About
May 2009
The Estes Park Institute Newsroom will entirely concentrate on innovation by hospitals dealing with pressures to change the delivery system and the pressures for health care reform now manifesting themselves by legislative action in Washington.
As you know, the President has made health reform an immediate goal of his administration. As a result, two committees in the Senate and two in the House of Representatives have been holding hearings and are now beginning the process of drafting bills.
Estes Park Institute is determined to be a part of the process of making our views on certain parts of the proposed reform known to policymakers.
The first step in understanding what is happening is to look at the three “option papers” issued by the Senate Finance Committee. At present they represent bipartisan products that address three main subjects:
- Transforming the Health Care Delivery System:
* Proposals to improve patient care and reduce health care costs - Financing Comprehensive Health Care Reform
- Expanding Health Care Coverage: Proposals to provide affordable coverage to all Americans
Last week, I spent a day in Washington on behalf of Estes Park Institute, talking with staff members of the Senate Finance Committee and the House Ways and Means Committee. It was a very interesting day.
In the course of my discussions, I gave the staff copies of a short paper opening a discussion of one model of changing to a plan for integrated and coordinated care and what might be required to facilitate such a transition.
I didn’t expect to get them to adopt what I had to say, but we were satisfied that they listened carefully and that the questions that were asked were meaningful. I think the major problem that we have in trying to affect policy is having gotten into the debate late. Particularly in the Finance Committee, the work on a health care reform bill started in December with a fairly detailed policy paper giving the options of the various reform ideas. Therefore, by the time we first made known our interest, it was rather late in the game.
So far as what we have recommended, we made the decision not to take a position on the major issues which are still unresolved in the areas of coverage of the uninsured and how to pay for the entire reform package. They are too contentious to affect with our resources. Both of these are issues that could still turn the entire debate very partisan or could sink any bill. They probably will come to a head in the next month and a half.
Where we’ve concentrated our efforts is in trying to find things in the delivery system that, by changing them, would enable us to deliver care more efficiently, more effectively and at a cost that would not continue to rise at the pace it has. Therefore, I concentrated on the delivery system.
While we have not seen concept papers from any of the three committees in the House which are writing a bill, we do have the concept papers that have come out of the Senate Finance Committee. One of the ideas that is receiving a lot of attention is the idea of “Accountable Care Organizations.” These are recommendations by Medpac presented to the Congress last year and the American Medical Group Association and reflect a demonstration project by CMS. The idea is that what they call an Accountable Care Organization could organize care in such a way that the organization would have savings and those savings would be shared 80% for the organization and 20% back to Medicare. It is a very weird organizational scheme which gives physicians a high degree of control over the organization and keeps the payment for both physicians and hospitals on a fee-for-service basis, leaving the possibility of bundled payments for a later date. We’ve not been impressed by the idea.
And, finally, we examined the question of 501(c)(3) status for hospitals, if, as a result of the reform bill, most of the remaining population of the country is covered by some sort of insurance. In that case, much of the thrust of the tax exemption new form of delivery system debate which has concentrated on the amount of free care which hospitals offer would go away because most people would have insurance. We, therefore, indicated that it might be wise to consider something which dealt with prevention, wellness, and promoting health as a measurable charitable mission for not-for-profit hospitals.
We will continue to visit the staffs of the various committees. We need to talk more with the Senate Finance staff, where most of the action is at the moment, and we certainly have to talk with the Waxman Committee staff and some of the other staff in the House of Representatives. In addition, we want to visit with some of the Senators and Representatives on the committees. So the work of getting out these ideas certainly is not yet done.
Nonetheless, it was interesting and I will keep you informed as things go on.