In this New England Journal of Medicine perspective, Meredith B. Rosenthal writes about the prospect of achieving compromise in payment reform:

Which recipe will yield the best balance of meaningful incentives for cost control and quality improvement, risk protection for providers, and selection incentives remains to be seen. The prospects for payment reform, however, hinge more on politics than on economics. Given that the two major goals of reform are to constrain spending growth and to move money from more intensive to less intensive settings — from doctors who carry endoscopes and scalpels to primary care physicians, for example — there will be substantial resistance to even the best-designed plans.

How should Congress address issues of competing interests in payment reform?  Could doctors come to an agreement or a compromise with our own community?  What would help facilitate that?

The Los Angeles Times reports on the payment reform proposal released by Senators Baucus and Grassley of the Senate Finance Committee:

Pushing to change how medicine is paid for as part of a sweeping overhaul of the nation’s healthcare system, two leading senators offered a plan Tuesday to pay more to hospitals and doctors who meet federal quality standards and penalize those who do not. . . .

In addition to promoting quality standards, Baucus and Grassley have proposed pay incentives to encourage primary-care physicians to manage a Medicare patient’s dealings with multiple providers.

And their memo suggests that the amount private insurers receive from the federal government for offering Medicare coverage to seniors could be linked to some quality measure.

How should payment be linked to quality of care?   How can we shift from a volume-based payment system to an outcomes-based system?   Is that the best way to incentivize high-quality care?

In this New York Times article, “Hospitals Pay for Reducing Costly Readmissions,” from May 8, 2009, Reed Abelson explores the paradox that hospitals with fewer readmissions lose revenue doing so:

But even when hospitals find ways to greatly reduce the return trips, saving money for Medicare and other insurers, their efforts go unrewarded. In fact, because insurers typically pay hospitals to treat patients — not to keep them away by keeping them healthy — hospitals can actually lose money by providing better care. Empty beds mean lost revenue.

The article continues on to say that the Senate is looking at ways to address this problem. Should hospitals receive payment that bundles payment for follow up care?  What is the best way to realign payment and incentives for hospitals?

Healthcare Professionals for Health Reform has proposed an alternate plan for reform called EMBRACE in the Annals of Internal Medicine:

The group proposes a tiered plan, the core of which (Tier 1) would be lifetime, basic, publicly funded coverage for the entire population on the basis of the best evidence about which therapies are considered life saving, life-sustaining, or preventive. Optional coverage (Tier 2) would be funded by private insurance and cover all therapies considered to help with quality of life and functional impairment. Items considered to be luxury or cosmetic (Tier 3) would generally not be covered, as is the case under the current system.

Should Congress consider EMBRACE as an alternative to the plans currently being discussed?  How would a tiered system compare with the current system and with the reform being discussed in Congress?

An editorial in the Philadelphia Inquirer asserts that public plan is the best option for controlling costs and increasing coverage:

The most assured means of tamping down costs while providing greater access to health coverage could be through the government-run health plan that Obama proposes as a new option.

Private insurers so far oppose that idea, but congressional proposals being developed would level the playing field between the public and private health plans. That’s a good approach.

Is a public plan option the best way to control cost and increase access?

In a Wall Street Journal op-ed, the CEO of Eli Lilly argues against the public insurance option:

On the contrary, without new, more effective medicines — along with new devices and diagnostic tools, and better treatments and surgical techniques — it will be impossible for larger numbers of Americans to obtain better health care at a manageable cost. So it is vital to all of us that we insist that reform proposals pass the “innovation test.” Providing insurance to millions of Americans through a government-run plan would fail the test.

Does increasing access to health insurance via a public plan hamper medical innovation??

The Boston Globe reports on concessions by the insurance industry in response to the threat of a public plan:

The health insurance industry offered yesterday to end its practice of charging higher premiums to women if all Americans are required to get coverage, its latest concession as it tries to head off creation of a government insurance plan that would directly compete with private insurers.  Last year, insurers offered to end the practice of denying coverage to sick people, and earlier this year they went still farther by offering to stop charging sick people more.

Are these insurance company offers enough?

A New York Times editorial counters the argument that a public plan would overtake private industry:

Innovative, nimble private plans with well-integrated service systems might outperform any government plan, just as some now outperform Medicare through better coordination of services, stronger preventive care and broader benefits.

A new public plan is neither the cornerstone of health care reform nor the death knell of private insurance. It should be tried as one element of comprehensive reform. If, over time, a vast majority decides the government plan is superior, so be it.

Can public and private insurance compete on a level playing field?  Should they?

This Kaiser Family Foundation article reports on defining “meaningful use” of health IT:

HHS soon will issue guidance and specifications on the definition of “meaningful use” of health information technology, National Coordinator for Health IT David Blumenthal said on Friday, CongressDaily reports (Noyes, CongressDaily, 5/8).  “Meaningful use is very much on our mind,” he said, adding, “We hope to provide a direction and some specifications in the late spring, early summer” (Goldstein, “Health Blog,” Wall Street Journal, 5/8).

What do you think is meaningful use of health IT (something that doctors and hospitals should get incentive payments for)?  How should that be decided?

In this Health Affairs perspective, Michael D. Greenberg, M. Susan Ridgely and Richard J. Hillestad examine patient privacy issues in the context of the Nationwide Health Information Network:

In 2009, privacy continues to be a major driver of health care policy, in the shadow of the emerging national network. We suggest that the current framework of privacy laws is fundamentally ill-suited for regulating a transformed health care system, in which computer networks begin to supersede conventional communications.

How do we balance the push toward an interoperable, accessible health IT system with the protection of patient privacy?  Who should have primary responsibility for protecting patient information?

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