Sen. Max Baucus (D-Mont.) might be the most devoted champion of healthcare reform on Capitol Hill today. He chairs the Senate Finance Committee, which has jurisdiction over Medicare, Medicaid, the State Children’s Health Insurance Program (SCHIP), and other healthcare entitlement programs. He has worked for healthcare reform in large and small measures, and recently put forth a comprehensive—and controversial—plan for changing the U.S. healthcare system.
Sen. Baucus penned a white paper, “Call to Action: Health Care Reform 2009,” which was published after the November election and outlines his proposals for universal healthcare coverage. Although he hopes to introduce some form of his white paper as a Senate bill, as of press time, he had not done so.
A Stanford Law graduate, Sen. Baucus was the executive director of the 1972 Montana Constitutional Convention, which rewrote that state’s constitution. He has served in public office since 1973, including six consecutive terms in the U.S. Senate.
The Hospitalist caught up with Sen. Baucus to discuss national healthcare reform and how hospitalists can—and will—factor into the changes.
Question: You are pushing for action on healthcare reform in 2009. What’s the status of your first piece of healthcare legislation this year?
Answer: My goal is to craft consensus legislation and move it through the Congress and into law. Now that Congress has passed the American Recovery and Reinvestment Act, I intend to return the attention of the Finance Committee to health reform.
Q: Where will funding come from for some of the immediate healthcare initiatives you’d like to see?
A: Healthcare reform will require an upfront investment in order to achieve the savings we all know are possible. It is my intention that after 10 years, the U.S. will spend no more on healthcare than is currently projected, but we will spend those resources more efficiently and will provide better-quality coverage to all Americans. One of the reasons healthcare reform is so important is that if we ignore the problems in the system and fail to act, healthcare costs will only grow. Acting now is a cost-saving proposition.
Q: As coverage is provided for more Americans, what steps should be taken to ensure an adequate number of physicians, hospital beds, clinics, etc.?
A: With more people in the healthcare system, we will need more physicians and resources. My plan increases the number of primary-care doctors by strengthening the role of primary care. Today, America’s system undervalues primary care relative to specialty care. This has caused fewer medical students to choose careers in primary care. My plan will increase the supply of primary-care practitioners by using federal reimbursement systems and other means to improve the value placed on their work.
My plan also builds on existing resources that have been successful in delivering primary-care services, like community health centers. The proposal I’ve put forward increases funding for low-income and rural clinics designated by Medicare as Federally Qualified Health Centers. [It would provide] more funding for Rural Health Clinics. By strengthening community and rural providers, we can improve access to primary care and better manage conditions before they become serious. That will keep people healthier and save money in the long run.
Q: You call for refocusing payment incentives from quantity of care to quality of care. Do you have CMS’ Physician Quality Reporting Initiative (PQRI) in mind to help move the focus of compensation?
A: My plan builds on a number of programs that are already in place to improve the quality of care, including PQRI, which provides incentives for physicians who track and report data on the quality of care they provide. My plan would expand this initiative using cutting-edge technology to collect and analyze data on quality, and improve it by increasing outreach, information, and assistance to doctors who participate in the program. ... My plan would expand gain-sharing programs, which allow providers to share savings from improved efficiency and quality.
Q: SHM has identified improvements in care coordination, particularly as patients transition from the hospital to the home, as an important element of health reform. You, too, have identified this as priority. Can you elaborate on the types of proposals to improve care transitions that we might see in your healthcare reform bill?
—Sen. Max Baucus
A: Today’s healthcare system doesn’t do enough to encourage healthcare providers to work together, which can be particularly detrimental for patients who are transitioning from hospital to home. According to some estimates, 18% of Medicare hospital admissions result in a rehospitalization within 30 days. This is simply unacceptable, and it is avoidable. Providers can work better together to ensure that patients receive proper follow-up care post-discharge.
In my blueprint for reform, I laid out a series of proposals to encourage greater collaboration among providers. These proposals include a plan to reduce hospital readmissions through increasing public disclosure around readmission rates and, in later years, reducing payment rates for hospitals with readmissions above a certain benchmark. My plan also identifies “bundling” hospital and physician payments under Medicare as a way to encourage greater provider collaboration across a patient’s episode of care, and other concepts like the development of accountable care organizations. My hope is that these proposals will encourage and reward health providers who work together to provide patients the best possible care.
Q: Regarding value-based purchasing, your paper states, “Every effort must be made to align hospital and physician quality goals.” Would this alignment apply to bonus payments, and if so, will it necessitate loosening current restrictions on gain-sharing?
A: Successful implementation of new payment and delivery system models may require changes to the regulatory structure governing provider collaboration. ... It is critical that we strike an appropriate balance between offering providers incentives to work together while also protecting against financial conflicts of interest that could negatively impact quality of care. Regarding value-based purchasing, we are continuing to explore ways to encourage hospitals and doctors to work together to improve quality and are evaluating the best way to align payment incentives to meet this goal.
Q: How can hospitalists help with healthcare reform efforts?
A: As is true with all members of the healthcare community, I encourage hospitalists to work with me and my colleagues throughout the reform process. It is certain to take significant cooperation to create a more accessible, lower-cost, higher-quality system, but I’m confident that working together, we will succeed. I’m asking everyone in the healthcare community to help me create a “can-do” environment for healthcare reform. All stakeholders have a particular focus, and I am willing to listen to every issue. But our collective focus should be on [making] the health system better for everyone.
As always, I appreciate all questions, comments, and concerns, and I look forward to working with all stakeholders throughout this process. TH
Jane Jerrard is a medical writer based in Chicago.