Senate Finance Committee Holds First Roundtable on Health Care Reform
Senate Finance Committee Holds First Roundtable on Health Care Reform
The Senate Finance Committee held the first of the three roundtable discussions on Tuesday, April 21, on delivery system reform. The other two roundtables will be held on May 5th and May 14th when the Committee will discuss the expansion of health care coverage and the financing of health reform, respectively. Senate Finance Committee Chairman Baucus said the committee will hold a closed door walk-through on Wednesday, April 29 in order to review tentative legislation aimed at delivery reform. A later markup to deal with comprehensive health legislation is scheduled for June.
The roundtable discussion focused on reform of the payment system, the current shortage of primary care physicians and means for incentivizing doctors to join this field, bundling, and the treatment of chronic conditions. An underlying theme was the need to promote and reward primary and preventative care and increase care coordination via bundling and other innovative payment and delivery approaches.
The witnesses mostly agreed that changes in Medicare can encourage health care delivery system reform but only if the program has more latitude and resources. Glenn Steele, president of Geisinger Health System, said one step toward reforming Medicare is to redesign the Centers for Medicare and Medicaid Services (CMS) around patient-centered care. He said CMS should be redesigned as an “engine of innovation” and that redesign should begin with a patient-focus on those groups which are the most expensive. Steele also urged that CMS be given more latitude to institute procedures that allow the agency to process which reforms are working more quickly rather than wait for demonstration projects that can take years.
Mark B. McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution and a former CMS administrator, said reform may require some upfront spending but ultimately should have to demonstrate quality improvements and cost containment. He mentioned that CMS will need more money for incentivizing primary care physicians and the medical home model.
Other witnesses agreed but also said efforts must be made to address workforce shortages in primary care through loan forgiveness programs, the use of primary care providers other than doctors, and other measures.
On health information technology Ronald Williams, CEO of Aetna, said that potential changes for CMS could be a public and private partnership that enriches the claims database and increased flexibility that will allow for measures such as alerts during health screenings.
Allan Korn, Senior Vice President and Chief Medical Officer, Blue Cross Blue Shield Association, stated in his testimony that “increasing payments to primary care physicians, while at the same time strengthening the foundation of the overall primary care workforce, are critical delivery system reforms to ensure a high performing health care system.” To increase payments, he recommend adjusting payments through the Resource Based Relative Value Scale (RBRVS) to give primary care providers a 5 percent relative increase in 2010; 10 percent in 2011; and 15 percent thereafter. He further stated that paying for this could be done primarily by reducing payments for imaging services to providers who rely heavily on costly imaging machines. At the same time, he recommended a change to the membership of the RVS Update Committee and an increase in the proportion of primary care physicians to at least 35 percent of the medical professionals on the Committee, and an addition of private payers as non-voting members.
