Options for overhaul of health care studied

WASHINGTON -- Doctors and hospitals would see big changes in how they're paid and what they're expected to do under proposals lawmakers will consider today as they narrow options for health-care legislation.

Senators on the Finance Committee will meet behind closed doors to review policy options aimed at making medical providers more accountable for the quality of care. Right now, providers are mainly paid for the number of services they perform, from office visits to tests and procedures.

Changes are also in the works for private insurance plans that serve seniors on Medicare, as well as nursing homes, home health agencies and other providers.

The policy options -- the first look at what a health-care overhaul would involve -- were released yesterday by Finance Chairman Max Baucus, a Montana Democrat, and Iowa Sen. Charles E. Grassley, the senior Republican on the panel. That's a sign that Democrats and Republicans in the Senate are still working together to craft legislation, though political sparring over health care has gotten louder in recent days.

"The key to health-care reform is delivery system reform -- reimbursing providers on the basis of quality, not volume," Baucus said in a recent session with reporters, adding that he would use the feedback from today's session to write a bill he plans to reveal by early summer.

Baucus wants to use giant federal programs such as Medicare and Medicaid as a testing ground to spur changes throughout the system.

Patients would notice differences as well. People with chronic illnesses would be encouraged to get a "medical home," a single doctor or practice to manage their dealings with the rest of the system. The "home" doctor would do such things as making sure that medications prescribed by different doctors don't have bad interactions, and that patients with chronic illnesses are getting the right kinds of follow-up care.

The U.S. has the world's costliest health-care system, but quality can vary dramatically. Some experts estimate that as much as 30 percent of health-care spending goes for services that are of little or no benefit to patients. It's unclear whether the Finance Committee options -- which tend to rely on carrots, not sticks -- would start saving money immediately.

What it might mean for different groups:

Doctors: Primary-care doctors would get bonus payments of at least 5 percent from Medicare for coordinating care for their patients. But payments to doctors from drug makers, device manufacturers and medical suppliers would have to be publicly disclosed.

Hospitals: A portion of Medicare payments would be based on how well they perform on quality-of-care measures for common conditions such as heart attacks, pneumonia and heart failure, as well as surgical care.

Insurance companies: Private companies now cover about 10 million Medicare beneficiaries, and the program is controversial because the government pays the companies more on average than it costs to care for seniors in traditional Medicare. Senators will look at several ways to change the payment system, including one based on competitive bidding.