Presidential Opportunity

The Hospitalist. 2008 August;2008(08):

August 1, 2008 | The Hospitalist

Policy Points

Medicare Urged to Innovate Payments

At the Senate Finance Committee’s Health Care Summit on June 16, Karen Davis, president of the Commonwealth Fund, mentioned hospitalists while testifying that Medicare can be a leading force for change in healthcare quality. “… both Medicare and private insurers could move much more quickly to offer new methods of payment for patient-centered medical homes, physician group practices, hospital systems that employ hospitalist physicians, and integrated delivery systems that are willing to be accountable for the total care of patients and willing and able to assume financial risk for a broader continuum of care over time,” she told the committee.

Premier Project Pays Out

The Centers for Medicare and Medicaid Services (CMS) announced it is awarding $7 million to 112 top-performing hospitals in the third year of its pay-for-performance project with Premier Inc., a nationwide alliance of not-for-profit hospitals. The project, initially scheduled for October 2003 through June 2007 and then extended through 2009, has 250 Premier hospitals reporting on 34 quality measures. CMS has found that current results show substantial and continual improvement among all 250 participating hospitals in 36 states.

Pay-for-EHR Demo

The Department of Health and Human Services (HSS) has named 12 locations that will participate in a five-year Medicare demonstration project that offers incentive payments to providers who use qualified electronic health records. The participants are Alabama; Delaware; Georgia; Jacksonville, Fla.; Louisiana; Madison, Wis.; Maine; Maryland/Washington, D.C.; Oklahoma; Pittsburgh; South Dakota; and Virginia.—JJ

Obama’s Funding Plan

Meanwhile, Democratic candidate Obama approaches the issue with a different solution. He proposes universal coverage through the following:

The proposal would mandate all children have healthcare coverage, and would expand eligibility for Medicaid and SCHIP (State Children’s Health Insurance Program);
A new public insurance program that would bridge the gap of the uninsured, covering Americans who don’t quality for Medicaid or SCHIP and have no access to coverage through their employer. The coverage would be similar to that offered to members of Congress; and
A National Health Insurance Exchange to aid individuals and businesses that want to purchase private health insurance directly. Obama’s plan would require all employers to contribute toward health coverage for their employees or toward the cost of the public plan—all, that is, except small businesses who meet certain exemptions.

Congress Is the Decider

“McCain’s plan is, far and away, the more daring, and will present a greater shock to the system,” Dr. Flansbaum maintains. “It would probably lead to gridlock in Congress, because it would need bipartisan agreement to pass and I don’t think the Democrats would agree to it.” If, on the other hand, Obama wins the election, he would almost certainly have a sympathetic Democratic Congress to work with. “He’d have a greater chance of leading change along his lines,” predicts Dr. Flansbaum. “In this case, we might see a Massachusetts-esque plan.”

In either case, the candidate’s proposal may not become reality. “Folks have to remember, it’s Congress that has to come up with the plan” for reform, Allendorf cautions.

A strong president may carry some weight in this regard. “Like all presidents able to effect change, once [the 2009 electee] has the bully pulpit and can sway opinion, Congress should fall into line,” says Dr. Flansbaum. “There will be pressure to change things.”

That change, whatever shape it takes, is almost certain to include some belt-tightening for hospitals, he says. “You have to look at the facts: One-third of healthcare dollars are spent in hospitals … and the numbers given for waste in care in the system are upwards of 30%. You have to assume that hospitals are the logical place to cut.” Regardless of the election outcome, he cautions: “Hospitals will probably have to make painful cuts and changes. It’s going to happen at some point, though I’m not sure that Congress has the political will to push through any changes soon.”