Editorial: Fixing an ailing system

Friday, Sept. 22, 2006 | 7:32 a.m.

A report on Medicare released Thursday says the federal government should cut Medicare's base payments for hospitalization and nursing home care in order to increase funding for patient education and preventive care.

The report was prepared for Congress by the Institute of Medicine, a division of the National Academy of Sciences that provides research for the federal government. The institute says Medicare - the federally funded health care program for Americans 65 and older and some disabled people - rewards quantity rather than quality by paying for what it called "excessive use" of high-cost and complex procedures in hospitals and nursing homes.

It would be more cost-effective and better for patients overall, the report says, if Medicare cut back on payments for hospital stays and used the money for better early intervention and self-management counseling for patients with chronic conditions, such as diabetes and heart disease. It also recommends better coordination among patients' teams of doctors and specialists.

It is true that an ounce of prevention is worth a pound of cure. But it doesn't make sense to increase funding for counseling people in their 70s about healthier living by cutting funding for hospital or nursing home care that is, in many cases, already inevitable. Diminishing reimbursements for institutional care could result in sick people being released prematurely.

Physicians should communicate better with each other about patients they have in common, and people should be taught how to take care of themselves. But these are services that the federal government should demand of Medicare without cutting funding for the hospital and nursing home care needed by our most frail population.