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Volume 12 Number 143
ISSN 1091-4021
Thursday, July 26, 2007

Lead Report: Reform Proposals

A study scheduled for release July 26 by a private research foundation says bills before Congress all hold the potential to improve health care in the United States, but fall short of what the group thinks is needed for the system.

The Commonwealth Fund (CWF) study, Congressional Health Care Bills, Part II, Quality and Efficiency, analyzed 16 different bills before Congress to assess how well they address quality and efficiency issues facing health care today. Their analysis classified proposals into three large categories: payment systems reform, transparency improvements, and health information technology improvements.

Payment system reforms, such as promoting pay-for-performance pricing should give the best return in quality and efficiency improvements, the study found. Pay-for-performance systems, the study said, give hospitals financial incentives to improve the quality of care. "Even modest financial incentives for hospitals contribute to improved quality," the study said.

CWF President Karen Davis said she was most impressed by the proposed Medicare Value Purchasing Act sponsored by Sens. Max Baucus (D-Mont.) and Chuck Grassley (R-Iowa), which would allow Medicare to reward physicians for good outcomes.

"The Grassley-Baucus bill puts real money on the table for rewarding doctors for doing to the right thing," she said, a strategy that has been proven to work.

The other categories, transparency and health information improvements, promise more modest improvements in quality and efficiency, the study found.

The transparency bills, for the most part, are too narrow in their scope, Davis told BNA. While they aim to make hospitals publish the cost of in-hospital procedures, the public should have the right to know how much an operation will cost in total, including outpatient care and rehabilitation, she said.

In regard to medical technology improvements, the study is critical of bills that seek to promote use of standardized technology to improve patient care, but do not address the financial barriers that keep many hospitals from adopting better medical technology.

But overall, no bill in Congress has what CWF officials think it will take to get the U.S. health care system to become "high-performing," as defined by CWF's Commission for a High Performance Health System. Rather, they said all the bills lack an "overarching strategy" that would bring the most improvements.

Recommendations

Davis provided eight recommendations for lawmakers to help them develop a high-performance health system:

• a coordinated policy strategy with national goals to guide improvement efforts, establish priorities, ensure implementation of effective strategies, and monitor their impact;
  
  
• fundamental payment reform that moves away from the current fee-for-service model and emphasizes paying for care coordination and population- or episode-based care and reducing the differential between high payment for procedures and relatively low payment for primary care services;
  
  
• creation of an entity such as a National Quality Coordination Board, as recommended by the Institute of Medicine, to ensure that public and private efforts reinforce each other;
  
  
• creation of a center that would offer comparative effectiveness information for drugs, devices, and procedures;
  
  
• reorienting the health care system to encourage prevention, early primary care, and chronic disease management, including patient designation of a patient-centered primary care home; and
  
  
• access for patients to their own medical records, along with patient information and tools to share in decisionmaking.

For the study, CWF included only bills that could significantly alter healthcare in the United States, had bipartisan support, and were "unique and innovative," according to a press release that accompanies the study.

The Commonwealth Fund is a "private foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults," according to the group's website.