Senators try for bipartisanship on Medicare reforms

The Senate Finance Committee is trying to do something a bit rare in an election year: legislate in a bipartisan way on a wonky but important issue.

The project is to improve the way Medicare covers people with chronic conditions, such as diabetes and Alzheimer’s, so as to improve the coordination of care and bring about healthier outcomes at lower cost.

At a hearing last month on failures of nonprofit “co-op” health insurers set up under ObamaCare, which featured some of the predictable partisan battles, Sen. Ron Wyden (Ore.), the top Democrat on the committee, pointed to the chronic care project as a hopeful sign of things to come, working with the chairman, Sen. Orrin Hatch (R-Utah).

{mosads}“If I had a nickel for every time I heard somebody on cable news say you can’t do anything big in an election year, you could take care of your kids’ education,” Wyden said.

“I don’t buy that,” he added. “I know [Hatch] very much wants this committee to work in a bipartisan way. That’s what we’re doing with respect to the chronic disease issue. I have to think both political parties missed that during the Affordable Care Act debate.”

The potential bipartisan action is all the more remarkable given that some of the proposed initiatives involve improvements or expansions of programs created by the Affordable Care Act (ACA), usually the opposite of an area for bipartisan legislating.

Perhaps working in the committee’s favor is that it is dealing with little-known parts of the Affordable Care Act dealing with reforming Medicare’s payment system to reward quality health outcomes rather than simply the number of health services provided. Those programs have been much less controversial than aspects of the health law like the individual mandate.

Sen. Johnny Isakson (R-Ga.), one of the leaders of the chronic care effort, said the fact that some of the proposals deal with Affordable Care Act initiatives “hasn’t had any impact so far. I don’t see why it would.”

The Finance Committee’s working group in December released a document with a range of options to consider for making Medicare’s coverage of chronic conditions smarter.  

One proposal would expand the ACA’s “Independence at Home” pilot project, where Medicare gives financial incentives to teams of doctors to provide coordinated care for a patient at home, with the intention of saving money while improving care.

Other ideas seek to improve ObamaCare’s Accountable Care Organizations (ACOs), which are groups of doctors that come together to coordinate care and get financially rewarded through Medicare if they lower costs while hitting quality benchmarks.

Another set of proposals would encourage the use of telehealth—using technology to provide care remotely.

“We know that better care coordination provides better quality care at a less costly price,” said Sen. Mark Warner (D-Va.), who is leading the effort along with Isakson, Wyden and Hatch.

The goal is to “bring Medicare into the 21st century,” he said.

Still, there is more work to be done. The committee will be reviewing hundreds of comments from stakeholders and industry in working to turn the list of ideas into an actual legislative document.

Changes to Medicare’s payment system can have high stakes for industry. Comments from the Federation of American Hospitals, for example, stressed that payments need to be high enough to cover the cost of transitioning to new systems of care.

The American Health Care Association, the nursing home trade group, commented that it is “concerned about the number and pace of changes” in payment system innovations.

Hatch has made clear that the bill cannot add to the deficit, so working with the Congressional Budget Office to make sure the programs that save money outweigh those that cost money is an important step.

“Finding real solutions to something as complex and important as chronic care is a challenging task,” Hatch said when the committee’s options document was released in December. “[W]hile there are no easy answers, I remain committed to finding budget neutral solutions that will provide better care for patients.”

This article is a part of the From Volume to Value series sponsored by Astellas. To read more articles in the series, click here.