Sen. Ron Wyden and three other lawmakers are expected to introduce bipartisan legislation Wednesday intended to remove obstacles they say prevent Medicare providers from focusing on chronically ill patients.
Nearly 70% of Medicare enrollees suffered from two or more chronic conditions in 2010 and accounted for about 93% of Medicare spending, or about $487 billion each year, according to a summary of the bill. Providers participating in innovative-care models are concentrated in the Pacific Northwest, Midwest and Northeast, leaving millions of Medicare enrollees elsewhere in the country without access to the best care, the lawmakers said. The bill they propose aims to change that by encouraging team-based care with rewards for improving patient outcomes.
Wyden (D-Ore.), who is expected to succeed Sen. Max Baucus (D-Mt.) as chairman of the Senate Finance Committee, mapped out some of these reforms
last summer at the National Accountable Care Organization Summit.
Joining Wyden as co-sponsors are Johnny Isakson (R-Ga.) and Reps. Erik Paulsen (R-Minn.) and Peter Welch (D-Vt.), who plan to introduce the Better Care, Lower Cost Act of 2014 at a news conference on Capitol Hill.
The bill would set up a Better Care Program, or a BCP, which differs from an ACO in several ways.
For instance, the ACO's attribution rule prevents providers in ACOs from actively targeting and enrolling the sickest patients. There would be no such rules for BCPs. Also, a BCP would be required to have a tailored plan unique to the needs and conditions of each individual.
And although ACOs are eligible for shared savings if they reduce costs while meeting quality benchmarks, they continue to operate in a fee-for-service system. BCPs would be paid a fixed amount for each enrolled beneficiary.
Ken Willis, Wyden's press secretary, noted in an e-mail that the current healthcare system many times limits which providers can provide care and where that care can take place. Under this legislation, the team of professionals caring for patients would have more flexibility in where they would provide services.
“For example, social workers, nurses, dieticians or nurse practitioners would be able to provide home evaluations or visits as part of the team-based approach, so long as their license allowed them to conduct such an evaluation,” Willis said. “This would allow patients' health teams to maximize the full range of health professionals' expertise, and lessen the impact of the current provider shortage.”
Providers, payers and advocates have been invited to attend the news conference, including representatives from Emory Healthcare in Atlanta, Health Quality Partners, Montefiore Medical Center in New York, Blue Cross and Blue Shield of Massachusetts and the AARP.Follow Jessica Zigmond on Twitter: @MHjzigmond