In the 1959 article written by Charles Lindblom, entitled, “The Science of Muddling Through”, Lindblom argued that in general, people make decisions in relatively small increments rather than in big leaps (Birkland, 2001). The rational comprehensive method of decision making is referred to as the root method because decisions start from the “root” of the [tree] issue (Birkland, 2001). Lindblom describes incrementalism as the [tree] branch of an issue because it builds on prior knowledge about an issue (Birkland, 2001). The history of the Medicare program, focuses on program implementation reform in reference to coverage and reimbursement. In this study, incrementalism was used the academic approach to build on the Medicare program reform from the perspective of program implementation reform for coverage, and the reimbursement in the diabetes diagnosis related group at the healthcare provider level.
The purpose of this study was to explore the factors that contribute to Medicare reimbursement payment variations among healthcare providers that treat the diabetic diagnosis related group (DRG). The current regulatory policy practices of the Medicare program where examined for causes in Medicare reimbursement payments variation. In consideration of the type of regulations (i.e. quality, quantity, price and indirect control) used by government agencies, a rulemaking framework was used to recommend alternative policies (i.e. precise, flexible and Pareto Optimum).
The study did not suggest that all variation in Medicare reimbursement payments were due to the aforementioned factors. Nor did the study settle on the idea that variation in Medicare reimbursement payments is unexplained or intentionally created for the benefit of some healthcare providers (i.e. rural or urban healthcare providers). Solving all problems in the entire Medicare program is a big leap, therefore this was not the objective of this study. Therefore, findings in this study suggest that a research approach involving an incremental examination of the Medicare contractor LCDs and National Medicare PPS’s impact on all DRGs (i.e. leukemia, transplantation, cardiovascular disease etc.,) to address issues in the clinical specialty practice is a novel approach for healthcare reform for the Medicare program.