Benefit Quest

Policy Points

HHS Cornerstone Plan Gains Ground

The federal government, health plans representing 100 million Americans, and 97 of the nation’s top 200 corporations have pledged their support for an overhaul plan promoted by Health and Human Services Secretary Michael Leavitt. Also signing on are Medicaid programs in 18 states and the District of Columbia, collectively representing some 26 million enrollees, HHS reports.

Leavitt’s “four cornerstones” plan aims to revamp the healthcare marketplace. His four-point plan features a wider adoption of health information technology, standardized methods to measure quality of care, pricing information on individual medical procedures to allow their cost to be compared “apples to apples,” and payment incentives for providers to dispense higher-quality care and for consumers to choose care that offers the best value—the best combination of lower cost and higher quality.

Legislation on Kids and Quality

With all the attention being paid to quality initiatives, what about the children? Rest assured, some senators want pediatric patients to benefit from the type of quality measures included in CMS demos. The Children’s Health Care Quality Act (S.1226), introduced in May, would provide $100 million over five years for the development and testing of quality measures for children’s healthcare.

Sponsored by Sens. Evan Bayh, D-Ind., Orrin Hatch, R-Utah, Blanche Lincoln, D-Ark., along with Jeff Bingaman, D-N.M., Norm Coleman, R-Minn., and Ken Salazar, D-Colo., the Children’s Health Care Quality Act would not only provide support for private sector’s development of pediatric quality measure development, it would make it possible for CMS to fund demonstrations of evidence-based approaches to improve hospital care for children.

SHM Represented on AHRQ Council

SHM member and Public Policy Committee member Andy Fishman, MD, FACP, has been reappointed to AHRQ’s National Advisory Council. The council, which consists of 21 members from the private sector and seven ex-officio members from other federal health agencies, provides advice to Department of Health and Human Services (HHS) Secretary Mike Leavitt and AHRQ Director Carolyn M. Clancy, MD, on priorities for a national health services research agenda.

Upcoming topics for the committee include the new AHRQ improvement initiative, AHRQ’s role in involving consumers in healthcare, and enhancing the activities of the National Advisory Council. Dr. Fishman was reappointed in April, when Leavitt named six new members and reappointed two members to the council.

HIT for All

Congress is considering financial aid to help smaller practices adopt health information technology (HIT) in a big way.

Introduced in March, the National Health Information Incentive Act of 2007 would facilitate the development and adoption of national standards, and provide initial financial support and ongoing reimbursement incentives for physicians in smaller practices to adopt HIT, such as electronic medical records, to support quality improvement activities.

The bill includes one-time financial incentives such as grants, loans, and tax deductions, as well as sustained funding through changes in Medicare reimbursement. It would support continued use of technologies by authorizing an add-on payment to Medicare office visits when supported by such technologies and separate payment for e-mail consultations that meet defined standards of appropriateness.

CMS to Negotiate Drug Prices? Senate Says No

On April 18, the U.S. Senate failed to get the 60 votes needed to bring to a vote a bill that would have allowed the government to negotiate Medicare drug prices. Under the current Medicare Part D plan, private insurers handle price negotiations with pharmaceutical companies.

Some members of Congress—mostly Democrats—maintain that the federal government could use its clout to get lower drug prices than individual insurers. This, in turn, would lower the cost of Medicare for taxpayers and beneficiaries. However, many Republicans contend the program costs much less than expected because the private sector is conducting the negotiations. — JJ