Senate Finance Committee Considers Reform Options in Closed Sessions

Janice Simmons, for HealthLeaders Media , April 30, 2009

One week after holding a hearing on reforming the healthcare delivery system, members of the Senate Finance Committee met behind closed doors on Wednesday in a "walk through" session to examine options on paying for and delivering healthcare.

Many of the options brought up at the earlier hearing—addressing issues such as chronic care management, quality measure development, provider collaboration, health information technology, and workforce strategies—are found in the committee's new 52-page report. Providers, along with the public, can comment on the options through May 15.

The walk through—essentially examining a draft of ideas—is the first of three expected from the committee as it looks for ways to address healthcare reform and care delivery. "But nothing is set in stone," Baucus said on issuing the report. "The policy options ...put some meat on the bones of those ideas to strengthen our discussion moving forward."

Among the areas that providers would find of interest are:

Establishing a hospital value-based program. Looking at Medicare's Hospital Quality Data for Annual Payment Update program (also referred to as the hospital pay-for-reporting program), the committee is examine a value-based purchasing program that goes beyond paying for reporting on quality measures and activities; instead, payment would be based on hospitals' actual performance with these measures.

Primary care and surgery bonus. Physicians could receive bonuses over fee schedule amounts by demonstrating "quality achievements," using electronic prescribing or working in underserved areas. Providers who furnish at least 60% of their services in ambulatory settings could receive bonuses of at least 5% for evaluation and management services related to office visits, nursing home visits, and home visits; these services could be provided to both new and established patients.

Readmission. The committee is looking at ways to reduce "avoidable and preventable" hospital readmissions while using payment incentives to encourage greater care coordination. Under this option, Medicare in 2010 would begin to identify national and hospital-specific data for readmission rates related to eight conditions (selected because of their high volume and the high rates of readmission). Hospitals later would be informed about how their readmission rate compares nationally, and could receive a payment withhold if they do not improve.

Bundled payments. Also being eyed are bundled payments for hospitals and post-acute care services (such as home health or skilled nursing facilities) following discharge from a hospital during a period of up to 30 days.

Health information technology. Options include encouraging widespread adoption and meaningful use of health information technology by extending Medicare health IT incentives to other providers not included in the American Recovery and Reinvestment Act passed in March.

Healthcare workforce. To promote a sufficient supply of healthcare professionals for the future, the policy options under consideration look at increasing graduate medical education training positions for primary care.

Comparative effectiveness research. The committee said it would consider options to create long-term or permanent framework for setting national priorities for comparative clinical effectiveness research.

Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at

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