All the major participants in the governmental reform processes — Congressional Committees and the White House — are putting words to their ideas for health care reform at a frenetic pace (just look at the media coverage). ACC has been asked for feedback again this week from all of these key determiners, including intense meetings with the Office of Management and Budget team and with the Senate Finance Committee staff leadership.

The Senate Finance Committee has begun their debate three buckets of health reform issues earlier this week: delivery system, coverage and financing. Of course, most of our issues fall under delivery system reform, but financing is where it will all happen or not. The roundtable included input from payers, think tanks, providers, consumer advocates and business. WE have made sure our views are on the table. Most of what happens is behind the scenes -- the window dressing is just to make sure the media knows things are happening.

Legislation is still likely to officially emerge from these almost-occult processes in May or June. Rumors abound about what it might look like.

What Reform Could Look Like
Reforms will likely be proposed and funded over three time phases: immediate changes (in the next one to three years); intermediate reforms (over two to five years) and longer-term reforms (over seven years). In each phase, the delivery system, payment models, financing structures, and administrative and regulatory systems will undergo fairly dramatic change. The administration reiterates the future health care system should preserve choice, should cover all citizens, should promote quality and should do all this while slowing the rate of cost increases. [more]

If the leading reformers have their way, some of the likely long-term transitions could include:

• Phasing out the current fee-for-service payment mechanism, except for certain very episodic care circumstances
  
  
• Creating competitive bidding for Medicare Advantage contracts nationwide (meaning new players could emerge)
  
  
• Repealing antitrust laws to allow gainsharing among physicians, hospitals and insurers (we are supporting that strongly)
  
  
• Providing significant disincentives (after the incentives run out) for failure to fully implement health information technology
  
  
• Promoting physician and hospital integration to allow for bundling of payments around episodes of care and chronic conditions
  
  
• Promoting funding for medical homes that could include primary care, specialty care and hospital-centered versions
  
  
• Capping Medicare payments for inefficient providers while more efficient providers get annual increases
  
  
• Correcting hospital price (DRG) distortions
  
  
• Encouraging specialty societies to propose pilots and incentive-based shared savings models to reduce hospital readmissions, emergency department care, and inappropriate uses of technology and procedures for patients with conditions in their specialty (in this latter area, note that the ACC has proposed as many as 11 different pilots and shared savings offers to CMS if they’re serious)

I’m increasingly concerned about how to keep cardiologists and ACC members plugged in to the speed and scope of changes proposed. We are at the table, but there are so many moving parts that the ultimate result is hard to predict, particularly when we don’t know how we’re going to pay for all this yet. (Toto, we’re not still in Kansas…)

*** Image from Flickr (~MVI~). ***

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