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.

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.”

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