Sep 17, 2009

Quality Improvement in Baucus's Bill!

There is a lot to complain about in Senator Baucus’s health care bill, unveiled yesterday, and pretty much every stakeholder, editorialist and lawmaker has pointed out its flaws. I count myself among the disappointed—Baucus has come out with a bill that is rife with compromises, without managing any bipartisan support that would justify them. Still, I don’t want to add to the cacophony of complaints. There are, in fact, bright spots in this bill that relate to health care quality improvement. A section of the bill is devoted to improving the health care delivery system through reforms to Medicare’s payment structure. You can read the full Mark here, but if reading several hundred pages of legal jargon sounds as unappealing to you as it does to me, I’d recommend this summary, provided by the Baucus office.

The bill provides for greater coverage of preventative care under Medicare, including providing a free yearly visit with a primary care physician for every beneficiary. There is some limited recognition of a primary care physician shortage. The bill will give PCPs a 10% Medicare payment bonus for five years.

The summary notes that a fee-for-service payment system is part of the problem, incentivizing more, not better, care. So, Baucus proposes various “value-based purchasing” schemes for Medicare to test. Under the hospital scheme, “a percentage of hospital payment would be tied to hospital performance on quality measures related to common and high‐cost conditions, such as cardiac, surgical and pneumonia care.”

There are also measures to promote greater coordination of care. It would “establish an Innovation Center at the Centers for Medicare & Medicaid Services (CMS) that would have the authority to test new patient‐centered payment models that encourage evidence‐based, coordinated care. Payment reforms that are shown to improve quality and reduce costs could be expanded throughout the Medicare program.” It also directs CMS to track hospital readmission rates, and provides for financial rewards for those hospitals that keep readmissions low.

These measures are steps in the right direction—baby steps, perhaps, but they have legs. If CMS takes up the challenge they are being handed, and implements real quality metrics, this out-of-the-spotlight section of the bill could end up being incredibly significant. However, I do worry that these provisions may not be “safe” as the next round of negotiations go forward. They are threatened by rumors and fear mongering (we saw how end-of-life care counseling turned into “death panels”), and they are threatened by lawmakers who do not understand their importance. Baucus will have to demonstrate that these provisions are worth their costs; otherwise, they may not make it to the president’s desk. Let’s hope they do.

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