Get ready -- and tell your friends. We’re going to get health care reform this year. We’re now at 50 million uninsured. A combined Senate bill on health reform (Finance and Health, Education, Labor and Pensions) and a House bill (Ways & Means and Energy & Commerce) are theoretically on track to be marked up for hearings in the first week of June. A flurry of debate and discussion will happen thereafter in June and July. Congress recesses for the entire month of August, but I suspect a good deal of behind-the-scenes lobbying by ACC will be conducted with the administration and congressional staff all through the sweaty month of August.

Senate Roundtable
Senate Finance had a roundtable last week to discuss delivery system reform. American College of Physicians and American Cancer Society were the only professional society reps asked to give formal statements. They didn’t have much new to mention we haven’t covered here (SGRrrr, patient-centered medical home, health IT). However, Glenn Steele, M.D., CEO of Geisinger, gave in my view the most compelling suggestions on how delivery system reform might succeed -- he was surely and deservedly the rock star there. As he has discussed previously with the ACC, Geisinger is showing the way to reduced waste, reduced readmissions, and improved coordination of care. Steele is also interested in working with the ACC on our quality networks ideas, AUC, and registries.

But 85-90% of health care isn’t in integrated systems like Kaiser and Geisinger -- yet. [more] Sen. Baucus seems to want all doctors moved into integrated networks NOW (and, geeze, he’s from Montana, with no integration! It ain’t gonna happen overnight, Max). One way to get there that I don’t recommend is for everybody to be employed by hospitals.

Other Debate
Meanwhile, the House Ways and Means Committee held their third in a series of health reform meetings this week, mainly arguing over the need for a “public plan,” in which CMS would compete with private insurers to offer a government-run insurance product for working Americans (with allegedly lower premiums and better coverage than privates could match). Republicans oppose such an idea. Uwe Reinhardt, ACC.09 Dack Lecturer, opined that private insurance ought to have the skills to be able to ‘kill’ CMS in this competition. Nonetheless, this is a lightening rod issue. Obama may be slowly backing away from it.

There is also continued modest interest in tort reform, possibly tied to adherence to guidelines and quality improvement. The idea of specialized “health courts,” managed by health-educated judges to expedite cases using more sophisticated expertise than a typical jury system provides, is increasing in popularity. There even are a few lonely voices talking about establishing some kind of caps on non-economic damages (pain and suffering awards). Note that attorneys have made sure that the law does not allow for non-economic damage judgments against legal malpractice — how smart they are. That privilege is reserved for physicians only.

There’s also a great deal of interest in antitrust relief that would allow physicians and other delivery system players at the community level to work together to improve quality and “gainshare” on achieved savings. We are very supportive, but Mr. Stark is talking about more anti-trust protections. The Obama folks seem to understand that relief is needed.

There’s a lot on the table here. And -- don’t be fooled -- some kind of major reforms are coming. The BIG challenge is in getting the attention of the average practice that these are important times to be paying attention.

*** Senate Dirksen Building. Image from Flickr (matthewberry). ***
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