As healthcare reform, reimbursement reform, and healthcare IT-related legislation moves forward on Capitol Hill, those performing advocacy work in Congress are busy sprinting across the Hill in order to keep up with fast-moving developments. One of those dashing across the Hill daily is Blair Childs, the senior advocacy executive at Washington-based Premier Inc., the nationwide healthcare alliance. Childs took time out recently to update Senior Contributing Editor Mark Hagland on the latest in federal healthcare legislation developments, developments that could have far-reaching implications for healthcare CIOs and their teams.
Mark Hagland: What’s the latest on Capitol Hill? Do you think a comprehensive healthcare reform bill will come out of the House and Senate before the August recess?
Blair Childs: I believe you’ll see a House bill passed before the August recess, but I think it will be a stretch to think the Senate will get theirs done before the recess. The health committee has got theirs done, but the Senate committee still hasn’t marked up their concepts. And they’re reserving the last week of this session to focus on the nomination of Judge Sonia Sotomayor. On the other hand, they are really, really wanting to make this happen before the recess.
There are some variables, though. One is whether Senator [Edward] Kennedy (D-Mass.) will be capable of coming back to support cloture? The majority leadership has got the health of both Senator Kennedy and Senator [Robert C.] Byrd (D-W. Va.) to deal with, though now Sen. Al Franken (D.-Minn.) has been seated. And there are some Republicans with whom Senator Reid has been working. So there’s a possibility they could slam something through with just a few Republicans joining Democrats. Then they could reconcile the Senate bill with a House bill.
MH: What are the chances of that?
BC: The imperative among those working for healthcare reform is to try to get it done this year, because next year—getting something as politically complicated as health care reform in an election year, is very difficult. And they’re saying, if we don’t start off in early September with some serious negotiations between House and Senate bills, we won’t get a final package done in time. So I could see them simply deciding to ram something through in the Senate. So if they don’t get something done before the August recess, they’ll take it up again right after they get back. I still think, though, no matter how you slice it, that you won’t see something done before November or even December.
MH: Will the public health insurance option happen?
BC: It all comes down to the question of whether this will be bipartisan or not. And I think that they would very much like it to be bipartisan, but I think they’re also saying, if this isn’t going to end up being bipartisan, they’re still going to do it. If it ends up being a bipartisan process, I would say the odds for a public plan are 50/50 at best. And of course, there are a lot of different ways a public option could be structured.
MH: Let’s talk about value-based purchasing, quality and safety provisions of healthcare reform and reimbursement reform, all of which could hold major IT implications.
BC: I still believe they’re moving towards value-based purchasing and the creation of voluntary accountable care organizations, with a pilot on bundled payments, as well as the creation of some kind of readmissions policy that will encourage hospital performance, to address readmissions. I think the thing that was significant in the announcement on June 8 by the hospital community is that the announcement talks about some broader ways to bend the curve that don’t end up being driven by payment reform. Because in the Obama budget and in the Senate Finance Committee’s early documents, they were suggesting that they use readmission policy and value-based purchasing to reduce spending. So those approaches weren’t so much focused on changing incentives, but instead as a hammer to reduce spending, to pay for other things. And our point to them has been that that’s sending the wrong message: if you’re really trying to realign incentives, don’t just use the money to pay for other things. So this takes some of the pressure off from use those kinds of mechanisms and tools. But there’s still the clear view that we’ve got to do something about the misalignment of the payment system overall.
MH: What were the key things you put forward?
BC: We talked a lot about what constitutes the definition of hospital-based physicians. There’s the definition in the ARRA-HITECH legislation that talks about hospital-based clinical professionals. We want to make sure it doesn’t exclude physicians employed by hospitals. We also talked about the fact that we thought that the EHR incentives should be based on hospitals’ annual Medicare, Medicaid and total inpatient discharges. There’s been a lot of discussion around the Medicare identifier. There’s been a lot of discussion around quality performance, for example. Now, there are a number of HIT elements in the reform legislation up on the Hill.
BC: Yes. I think a lot of the focus on the quality aspects—there’s a lot of discussion around putting additional funds into the quality reporting side. And clearly, that will have implications. For example, there’s the question of how you measure performance There’s activity around that; that’s a whole area of increased focus.