Robert M. La Follette School of Public Affairs
Friday, July 12, 2013

New form of governance for Medicare surgeries could save money, improve outcomes

David Weimer

Available online

Stakeholder Rulemaking:A Model for ImplementingEvidence-Based Medicine, Spring-Summer 2013 La Follette Policy Report

A governing body of stakeholders that decides which surgeries Medicare should fund could help save money and improve health outcomes of people on Medicare, professor David L. Weimer suggests in an article in the most recent La Follette Policy Report.

Weimer outlines how a self-regulating system based on the highly regarded and successful Organ Procurement and Transplantation Network could help surgeons determine which surgeries are most effective and create a mechanism that would ensure Medicare funds only effective surgeries.

"We have little evidence about which surgical procedures are the most effective," Weimer says, "and the surgical profession and the Medicare program do not make use of the evidence that is available."

To help make surgery more evidence based, Weimer suggests creating a Medicare Surgery Assessment Volunteers for Effectiveness to assess the effectiveness and cost-effectiveness of surgeries. "In creating MedSAVE, Congress would ensure it represented all the surgical specialties, other medical professions, older adults, entities interested in specific diseases and taxpayers."

Committees would advise the board of directors, which would approve surgical payment schedules based on an overall cap on the funds available for Medicare-funded surgeries. "Any expenditures in excess of that cap would trigger proportional reductions of all subsequent payments for surgeries," Weimer says. "Because MedSAVE would be governed by surgeons and other stakeholders, they have an incentive to not exceed the gap, to not use surgeries that are ineffective. The threat of across-the-board reductions in surgical fees combined with the ability to affect the determination of inappropriate surgeries would provide meaningful stakes to encourage voluntary cooperation with MedSAVE by the most relevant stakeholders — the surgical specialties."

Weimer's Policy Report article is based on a chapter from his 2010 book, Medical Governance: Values, Expertise, and Interests in Organ Transplantation, published by Georgetown University Press.

"We know from experience that isolating organ allocation from outside influence and letting all the stakeholders work out how best to distribute organs for transplantation is effective," Weimer says. "Although no governance arrangement is perfect, stakeholder governance for Medicare surgeries could help control costs and advance evidence-based medicine."