Freshmen senators spending too much time on issues, not enough time chasing headlines
Though there haven't been any impressive coalitions of Republicans and conservative Democrats coming together to improve the bill's cost savings, Sen. Mark Warner (D-Va.) has rallied his fellow freshmen behind a set of common-sense improvements to the delivery system side of things. You can download the full list Frosh Package Section-by-Section (12-6-09).pdf (pdf), but I want to focus on Section 10004: "Revisions to National Pilot Program on Payment Bundling."
This section would modify the new CMS pilot on Medicare bundled payments created by the Patient Protection and Affordable Care Act. It would expand the number of health conditions tested under the pilot and give the Secretary authority to expand the duration or scope of the pilot after January 1, 2016 if the CMS Chief Actuary determines it would reduce Medicare program spending while maintaining or improving the quality of care.
In other words, this helps the Medicare bundling pilot become a policy. And that's a big deal: The bundling efforts might be the most unjustly neglected element of health-care reform. The graphic above comes from the New England Journal of Medicine (pdf), and shows the consensus of most experts I've spoken to: Bundling has more potential to lower costs and improve care than any other delivery-system reform in the bill.
Lots of people say they want to move past the fee-for-service paradigm, in which hospitals are paid for selling you more procedures just as Best Buy salesmen are paid for selling you more televisions, but bundling is the bill's most direct step in that direction. The way it works is simple enough: If I come down with something or other, the hospital that treats me gets a lump-sum payment for, say, 60 days of treatment for all issues related to something or other. If they treat me, and 15 days later, I'm back in for complications relating to something or other, they don't get more money.
"It's a big deal because you're trying to take a fragmented delivery system and force it to work together," says health economist Kenneth Thorpe. "In today's world, hospitals don't need to worry about re-admissions. It's just more revenue for them. When the patient leaves the hospital, the hospital’s job is to wait for the next person to come in."
"But this says if you're readmitted, we're going to ding you. So one thing to lower re-admissions is to have a transitional nurse working with the patient to implement the care plan. Right now, the hospital isn't linked to that nurse. This gives the hospital an incentive to pay more attention to what happens to the patient when they leave the hospital." Accelerating this transition is a good idea, and props to Warner for taking the reins on it. Health-care reform needs more legislators interested in bearing down on the dull guts of the policy, the stuff that doesn't get you quotes in the paper but will decide the success of the policy.
December 7, 2009; 5:52 PM ET
Categories: Health Reform
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