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QUALITY: What Not To Overlook in a Health Care Bill

September 16, 2009 - 3:06pm

With Baucus's bill now out, there will be ample and we expect acrimonious debate about subsidy levels and affordability, the mechanics of the insurance exchange, the financing, and of course the lack of a public plan option. (We wonder if the recent survey showing how popular the public plan is among US doctors will have a discernible impact.)

But we wanted to point out some of the less controversial measures (if there is such a thing as uncontroversial after this summer) that touch on some of the topics we've been writing about that aim, simply, to keep us healthy, or to reduce avoidable complications and deterioration when we get sick. As Sen. Baucus himself put it, steps toward changing how we deliver and pay for health care are often overlooked in the national debate but can have a "transformative" effect on enhancing quality while holding down costs.

Preventive care will get more emphasis, and Medicare patients won't have a co-pay for certain screening tests and preventive services proven to be effective. Medicare patients would also get a "wellness visit" annually (which isn't covered now.)

Hospitals with high rates of avoidable hospital-acquired infections and certain errors will face penalties.

New ways of delivering more coordinated care will be tested and/or introduced. These include patient-centered medical homes (including for Medicaid beneficiaries with one or more chronic diseases), accountable care organizations,  "bundled payments" (to include acute as well as post-acute care). Payments to doctors and hospitals will be based, in part, on quality of care over quantity of procedures. New models will be tested to provide more coordinated and home-based care for chronic disease, including more care and monitoring for patients in their own homes.

The bill incudes several approaches to reducing unnecessarily rehospitalizations, including a renewed focus on successfully transitioning patients from the hospital back into a community setting, making sure, for instance, that they get in to see their own doctor quickly after a hospitalization. (You would think this would be part of routine care. It is not.)

There is also (on page 53) a small but important provision expanding palliative care to dying children under Medicaid, so that they can basically get hospice-type care at the same time they can still be getting "disease-modifying" treatments aimed at slowing down a terminal illness and prolonging life. Quite a few states had been trying to do this on a one-by-one waiver basis, this national approach woudl be far less cumbersome.

The Finance draft is only one step on the road to health reform -- albeit an important one. It will go through a lot of changes, and lots of compromises as it goes through committee, gets melded first with the Senate HELP bill and then with the House version. But as the process unfolds -- and we suspect, at times, explodes -- it's important to remember that there's a lot more to health reform than fighting about mandates, money and markets. 

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