“Now, finally, we've got an opportunity to start moving Medicare in the right direction because in effect we're setting the first real date for getting serious about moving away from fee-for-service medicine,” Wyden said. “Starting in 2017, as a result of this legislation, providers would be rewarded for pursuing the delivery models that are no longer built around just fee-for-service medicine,” he said. Those who decide against participating can continue to practice but will not have the same kind of financial rewards, he noted. More than 80% of Medicare spending is spent on treating chronic diseases, and the current Medicare system hasn't kept up with this problem, he emphasized.
In January, Wyden and three other lawmakers introduced bipartisan legislation that aims to help those with chronic diseases.
“The fact that we're now moving with the SGR bill in a coordinated care push means that when SGR gets passed and we start those incentives for coordinated care we naturally can segue into a better delivery system for chronic care patients,” Wyden said.
But Wyden didn't say how lawmakers will pay for repealing the SGR, which the CBO estimates will cost about $126 billion over 10 years.
“A permanent SGR fix if we can put it together would be a huge policy change and we're going to pull out all of the stops to do it,” Wyden said after his speech. “And obviously if I had a checkbook at my disposal, I'd start writing out payfors,” he said, adding, “If I had my way, I could find places in the military budget to generate the savings and payfors, but that's not on the table.”
He also wouldn't say whether he thought Congress will have to pass another temporary patch to the SGR if lawmakers can't reach a decision by March 31, when the current fix is set to expire.
“Let me see what the Senate's appetite and the views of the finance members are,” Wyden said.
That collaborative tactic of seeking input from committee members is one that Wyden said he will also take on issues related to the Patient Protection and Affordable Care Act. He has long been interested in greater flexibility and less bureaucracy for businesses and employees surrounding the law, he said. He will l look to his fellow committee members for ideas, he said.
Above all, Wyden said he will continue to approach the Affordable Care Act in the same way he approached Medicare part D, a major piece of health policy legislation under President George W. Bush. Wyden was one of only 9 Democrats in the Senate who supported Medicare part D, and he said Tuesday he still has “the welts on my back to show for it,” adding that he can't remember an occasion in which he took more flack than he did for his support of Medicare part D.
He emphasized that part D is now a successful program that has come in 45% below the Congressional Budget Office's projected costs, and that stories about the ACA in its early stages show a “remarkable resemblance” to the early months of Medicare part D.
“What I'm going to try to do in the finance committee is bring the same bipartisan approach that I did in terms of working when a Republican president got his major health initiative through,” Wyden said. “I'm going to bring that same approach that I used in part D to try and work with colleagues in a bipartisan way on the ACA as we move forward.”
Follow Jessica Zigmond on Twitter: @MHjzigmond