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Better Care Lower Cost Act Provides Care for Chronically Ill Seniors

The fastest growing portion of Medicare enrollees is also the most expensive group to provide services to. The Better Care Lower Cost Act is intended to create substantial Medicare savings while improving care for these patients who typically have multiple chronic conditions.

The numbers are astounding: Medicare beneficiaries with two or more chronic conditions account for 93% of Medicare spending, approximately $487 billion annually.

losing-money-better-care-lower-cost-actWhere does the money go? The website of Senator Wyden of Oregon, one of the authors of the Bill, compares the statistics of those with one or no chronic conditions with those who have two or more and reports the following facts …

Hospitalizations

  • 4% of beneficiaries with 0-1 chronic conditions are hospitalized in any given year.
  • 63% of those with 6 or more are hospitalized in any given year.

Emergency Room visits

  • 14% of beneficiaries with 0-1 chronic conditions visited an Emergency Room.
  • 70% with 6 or more visited an ER.
  • 27% with 6 or more chronic conditions had 3 or more ER visits.

Home health care

  • 1% of beneficiaries with 0 or 1 chronic conditions received at least one home health visit annually.
  • 14% with 4 or 5 received at least one – and 9% received 13 or more.
  • 36% with 6 or more had at least one home health visit and 27% had 13 or more.

Hospital readmissions

  • 98% of all hospital readmission rates are Medicare beneficiaries with 2 or more chronic medical conditions.

Healthcare Spending

  • Average annual healthcare spending per Medicare beneficiary over all is $9,738.
  • For those with 4-5 chronic conditions it rises to $12,174.
  • With 6 or more chronic conditions it rises to $32,658 annually.

The Bill, known officially as the Wyden-Paulsen-Welch Better Care, Lower Cost Act – named for the Senators who have sponsored it, “removes barriers that prevent Medicare providers from building on existing successful delivery models, and provides a framework for encouraging innovative chronic care delivery across the country,” according to Senator Wyden’s website.

The Better Care, Lower Health Act attempts to address these concerns by building on existing care delivery models that have been successful at improving patient care for this vulnerable group while generating Medicare savings, and expanding their implementation across the country.

The Better Care, Lower Health Act would …

Provide Critical Support for Healthcare Providers

  • Encourages team-based care.
  • Offers rewards for improving patient health outcomes.
  • Increases access in rural areas through telemedicine and knowledge networks.
  • Improves compliance through vital case management services.

Focuses on Unique Needs of Enrollees

  • Does not include the attribution rule in any form.
  • Focuses on preventing illness rather than treating illness.
  • Provides changes to medical school curriculum to reflect the changed focus of health care.

Nationwide Integrated Care

  • Creates incentives to provide high-quality healthcare regardless of patient’s income and/or geographic location.
  • Removes barriers for practitioners who want to practice at the “top of their license” in areas with provider shortages.

Moves away from fee-for-service

  • Best Care Providers (BCP) will be responsible for the full cost, care and overall health outcomes of their patients.
  • Centers for Medicare and Medicaid Services will determine costs based on similar patient costs for those not enrolled in a BCP.

The bipartisan “Better Care, Lower Cost Act seeks to establish the Better Care Program, which would enable healthcare providers to form networks similar to accountable care organizations, but with a special focus on coordinating care for those with chronic conditions,” according to Tim Mullaney, of McKnight’s.

BCPs will be different than Affordable Care Organizations that allow providers to share any savings incurred after successfully treating a Medicare beneficiary at less than the set-cost threshold defined by CMS.

  • BCPs will receive a single, capitated payment for each beneficiary.
  • A unique care plan will be required for each enrollee.
  • BCPs will not have to provide for the long-term care needs of enrollees.
  • BCPs will have to offer post-acute, skilled nursing and rehabilitation care to enrollees.

General Medicine, The Post-Hospitalist Company offers practitioners who specialize in the care of post-acute and chronic care patients in long-term care settings. Our post-hospitalists hold, regularly scheduled, onsite office hours and offer 24/7 on-call services.

That means they are readily available for early assessment, intervention and monitoring when patient health concerns arise. It also means fewer hospitalizations and ER visits, lower healthcare spending and improved overall patient health outcomes.

Contact us today to learn more about how General Medicine’s post-hospitalists can help improve your long-term care facility.

Tom Prose

CEO at General Medicine, P.C.
As founder and CEO of General Medicine PC, the nation’s premier post-hospitalist care company,Tom Prose leads an exceptional team of internal medicine, geriatrics and healthcare administration specialists.