- - Tuesday, June 26, 2018

ANALYSIS/OPINION:

Second to Social Security, Medicare is the largest social program in the United States, with more than 58 million beneficiaries. The majority of this population is 65 or older. About 10 percent of beneficiaries are in the program because they are facing life-changing disease or disability. As such, Medicare remains a critical lifeline for many Americans around the nation and must be sustained into the future. My commitment is to save Medicare.

Prior to being elected to Congress, I spent nearly 30 years as a therapist, rehabilitation services manager and a licensed nursing home administrator. I provided care for patients struggling with illness or injury and equally struggling to understand their benefits from the complex maze of regulations created by the Centers for Medicare and Medicaid Services, more commonly known as CMS. During my professional career, I was honored to be asked to serve on two Medicare Technical Expert Panels.

I have also been on the payee side of the Medicare equation. Most providers want the best care for their patients but recognize that Medicare’s reimbursement rates are much lower than private-market health insurers. This becomes increasingly concerning when coupled with findings from the recently released annual report on the fiscal solvency of the Medicare hospital program, which indicates that it will not be able to pay full benefits beginning in 2026, three years earlier than predicted last year.

Medicare spent $710 billion in 2017 and projections show increased spending at a faster rate than the overall economy through nearly the remainder of the 21st century. Recognizing the budgetary constraints on the program and the fact that 10,000 baby boomers are enrolling in Medicare every day — and will for the next 13 years — it is essential to find ways to innovate for the prolonged solvency of the program.

Anyone can tell you there is a simple answer: Spend less from the program than incoming revenues and it will remain solvent. However, we need to recognize that beneficiaries are not a simple calculation but rather individuals with unique healthcare needs and histories. And as a former healthcare provider, I know firsthand that when a benefit is underutilized or denied, outcomes are almost certain to be negative for the patient and have an additional effect of increasing costs through hospitalization or long-term care. Rationing is simply not the answer. The American people deserve better.

It also needs to be understood that raising Medicare payroll taxes is not a viable solution. Raising payroll taxes would only equate to putting more cost burden on the beneficiary, many of whom have already witnessed his or her out-of-pocket healthcare costs drastically increase as a percentage of their income over the past decade.

So where does that leave us?

Simply put, we must begin to look at the equation through a different lens. While there is more than enough room for the reduction of waste, fraud, abuse and limiting overregulation, we must utilize innovation and technology to promote better outcomes and in turn create savings for the Medicare program, so it will remain viable well into the future.

Innovation starts with better case management of those beneficiaries who require the most care due to intensive chronic conditions. The aim would be to reduce avoidable hospital admissions, which become costly for the program and difficult for the patient.

According to CMS data, the prevalence of Type II diabetes in Medicare beneficiaries 65 and older is approaching 19 percent. These beneficiaries experience a much higher prevalence of hospital admissions than those without diabetes, and those living with diabetes have 2.3 times the cost of care than the average American.

We must continue to focus efforts on compliance with the beneficiary’s medical plan and encourage community-based approaches and best practices into chronic care management. Without question, this is certainly a two-way street and not enough can be said in praise for individuals stepping up and taking control of their own health.

Today, we have access to technologies that our grandparents only read about in science fiction novels. Telemedicine, which utilizes the internet, video and voice, has been able to remove geographical barriers that would otherwise add time and out-of-pocket travel costs for beneficiaries. This is especially true in rural America, which faces higher prevalence of chronic conditions, sometimes-inconsistent delivery systems, and challenges with the recruiting and retention of healthcare professionals.

I was exceptionally pleased when CMS announced its first Rural Health Strategy in May, which seeks to expand the prevalence of telehealth and telemedicine to provide better outcomes to Medicare beneficiaries and generate overall program savings. Moving forward, utilization of these technologies should be looked at as an avenue to reduce significant healthcare expenditures and improve the overall patient experience.

Now is not the time to turn a blind eye. We understand the challenges that face our country when it comes to preserving Medicare for future generations. We must continue to empower America’s unique ability to adapt, innovate and utilize technology to improve the lives of our citizens. And we must always uphold the promise of Medicare and make certain it is there for those who need it. Americans deserve no less, and it is the leaders of today who will ensure that.

Rep. Glenn “GT” Thompson, Pennsylvania Republican, is Vice Chairman of the House Agriculture Committee and Chairman of the Subcommittee on Nutrition. He also serves on the House Education and the Workforce Committee and House Natural Resources Committee.


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