The pace of planning for health care reform in Washington is frenetic. The President wants action this summer. Democratic leaders want a bill to be ready to be marked up by June for debate over the summer. The Senate Health, Education, Labor and Pensions (HELP) Committee (Kennedy) is trying to get their first draft done, as is the Finance Committee (Baucus) in the Senate. Now, Representatives George Miller, (D-Calif., representing Speaker Pelosi), Henry Waxman, (D-Calif., Energy and Commerce chair) and Charles Rangel (D-N.Y., Ways and Means chair) have committed to developing a House strategy by June as well, vowing not be “rolled over” by the Senate. We all could be rolled over.

I was called to talk last week by the Senate HELP staff to provide ideas about quality of care pilot projects. We have them. HELP Committee is interested in reducing readmissions for heart failure and acute coronary syndrome, and they are very interested in how registries and clinical decision support systems could be accelerated in the outpatient arena toward improving quality and reducing costs (IC3 and Quality First! ACC has “shovel ready” projects). They also want a proposal on how the various cardiovascular registries could be made interoperable. It would cost several million $$$ to have the registries (we have several) on one interoperable platform, but the yield in terms of advancing comparative effectiveness and clinical quality would be terrific.

Our ‘Quality First Network’ idea can rather easily be extrapolated to include other specialties -- Congress wants to create pilots that all specialties can participate in if desired. Our proposal would be to pay a significant payment increase (perhaps 10%) to incentivize the costs of health IT adoption and workflow change to use clinical decision support to track guidelines, performance measures, and appropriate use criteria (AUC) across all outpatient care with reporting to CMS and insurers. Congress might require a “stretch goal” for each specialty -- something that would be negotiated by CMS and each willing specialty -- to be eligible for the full incentive. For cardiology, a stretch goal could be reducing hospital readmissions, or applying AUC for imaging, for example.

If Congress would actually help fund these kinds of ideas, we might really get somewhere in terms of reducing costs and improving quality. What ACC proposes as “quality first networks” fits with the Brookings Institution idea of “Accountable Care Organizations (ACOs).”

I also met last week with Senate Republican leaders and their staff. Senators Gregg (R-N.H.), Hatch (R-Utah), Enzi (R-Wyo.) and colleagues are curious about whether the profession is going to support the Democratic proposal for a new “public insurance plan.” As you may recall, the ‘public plan’ would be run by CMS as a choice for employed persons and those not eligible for Medicare or Medicaid, and would be designed to price-compete with private insurers to lower premiums over time. The Republicans understandably see this as a poorly disguised path to a single payer and want physicians to be forewarned that “if we think Medicaid payments are fair, wait until we see the payment model of the new plan.” I shared that we have similar concerns, but can’t really express them without seeing anything specific proposed as yet. Republican leaders also remain interested in tort reform, as do we; but unfortunately, nobody seems to be interested in truly substantive reform, such as putting MICRA-like caps on non-economic damages. Rather, they seem to be talking about health courts and other nice, but less powerful ideas.

*** Image from Flickr (Rob Shenk). ***

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