Sens. Baucus, Grassley Release Memo on Payment Reform, Improving Health Care QualitySenate Finance Committee Chair Max Baucus (D-Mont.) and ranking member Chuck Grassley (R-Iowa) on Tuesday released a 48-page document outlining a number of health reform proposals, including payment reform and quality improvement, the Los Angeles Times reports (Levey, Los Angeles Times, 4/29). The committee will discuss the proposals Wednesday in the first of three closed-door meetings that will be held over the next several months to write health reform legislation (Budoff Brown, Politico, 4/28).
The proposal aims to increase the number of primary care physicians, reduce hospital readmission rates, increase transparency, overhaul Medicare Advantage plan payments and create quality benchmarks for physicians and hospitals. Under the proposal, primary care physicians who treat Medicare beneficiaries would receive a 5% payment increase, while payments to specialists would be reduced (Edney , CongressDaily, 4/29). General surgeons in rural areas also would be eligible for the 5% bonuses (Alonso-Zaldivar/Werner, AP/Richmond Times-Dispatch, 4/29). The paper notes that the committee is still looking for a way to permanently fix the Medicare reimbursement formula for physicians that leads to annual payment cuts that Congress must halt each year. The paper suggests two possible solutions that both include a 1% increase in payments and then a freeze on Medicare physician payments through 2012 (Edney , CongressDaily, 4/29).
The senators also suggest that Medicare reimbursements to hospitals be based on quality-of-care measures for conditions such as heart attacks, heart failure, pneumonia and surgical care, with hospitals that meet or exceed quality standards receiving bonus payments (AP/Richmond Times-Dispatch, 4/29). In addition, they suggest withholding up to 20% of reimbursements to hospitals that have high readmission rates of patients with chronic conditions. According to the proposal, MA plans should be required to bid competitively to reduce payments, or plan payments should be cut by either basing them on a combination of federal and local Medicare spending, or a mix of across-the-board reductions or decreases in the highest spending areas (Edney , CongressDaily, 4/29).
Another proposal included in the document is the establishment of an independent institute governed by a "multi-stakeholder board" to conduct comparative effectiveness research for medical treatments and procedures, which would be funded in part by a tax on private insurance companies. According to the document, the research institute should be "prohibited from issuing medical practice recommendations or from making reimbursement or coverage decisions or recommendations" (Politico, 4/28).
More documents are expected from the committee, which will focus on how to increase health care coverage and how to finance a massive health system overhaul, CQ Today reports (Wayne, CQ Today, 4/28).
Sen. Dodd Discusses Health Reform
Sen. Chris Dodd (D-Conn.) -- a senior member of the Senate Health, Education, Labor and Pensions Committee -- on Tuesday said that he would like the Obama administration to be more involved in developing health reform legislation, CQ HealthBeat reports. Dodd spoke at a briefing for reporters sponsored by the Kaiser Family Foundation, Families USA and the National Federation of Independent Business (Reichard, CQ HealthBeat, 4/28).
Dodd said that any reform effort would be unsustainable without bipartisan support, noting that it could take a decade to implement a massive overhaul, in which time the political landscape could dramatically change. "You want to have something that will sustain that kind of change or this will be a chaotic mess," Dodd said, adding, "I sense no appetite to invoke reconciliation," which would allow Democrats to pass health care legislation without any Republican support (Edney , CongressDaily, 4/29).
A webcast of the briefing is available online at kff.org.
Caucuses Push for Public Health Insurance Plan
The leaders of the Congressional Progressive Caucus, Black Caucus, Hispanic Caucus, and Asian Pacific American Caucus on Tuesday sent a joint letter to the Democratic congressional leaders and President Obama that called for a public health insurance option to be included in any health care reform legislation, Roll Call reports. According to Progressive Caucus co-Chair Raúl Grijalva (D-Ariz.), the four groups include more than 100 members of Congress and "represent the most under-represented communities, in which livelihoods are paralyzed due to health care being set as a privilege" (Bendery , Roll Call, 4/28). All 77 members of the Progressive Caucus on Tuesday met with Obama at the White House to discuss issues, including health care reform (Bendery , Roll Call, 4/28). Caucus member Rep. Elijah Cummings (D-Md.) said Obama was "adamant" about passing major health reform legislation this year. However, Cummings added that the president wants to ensure that a public plan does not become a "dumping ground" for employers who decide to discontinue coverage (Bendery , Roll Call, 4/28).
At the American Hospital Association conference in Washington, D.C., this week, association President and CEO Rich Umbdenstock said that with health care reform coming to a head, "[w]e are in for months of political rough and tumble," The Hill reports.
He added, "A balanced final reform package will be a mixed bag of gain and pain for everyone." According to Umbdenstock, the proposals hospitals are concerned the most about include:
- A public plan option, which hospitals fear could lead to reduced reimbursement rates;
- The establishment of a federal health board that would dictate what treatments would be covered;
- "Bundle" payments to physicians, hospitals and other health care providers to pay a single fee for treating a condition; and
- Cuts in Medicare reimbursements for treatment required when beneficiaries are readmitted to the hospital for the same condition.