use with special populations, such as nursing home patients and those with chronic illnesses, Counsell said, working through organizations that deliver managed care to selected groups.
"There has to be a different infrastructure," Reuben said. "If the method of financing is good, good infrastructure tends to follow."
Details on health care for the elderly is provided by the American Geriatrics Society.
SOURCES: Steven R. Counsell, M.D., professor, geriatrics, Indiana University, Indianapolis; David B. Reuben, M.D., professor, medicine, University of California, Los Angeles; Dec. 12, 2007, Journal of the American Medical Association
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