Freshmen orientation

Several cost-savings amendments to the Senate’s health overhaul bill could create logistical headaches for the White House by imposing more and faster payment changes.

One amendment, backed by a dozen Senate newcomers, aims to strengthen several studies, pilot programs and demonstrations already included in the

10-year, $848 billion bill.

Meanwhile, a bipartisan group of senators said they would introduce a measure that would more than double the fines that hospitals would pay under the current Senate bill for having a high number of patients who develop a hospital-acquired infection.

Sen. Mark Begich, a first-term Democrat from Alaska, said that a number of freshmen colleagues are unhappy with the current slate of provisions aimed at wrangling in runaway healthcare costs.

“It’s really going to focus on cost containment,” Begich said. “A lot of us freshmen came in here focused on how to do the business differently–not the same old way of just putting money on the table and hope that solves the problem.”

Begich added that the key to the alternative proposal would be on changing “the system to improve the delivery so people get better service, better care and more care for less cost.”

Under the amendment, hospices, ambulatory surgical centers and other types of facilities would qualify to participate in a value-based purchasing program. Under the Senate bill, only hospitals could do so.

The freshmen’s amendment would also create a path for more flexibility in Medicare payment and would allow for newly created accountable-care organizations, or ACOs, to extend to private insurance companies and physician group practices.

The Senate bill, as written, allows qualified ACOs that meet certain quality-of-care and cost-containment benchmarks to recoup a share of the savings they achieve for the Medicare program (Nov. 23, p. 10).

Other provisions would expand the domain of a newly chartered CMS Innovation Center, give a newly created independent Medicare advisory board extensive ability to look at total health system spending and advise the non-Medicare sector, and require health plans in the exchange to share information on health plan quality and cost.

Senate veterans Susan Collins (R-Maine), Joseph Lieberman (I-Conn.) and Arlen Specter (D-Pa.) said that their amendment would collectively make physician-quality reports more widely available while rewarding patients who seek better doctors; bolster quality reporting for private payers; clamp down on avoidable hospital infections; and move up a timeline of the bundled payment program.

“The bill before us does contain a number of promising ideas to help us improve the quality of care while containing costs,” Collins said about the Senate’s package. “But the three of us believe, however, that we can and should do more.”

But the half-dozen or so new Medicare pilots and demonstrations set out in the bill have been chosen carefully and their timelines set at a deliberately slow pace, according to White House officials. White House budget chief Peter Orszag said last week that the federal government is essentially wading in uncharted waters with many of its proposals.

“I think one needs to remember that because we have not put as much attention on cost containment in the past—or sufficient attention—we don’t know exactly how to create the proper financial incentives” to accomplish some of the reforms outlined in the bill, Orszag said.

“The problem is, given the lack of attention to this key problem—rising healthcare costs and an inadequate attention to quality in the past—we don’t know enough to move the scale immediately,” Orszag, the former director of the Congressional Budget Office, added.

So far, Democrats have kept any alterations to the bill largely within their own party. Democrats beat back an amendment that would have essentially killed the bill on a 58-42 vote. The Senate voted unanimously to include a provision that would guarantee that Medicare benefits would not be diminished under the bill as well.

Another amendment, one that ensures that women would be covered for mammograms and cancer screenings, also passed 61-39.

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