Freshman Senators' Amendments Focus on Improving Value

Janice Simmons, for HealthLeaders Media , December 9, 2009

A group of 11 freshman Democratic senators, organized by Sen. Mark Warner (D-VA), introduced a set of amendments to the Senate healthcare reform measure Tuesday that they said will promote more cost awareness and affordability.

In a speech on the floor, Warner compared the bill to the efforts years before to promote cheaper airfares online. "What the package of amendments is trying to do to healthcare is what Travelocity did to the airline business" in terms of price transparency, he said.

The amendments, which the senators have been working on for the past several months, are designed to address the areas of:

  • Value-based purchasing. Medicare would be required to implement pay-for-performance testing for providers by 2016 for hospices, psychiatric hospitals, long-term care hospitals, inpatient rehab facilities, and inpatient psychiatric hospitals. The Health and Human Services (HHS) secretary would have the ability to expand the pilots if they are determined to reduce Medicare spending by 2018.

  • Ambulatory surgical centers. The HHS secretary would be required to develop a pay-for-performance program for the centers by 2011.

  • Shared savings program. The HHS secretary would be given more flexibility to reward accountable care organizations that lower costs and improve quality.

  • Disparity reduction. Qualified health plans under the proposed benefits exchange would need to demonstrate that they are working to reduce health disparities as part of their quality improvement activities.

  • Payment  bundling. The number of health conditions already proposed in the Senate bill would be expanded for testing.

  • Physician quality reporting. The Medicare Physician Quality Reporting Initiative would be modified to permit physicians who report quality data through a qualifying Maintenance of Certification program to be eligible for incentive payments in 2011-2014.

  • Fraud enforcement. The HHS secretary would be required to add certain “smart” technologies to provisions in the current Senate bill that could detect potential fraud and abuse processes.

  • Telehealth. Under the Center for Medicare and Medicaid Innovation proposed in the Senate bill, recommendations and analysis would be conducted on the effectiveness of telehealth behavioral health issues, such as post-traumatic stress disorder, and telestroke in medically underserved areas.

The other senators supporting the amendments are Mark Begich (D-AL), Michael Bennet (D-CO), Roland Burris (D-IL), Kay Hagan (D-NC), Ted Kaufman (D-DE), Paul Kirk (D-MA), Jeff Merkley (D-OR), Jeanne Shaheen (D-NH), Mark Udall (D-NM), and Tom Udall (D-CO).

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

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