Study: Medicare lacks tools to enforce policies

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Medicare lacks sufficient information in most cases to apply its policies. It also lacks the resources or incentives to acquire the information, a new study suggests.

While Medicare is required by law to pay only for care and services considered reasonable and necessary, it simply doesn't have the tools to make evidence-based medicine work, said Susan Bartlett Foote, the principal investigator and professor in the School of Public Health's Division of Health Policy and Management at the University of Minnesota.

Among the solutions offered by the researchers: Ensure that Medicare contractors have all necessary clinical information to evaluate claims, reward contractors to pay only for value, educate providers on the importance of coverage policies, and inform providers that policies will be enforced.