Three former healthcare professionals turned Democratic lawmakers are forming a congressional task force with the intent of pushing through stalled legislation. Their agenda is heavy with information technology provisions, preventive-care measures and provider incentives, yet light on details.
Reps. Lois Capps (D-Calif.), a former nurse; Allyson Schwartz (D-Pa.), a former healthcare administrator; and Jason Altmire (D-Pa.), a one-time hospital executive, will lead a task force that's part of a broader voting bloc of Democrats whose aim is to advance long-discussed proposals that have become casualties of congressional wrangling.
At its core, the task force wants to tackle chronic-disease management, aid the adoption of electronic prescribing, and develop comparative effectiveness and pay-for-performance programs. "The goal is to do something that is politically realistic that we can do this year," said Altmire, who worked as a government relations executive for the University of Pittsburgh Medical Center system and at the Federation of American Hospitals before that.
Separately, the Commonwealth Fund last week released a survey of the public regarding healthcare and the race for the presidency.
More details are expected later this month when the task force sponsor, the 60-member New Democrat Coalition, officially unveils the effort. The coalition, made up of moderate Democrats, has become a force on economic, technology and national security measures, and healthcare sources said that it expects the same to happen on the healthcare front as well. Adding healthcare to its platform is a good indicator that coalition members plan to use the opening given to them from last year's short-term Medicare bill to pass initiatives that either received short shrift or were dropped altogether in the partisan standoff in 2007, Altmire said.
Many of those provisions that did pass last year did so with an expiration date attached to them. Most notably, a provision that replaced a 10% cut in physician payments with a slight increase is set to end June 30a move meant to push lawmakers into earlier action this year.
Still, some sticking points may be unavoidable, the trio said. Provisions that would establish a pay-for-performance type structure have some industry groups leery. And other provisions meant to give consumers the ability to compare the cost and quality of providersideas championed by the White Househave also raised industry ire.
"In general, we agree on many of the objectives of this new task force and look forward to working with them," American Hospital Association spokeswoman Alicia Mitchell said. "We're particularly pleased to see a greater focus on chronic-disease management and a focus on public and private partnerships."
The AHA, however, would need to hear more information on how the task force would address issues of competition, Mitchell said.
The coalition hints that one pay-for-performance program could mirror the CMS-run Physician Quality Reporting Initiative, where doctors receive a bonus paymentwith the PQRI, 1.5%for following clinically based treatments.
Other components could move more easily. Provisions that would require physicians to use e-prescribing have garnered bipartisan support and barely missed being included in last year's Medicare bill, Schwartz said. The congresswoman is a co-sponsor of a bill that would provide a one-time incentive of several thousand dollars to each qualifying physician as a means to help them purchase and implement e-prescribing. The bill also establishes bonus payments for each Medicare prescription that is written electronically while penalizing those who don't e-prescribe after 2011.
"E-prescribing is a very significant first step," Schwartz said. "And it's a place where it has been demonstrated to make a difference in reducing errors and saving lives while reducing time and costsboth for the providers and ultimately for the whole system."
The Institute of Medicine has estimated that more than 1.5 million preventable adverse drug events occur every year in the U.S., with more than half of them happening to Medicare beneficiaries. Other studies show that drug errors cost the federal government more than $887 million per year.
"Health IT is important both to providers, payers and consumers of healthcare," Schwartz said. "One of the actions that we can take is to encourage the use of technologythe use of innovationand to spread that as broadly as we can to ensure better quality, patient safety and save lives and reduce costs."
James King, president of the American Academy of Family Physicians, lauded the effort, but with a caveat. "When you talk about preventive services and preventive care and increasing the use of electronic health records, we're right there," he said. "That's exactly what our push is." But he also said that in order to wring out the best care by using such tools, patients must first be in a "medical home," where a primary-care physician works with other providers to coordinate a continuous-care model rather than one based on episodic care. "If not, then it's just piecemeal," he said.
The AAFP is part of a broader coalition, called the Patient-Centered Primary Care Collaborative, whose goal is to test different models of medical homes with an eye toward finding out how such a program can work, including certain reimbursement issues.
"They are nice ideas, but they just might not work unless they're tied to a medical home where the patient gets the right service by the right physicians at the right time and place," King said about the task force's goal.
This story initially appeared in this week's edition of Modern Healthcare magazine.
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