A: My plan builds on a number of programs that are already in place to improve the quality of care, including PQRI, which provides incentives for physicians who track and report data on the quality of care they provide. My plan would expand this initiative using cutting-edge technology to collect and analyze data on quality, and improve it by increasing outreach, information, and assistance to doctors who participate in the program. … My plan would expand gain-sharing programs, which allow providers to share savings from improved efficiency and quality.
Q: SHM has identified improvements in care coordination, particularly as patients transition from the hospital to the home, as an important element of health reform. You, too, have identified this as priority. Can you elaborate on the types of proposals to improve care transitions that we might see in your healthcare reform bill?
—Sen. Max Baucus
A: Today’s healthcare system doesn’t do enough to encourage healthcare providers to work together, which can be particularly detrimental for patients who are transitioning from hospital to home. According to some estimates, 18% of Medicare hospital admissions result in a rehospitalization within 30 days. This is simply unacceptable, and it is avoidable. Providers can work better together to ensure that patients receive proper follow-up care post-discharge.
In my blueprint for reform, I laid out a series of proposals to encourage greater collaboration among providers. These proposals include a plan to reduce hospital readmissions through increasing public disclosure around readmission rates and, in later years, reducing payment rates for hospitals with readmissions above a certain benchmark. My plan also identifies “bundling” hospital and physician payments under Medicare as a way to encourage greater provider collaboration across a patient’s episode of care, and other concepts like the development of accountable care organizations. My hope is that these proposals will encourage and reward health providers who work together to provide patients the best possible care.
Q: Regarding value-based purchasing, your paper states, “Every effort must be made to align hospital and physician quality goals.” Would this alignment apply to bonus payments, and if so, will it necessitate loosening current restrictions on gain-sharing?
A: Successful implementation of new payment and delivery system models may require changes to the regulatory structure governing provider collaboration. … It is critical that we strike an appropriate balance between offering providers incentives to work together while also protecting against financial conflicts of interest that could negatively impact quality of care. Regarding value-based purchasing, we are continuing to explore ways to encourage hospitals and doctors to work together to improve quality and are evaluating the best way to align payment incentives to meet this goal.
Q: How can hospitalists help with healthcare reform efforts?
A: As is true with all members of the healthcare community, I encourage hospitalists to work with me and my colleagues throughout the reform process. It is certain to take significant cooperation to create a more accessible, lower-cost, higher-quality system, but I’m confident that working together, we will succeed. I’m asking everyone in the healthcare community to help me create a “can-do” environment for healthcare reform. All stakeholders have a particular focus, and I am willing to listen to every issue. But our collective focus should be on [making] the health system better for everyone.
As always, I appreciate all questions, comments, and concerns, and I look forward to working with all stakeholders throughout this process. TH