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Key Senate panel sets brisk pace for health system reform package

Washington -- The Senate Finance Committee, whose leaders appear to have taken the helm in the health system reform debate, started a round of public talks with health organizations in a run-up to an aggressive reform timetable. National reform legislation in the Senate will likely show the influences of an April 21 roundtable discussion. It focused largely on how a rural health system improved care and lowered costs for chronically ill patients, how patient needs and incentives should drive reform, and whether a federal health agency should have more authority to innovate. The Senate Finance Committee roundtable on improving care and reducing costs was the first of three on major health reform topics. Two more are scheduled for May. Committee members in the days following each discussion will review and comment on each corresponding piece of the legislation before the final package is unveiled publicly for a formal committee markup and vote, possibly as early as June. Senate Finance Committee Chair Max Baucus (D, Mont.) said it's time to move. "If we don't act now -- that is this year -- the consequences will be dire." Sen. Charles Grassley (Iowa), the committee's highest-ranking Republican, said tackling health care, which accounts for 16% of the nation's economy, is daunting. "This is the toughest and most needed issue that Sen. Baucus and I have ever been involved in." The Finance panel and the Senate Health, Education, Labor and Pensions Committee began conferring with health care organization leaders about legislation last year. House committee chairs began holding hearings more recently, and Republican groups in the House also are working on their own proposals. House and Senate committee chairs have agreed to try aiming for floor votes on reform legislation before the August congressional recess. The Geisinger way The Senate Finance roundtable on April 21 included 13 participants representing health plans, physician organizations, consumer advocates, auditors, researchers and others. But committee members spent a significant part of the discussion asking Geisinger Health System President and CEO Glenn Steele Jr., MD, PhD, about replicating on a national scale the organization's care coordination for chronically ill patients and other innovations. Health care costs account for 16% of the nation's economy. The Pennsylvania-based health care system is a mostly rural network of physicians, nurses and hospitals combined with a health plan serving about 30% of its patients. Dr. Steele said Geisinger asked its health professionals to follow evidence-based guidelines or to develop consensus-based care standards for prevalent chronic diseases, such as diabetes, coronary artery disease, congestive heart failure and kidney disease. It also targeted the sickest patients in its health plan and assigned additional nurses to assist physicians with care coordination. "What we've shown is that when you increase quality for these groups of high-utilizing patients, you're also decreasing costs," Dr. Steele said. A number of Geisinger's practice sites saw a 50% or higher decrease in hospitalizations in one year after the project launched about five years ago, he said. Many patients had not been taking their prescribed medications at the right dosage or frequency. Sen. Debbie Stabenow (D, Mich.) asked about the advantages of having an integrated health system. "That is a different delivery model than we have in a lot of areas," she said. Most patients still receive care in practices with five or fewer physicians, noted participant John Tooker, MD, American College of Physicians executive vice president and CEO. Dr. Steele said having its own health plan allowed Geisinger financially to reward physicians and nurses who improved patient care. Also, most of the system's patients live in rural areas and do not change residences often. This helps the health system track the outcomes of its care over years, not just weeks or months, he said. Geisinger's health information technology network is another key factor, Dr. Steele said. An electronic health record system implemented 14 years ago allows patients to see lab and radiology results, request prescription refills, e-mail questions to doctors and nurses, and schedule their own appointments. "We couldn't do it without [health IT] throughout our entire geography. It would be impossible because of the physical distances," he said. Centers for innovation? Baucus asked Dr. Steele how he would apply the lessons he learned at Geisinger on a national basis. "The first thing I would do is to redesign" the Centers for Medicare & Medicaid Services, Dr. Steele said. "I think CMS needs to be an engine of innovation, not a self-defined bureaucracy." The Geisinger chief said Congress should start by giving CMS more leeway to launch demonstration projects quickly that are focused on Medicare patients who cost the most and receive the least-coordinated care. That would entail giving CMS clear goals for the patients' health and creating a backup reform plan that serves as a stick to motivate the agency to achieve its primary goals. The project could begin with a few million patients and expand to the entire Medicare population, he said. Most patients receive care from practices with 5 or fewer physicians. Dr. Steele said CMS must be allowed to adjust the pilot project as needed. "A lot of what we did was accomplished because we were able to change on the fly." Sen. Jeff Bingaman (D, N.M.) asked the attendees if CMS could tackle such an undertaking. Mark McClellan, MD, PhD, a former CMS administrator, said the agency would need a bigger budget and more authority. "Medicare, the way it is managed now, does not leave a lot of room for discretion in implementing the kinds of reforms we're talking about today." Glenn Hackbarth, chair of the Medicare Payment Advisory Commission, suggested that Medicare could partner with private payers to work on incentives that reward effective care integration by health professionals. Grassley asked if national health system reform required additional spending. Other Republican senators questioned the need for new money, considering the billions they said could be saved by reducing fraud and unnecessary care. Sen. John Ensign (R, Nev.) said Medicare reform also should give beneficiaries financial incentives to shop for the best deal in health care. This could happen if electronic health records delivered health professionals' cost and outcome information to patients, he said. "We don't need more money in the system; we need to spend our money more properly and have the incentives." Hackbarth said national health spending variations could be leveled by focusing on the highest-spending areas while understanding that "there's not one single right way to deliver efficient health care." The discussion seemed to resonate with Baucus, who mentioned at a breakfast with reporters days later the possibility of reforming CMS. The full and original article can be found at:
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