Lawmakers praise healthcare group for delivering quality, not quantity care

Democratic and Republican lawmakers praised one of the
biggest healthcare groups in the nation for delivering on a key promise of the
new healthcare reform legislation: rewarding quality rather than quantity of
care.

Senate Finance Chairman Max Baucus (D-Mont.) and Reps. Earl
Pomeroy (D-N.D.) and Charles Boustany (R-La.) on Thursday applauded Premier
Healthcare Alliance’s launch of two collaborative efforts covering 1.2 million
patients in almost 60 hospitals.

{mosads}The lawmakers vowed that Congress would do its part to
address the antitrust issues and other glitches that will inevitably come up as
the hospital group moves forward with its proposal.

“We have what we have and we have to work through it,” said
Boustany, a retired heart surgeon who’s the ranking Republican on the Ways and
Means Oversight panel.

Blair Childs, senior vice president of Public Affairs for
Premier, said the alliance would come back to lawmakers and regulators with
their requests as they run into problems.

“The legal issues are huge,” Childs told The Hill.

“We don’t have a specific agenda at this time,” he said.
“But absolutely we will. We will through real-live experience see what we can
do now versus what we will not be able to do. And believe me we’ll be coming
back.”

A key provision is the new law is its support for
Accountable Care Organizations (ACOs), the types of collaborations Premier is
launching. These are basically groups of providers – hospitals and doctors, for
example – getting together and accepting joint responsibility for a patient’s
care.

The idea is to move away from the inefficient and costly
“silo” approach in which patients go through the hands of different specialists
who sometimes don’t communicate.

But the new approach faces many hurdles, from cultural
barriers (independent-minded doctors who don’t want to be employees of a big
hospital group) to payment issues (who gets to divvy up the remuneration for a
patient’s care?) to state and federal antitrust and anti-kickback laws (which
ban doctors from accepting pay for generating Medicare business, among other
things).

“No one wants to be the test case in court,” Boustany said.

Despite the slew of obstacles, Pomeroy, a former insurance
commissioner, sounded hopeful.

“If an activity is authorized in statute and regulated,
there can be antitrust exemptions for something that otherwise would come under
certain anti-trust acts,” he said.

“Without question, the congressional intent is very clear in
the bill: We want greater collaboration and reimbursement innovations along the
lines of Accountable Care Organizations. If that can’t be achieved in the
anti-trust context, then we need to ensure that it can be. I think you could
argue that the bill already takes care of that problem.”

But all three lawmakers acknowledged the work that still
needs to be done to truly transform the nation’s health care system.

“I see the effort on healthcare reform to be about as great
during this next year or two as it was when we wrote the bill,” Baucus said.
“This will require that much focus and attention on the part of Congress and
the administration … and others who are involved in healthcare reform.”