Yesterday, the House released its 1000+ page bill regarding health reform. What's interesting is what is not being discussed about the bill.
Believe me it is a schlog to get through this bill but it is an incredibly thorough health care bill that touches on everything from insurance companies to provider reporting.Of course, the controversial components are the new public plan paying Medicare rates plus 5%,the new taxes on the wealthy, and the mandate that employers cover their employees unless total revenues are under $250,000/yr.
What is not being discussed is the language in the bill regarding public reporting of performance of physicians and hospitals.This bill would significantly expand the public reporting of physician quality measures and of certain defect rates such as hospital infections. It would also levy stiff penalties for anyone not complying. In addition, it would expand the trend of not paying for defects including readmission to the hospital for certain conditions such as congestive heart failure.The language gives great leeway for the HHS Secretary to implement broad changes in payment and performance reporting. It also encourages that payment reform decisions be made by the Med- Pac Committee.
There are provisions in the bill to pilot both Accountable Care Organizations and Medical Home. The detail of how to pay for these two concepts is sketchy and left up to the Secretary to decide. In addition, there is language concerning moving to bundled payments for health services.
Total cost 1 trillion dollars. Paid for by 500 billion in increased taxes and the rest in "improved efficiency" of health care delivery. This,of course, means reduced payments to providers. If this doesn't work financially the government can then just increase taxes on the wealthy and reduce payments further to providers.
In summary, this "reform" plan is simply more of the same Medicare-like thinking. There is a mild attempt to try something different by allowing pilots of ACOs and medical homes, but most care will continue to be paid for in a traditional fee for service process with no attempt to truly reward high quality, low cost providers.The public reporting is positive, but not if it is done by CMS instead of regional authorities like the Wisconsin Collaborative for Health Care Quality. And although a feeble attempt is made to address the massive geographic discrepancy in provider payments, the fact is those of us who are most efficient continue to be severely penalized.When it is all said and done we better do better than this.It's time to get to work on these legislators.
Pleasant reading! House billAAHCA-BillText-071409.b
