Last week I paid another visit to Kavita Patel, MD, deputy staff director for health on the Senate Health, Education, Labor and Pensions (HELP) Committee to discuss "delivery system reform and physician payment options for the future." Patel is a wonderful resource and terrific contributor. She has the charge of designing the changes for delivery and payment for Senator Kennedy’s proposal, due in late January. Dr. Patel believes the Committee will use Senator Baucus’ white paper as their starting point. That means the idea of a ‘national health board’ is on their table; purchasing coalitions like Federal Employee Health Benefits Plan, payment reform, the medical home concept, health IT investment and quality measurement will be in their proposal in some form.

The behind the scenes banter last week has a number of features of interest:

• Congressman Stark (D-CA; Health Subcommittee Chair, House Ways and Means) has publicly stated we don’t have the money in ’09 to do major health system reform, and we need to think realistically about postponing big ticket items until 2010. He did emphasize we need to reauthorize sCHIP and fix or patch the SGR physician payment formula in ’09 no matter what we decide for later -- which is good  to hear. Stark is first in the line in terms of seniority to replace WAM big Chairman Rangel, who has serious problems -- he can’t survive as Chairman in the view of most pundits. But, Congressman Xavier Becerra (D-CA) is also a top contender. Becerra turned down becoming Obama’s chief trade negotiator to stay in the House lineup for leadership. We are friends with both of these folks.
• Hilda Solis (D-CA), another friend, left the Energy and Commerce Committee to become Secretary-designee of Labor. We hate to see her leave E & C, but the Secretary of Labor will play a role in system reform. This isn’t all bad for us.
• The CBO (Congressional Budget Office) put out some powerful recommendations on 2 key topics of interest to Obama and Congress on reform: insurance reforms promoting expanded access to care; and payment strategies for funding reform. Keep in mind that CBO Director Peter Orzag just left the agency to join the Obama Transition Team two weeks ago, enroute to being his Director of OMB (Office of Management and Budget). These reports are now to be considered Obama-speak in my view. I will summarize those voluminous reports after the holidays. They might be fun reading for many of you over the holidays -- if you’re sick. But, I’ll get to it for you.
• HHS Secretary Michael Leavitt is not out of office yet, and he has put out recommendations for his successors on “value based purchasing” in health care. ACC is working on a detailed response that reflects the deliberations of QSDC, PAR4, the Advocacy Committee, and the BOT.
• ACC is commenting this week on CMS’ proposed rule on e-prescribing. It’s not very bold -- doesn’t require that we be able to see the previous prescriptions for the patient in front of us, even though this information is generally available. Progress is progress; but a gradually declining 2% incentive is not going to move this agenda too fast!
• Stimulus planning is the biggest message on the Hill last week in health care. The buzz is that Daschle (Secretary-designee) has nailed down a promise for $50 Billion (yes, a B) for health IT in the Obama stimulus plan. They are thinking of massive loans and grants. That’s nice. But, we want then to also consider real payment incentives -- you know, like a 10% payment increase -- for health IT adoption and reporting. This is what our IC3 plans anticipate -- and we will eventually get there. But loans and grants -- while welcome -- won’t of themselves transform HIT adoption, which will require changing practice workflows to promote true quality improvement. Hopefully that should be the goal!

< Back to Listings