Today we held a briefing on Capitol Hill with Bob Berenson, M.D., of the Urban Institute, and Project HOPE’s Gail Wilensky, Ph.D., on the topic of “Realigning Payment to Improve the Quality of Patient Care.” During the briefing I discussed the difficulties that will ensue trying to change the current system. For one, the continuing government bail-out of financial companies is taking the billions of dollars needed for health care reform. It's not encouraging. Despite that, there are concrete steps we can take in the interim to improve quality and reduce waste, such as better utilizing legitimate clinical data (like the data found in NCDR) to improve outcomes and adherence to guidelines. Small but powerful steps can be taken between now and when major reform is finally put in place.

Wilensky offered two solutions during the briefing for fixing the SGRrrrr. Her preferred solution to fix incentives is episode-bundling, where hospitals and practices would receive one payment for one episode of care. It’s a little messy, but it’s still better than the present system, Wilensky said. Dr. Berenson countered that episodic bundling doesn’t provide incentives for appropriate, evidence-based care, which is crucial. He offered an improved version of capitation as a potential solution. If offices receive a per patient payment in addition to a lower fee schedule payment, this could encourage providers to offer higher quality of care, while potentially expanding to services such as e-mail or phone consultations.

The ACC is promoting a pilot that would move away from volume-focused payment and would instead focus on improved outcomes and better patient care, and to provide a business case for HIT adoption and e-adherence to guidelines. We hope to work with Congress in the future on it. To succeed in improving the health care system, all its players must come together to work on solutions. But, we're not 'there' yet.

Other coverage:

Health reform prospects in the wake of Black Sunday [The Health Care Blog]
Health care expansion? Forget about it [The Health Care Blog]
The Chance for Major Health Care Reform in Either 2009 or 2010 Is Now Zero [Health Care Policy and Marketplace Review]
The Chances for Health Care Reform? [Disease Management Care Blog]

< Back to Listings