Last week, the Social Security and Medicare boards of trustees released their annual financial forecasts, and media reports predictably led with their scariest interpretation of those forecasts: “Hospital fund set to run out by 2026” read one typical headline.
The trustees have a long-established track record of, well, let’s call it “conservative” forecasting, and nothing captures eyeballs like scary stories, so the “Medicare trust funds doomed!” headlines practically wrote themselves, as they say.
But what you need to be alert to isCMS’s announcement of its Primary Cares Initiative.
That announcement followed right on the trustee report stories’ heels — one that sure seems designed to provide the silver (plated) lining to the dark “trust funds empty!” clouds.
The Primary Cares Initiative is billed as “a new set of payment models that will transform primary care to deliver better value for patients throughout the healthcare system.” Some observers immediately labeled it “historic” (echoing the administration’s media release promotional language). Others called it “radical“.
Hmmm. Seems like this Initiative might be a pretty big health benefits deal. Or rather, a set of five deal options, basically five different ways for health treatment providers to opt-in to “at risk” compensation for the care they provide outside of hospital settings.
Details about how each of these payment models may operate are scarce. Ok, pretty much non-existent. That fits with the “management by media release” leadership style Verma has established, but in fairness, the initiative is newly-hatched.
More important is the dots the Initiative story connects between emerging CMS operating tactics and the Trustee reports dire financial forecast. The Trustees report says specifically that Medicare’s Part A trust fund will soon run out of money. Part A covers hospital care. Funding for Part B — which covers care for non-hospital treatment — is in better shape. And the terms under which Part B payouts are made is where CMS’s new Initiative focuses.
Peering into the old crystal ball, these simple facts suggest that payments for hospital care will be pinched off, and that providers of non-hospital care will be encouraged to provide specific types of treatment over other types — and in some cases punished for not re-arranging their priorities successfully.
Look for non-hands-on forms of primary care (can you say “tele-health”?) to proliferate even more rapidly & creatively than they have even recently. Oh, look, here’s signs of that development already! Will pharmaceutical manufacturers and their implementation of “chemical telehealth” solutions be far behind?