Medicare Could Serve as Test for Reducing Health Care System Waste, Experts Say at Senate Finance Committee Roundtable
At a Senate Finance Committee roundtable meeting on Tuesday, lawmakers and health care experts said health reform must change payment and delivery systems to reward providers for better quality of care and reduce wasteful spending, the AP/Philadelphia Inquirer reports. The meeting was the first of three the panel has scheduled for April and May. Finance Committee Chair Max Baucus (D-Mont.) said, "These roundtable discussions will preview many of the policies that the committee will consider" on health reform.
Tuesday's roundtable focused on using Medicare to test strategies for reducing waste in the U.S. health care system. Baucus said that "Medicare is going to be the driver to achieve quality reforms, in large part because the other players tend to follow Medicare." Experts told the panel that the program should focus on improving follow-up care for people with chronic diseases and preventing repeated hospitalizations when these conditions worsen. Experts also recommended increasing payments to primary care doctors and scrutiny of specialists, who typically order more tests and procedures. In addition, they said hospitals could be penalized when patients do not receive sufficient follow-up care and are readmitted for the same problems repeatedly (Alonso-Zaldivar, AP/Philadelphia Inquirer, 4/22).
A statement issued by AARP on the roundtable said, "Many gaps in care often occur at care transitions, as individuals move from one setting to another, such as from a hospital to home. A lack of coordination and follow-up care can lead to unnecessary hospital readmission" (Smith, Reuters/Boston Globe, 4/21). According to CQ HealthBeat, "the parties seem to be in relative harmony on the idea that payment incentives need to be changed to reward quality and efficiency and to promote more teamwork among providers toward those ends."
The committee members and experts also discussed other ways to increase the number of primary care physicians, such as by increasing payment rates to these doctors and providing incentives for medical students to practice in their home states. Glenn Steele, CEO of Geisinger Health System in Danville, Pa., discussed savings generated by improvements in quality of care at Geisinger. Steele said that the company first developed outlooks for the sickest patients' health care status in three to five years and then changed payment systems to promote better care and lower costs.
The panel also discussed proposed changes to the Medicare Advantage program. When asked about a potential bidding program for firms offering MA plans, Aetna CEO Ronald Williams said, "I think we're open to any changes in the system that results in a predictable slope, minimal impact on the beneficiaries, and whether" beneficiaries see an increase in value. Former CMS Administrator Mark McClellan told the committee that additional spending on primary care and health information technology would be needed to eliminate wastefulness in the health care system, and that such spending would require accountability checks to verify its effectiveness. He said, "You could get to the point with good" quality and effectiveness measures "where you're saving significant amounts of money over time and demonstrating to the American public that they're getting better health care as a result of those reforms" (Reichard, CQ HealthBeat, 4/21).
Next week the panel will hold closed meetings to discuss specifics of its reform bill related to delivery of care (AP/Philadelphia Inquirer, 4/22).
In related news, Chuck Clapton, an aide to Senate Health, Education, Labor and Pensions Committee ranking member Mike Enzi (R-Wyo.), on Tuesday spoke to a meeting sponsored by the American College of Emergency Physicians about the cost issues related to health reform. He said that "there's been a lot of happy talk in D.C. about how everybody wants to get everyone covered," but "there's going to be a real cost associated with that." According to Clapton, extending Medicaid to people with incomes of up to 100% of the federal poverty level would cost $400 billion over 10 years; providing insurance subsidies to people with incomes of up to 300% to 400% of the poverty level would cost $700 billion; and allowing people between ages 55 and 65 to enroll in Medicare would cost about $200 billion. He added, "Taken all together, you're talking somewhere between $1.2 (trillion) and $1.5 trillion." However, Clapton said, "I see a lot of good progress" in overhaul negotiations. He added that Enzi believes consensus can be reached if 20% of the issues that the parties disagree on can be overlooked (Reichard, CQ HealthBeat, 4/21).
At a Tuesday forum sponsored by the Congressional Health Care Caucus, Republican lawmakers and conservative speakers said they want to limit the growth of government in health care and, instead, increase personal responsibility and offer larger tax breaks for individual health plans. Rep. Michael Burgess (R-Texas) expressed optimism that a majority of Democrats will be receptive of Republican proposals in developing overhaul legislation. According to Burgess, "This appears to be a different product that's coming through as opposed to the stimulus bill, where we were shut out from start to finish."
Rick Scott, chair of Conservatives for Patients' Rights, said a Republican health plan should focus on patients' ability to choose their doctors and health care options, and also generate competition, accountability and personal responsibility. Gene Scandlen of the Heartland Institute's Consumers for Health Care Choices said policymakers either could implement a top-down approach, granting power to a "health care czar," or a bottom-up approach, stressing preventive medicine and rewarding people for controlling costs of their own care by using generic drugs or reducing emergency department visits (Norman, CQ HealthBeat, 4/21).
Video of the forum is available online.
Families USA, PhRMA
Families USA and the Pharmaceutical Research and Manufacturers of America on Tuesday announced a campaign promoting an expansion of Medicaid and other provisions addressing access to care issues. The plan -- which will be promoted as part of health reform through lobbying, advertising and grassroots efforts -- includes increasing Medicaid eligibility to include people with incomes of up to 133% of the federal poverty level, offering subsidies on a sliding scale to middle-income people who cannot afford premiums but do not qualify for Medicaid, and placing a "meaningful cap" on out-of-pocket spending on health care.
PhRMA President and CEO Billy Tauzin said, "This has the potential of expanding coverage to people who need it the most." He added, "We clearly agreed we have to have Medicaid reform as part of this package," because if "you don't get into that central question, how do you cover people, ... we're never going to solve this." He said of the out-of-pocket cap, "If you don't do that, statistics show us that people simply forgo" care, noting, "Half of the prescriptions written by doctors go unfilled in this country." He added that the two groups, traditionally at odds over health reform, intend to show that "there is broad support for these ideas" and that there "is an awful lot of common ground." Families USA Executive Director Ron Pollack said, "Where we have found common ground I think is the very essence of the health care debate," adding, "We're going to focus like a laser beam on these three (policies)."
Baucus said of the joint plan, "Increasing Medicaid access is a critical part of health care reform. It is a quick and efficient way to cover all low-income Americans, bringing us closer to the ultimate goal of coverage for all. I commend PhRMA and Families USA for coming together." He added, "Their partnership highlights the broad-based support for this plan and keeps the momentum moving forward" (Attias, CQ HealthBeat, 4/21).