Healthcare Council Policy Review
May Edition 2008
Comprehensive National Agreement in Place to Provide National Performance Standards for Doctors
Health insurers and doctors announced a landmark agreement earlier this month that many health care reform experts argue will go a long way towards transforming the quality of care, as well as the cost of delivering that care. The Consumer-Purchaser Disclosure Project, a coalition of employers, consumers, and labor organizations that have pushed for the implementation of national standards and physician performance reporting, announced the agreement on April 1st that will ultimately be used as the basis for pay-for-performance initiatives and other patient-centered payment reform measures.
The “Patient Charter for Physician Performance Measurement, Reporting and Tiering Programs” represents a set of principles that will guide measurement and reporting to consumers about a physician’s performance. Health plans that adopt the Patient Charter are essentially agreeing to these measurement and reporting standards and to have their consumer reports assessed by an independent review organization. The Disclosure Project touts the Charter as a way to ensure that consumers have the ability to make informed decisions based on both quality and cost. Physicians will also be able to use the information to help guide them in finding ways to improve the delivery of their care.
Some of the nation’s largest health plans, such as WellPoint, UnitedHealth Group, Cigna, and Aetna have already signed onto the agreement. Charter participants will have three months to hire an organization, such as the National Committee for Quality Assurance (NCQA), to audit pay-for-performance and tiering programs to ensure their doctors’ rating systems subscribe to valid measures.
“National Standards to Rank Physicians Planned”
“Uniform Doctor Ratings Sought”
“Insurers Reach Accord on P4P Principles; Standards Still to be Worked Out”
Federally-Sponsored Hospital Rating Report Evaluates Quality of Care, Patient Satisfaction
The U.S. Department of Health and Human Services (DHHS) launched a new website at the end of March that takes stock of national hospital quality of care issues as perceived through the patients’ eyes rather than benchmarks established by medical experts. The new patient satisfaction data is currently collected on a voluntary basis and less than half of U.S. hospitals are currently participating. The feds, however, have plans in place to encourage more hospitals to participate in the future by holding a portion of Medicare payments hostage for those hospitals that continue to refuse participation.
The data is intended to highlight problem areas for hospitals both on a global scale and an individual basis. The data also shows what areas a hospital may be excelling in, such as pain management, cleanliness, staffing issues, and the communication skills of doctors and nurses. For participating Illinois hospitals, as well as for hospitals nationwide, the new data presents both good and bad news. For example, more than half of Illinois patients reported receiving prompt staff assistance and strong pain management, while less than 40 percent of those surveyed were satisfied with the overall levels of hospital cleanliness.
Although still a work in progress, the new survey represents a major step forward in transforming the overall health care industry in the U.S. While the national debate regarding health care reform largely revolves around addressing rising health care costs and the uninsured, addressing efficiency in and effectiveness of the delivery of health care services also represents a major facet in this debate.
“Patients Rate Their Hospital Care”
Proposal Seeks Single-Payer Health Care for Illinoisans
Much of the health care reform buzz in Illinois has surrounded Governor Blagojevich’s Illinois Covered proposal; a costly proposal that seeks to provide health insurance coverage to a large number of Illinoisans. While the Governor’s proposal has failed to get off the ground in either the House or the Senate yet this year, another proposal has emerged in the House that could prove even more aggressive and controversial than Illinois Covered.
The Health Care for All Illinois proposal, sponsored by Democrat Representative Mary Flowers, would carve Illinois out as the new Canada, implementing a single-payer health insurance system that combines current Medicare and Medicaid funds, increases income taxes and imposes a new payroll tax to take health insurance coverage out of the hands of private insurers. Under the proposal, no Illinoisan could be denied coverage due to a pre-existing health condition and for-profit nursing homes and provider groups would become a thing of the past.
While the legislation has its supporters, opposition to the controversial proposal is widespread. The Illinois Chamber, along with physicians and the insurance industry, strongly oppose HB 311 for a variety of reasons. One of the biggest points of opposition to the legislation is the idea that it would place the state in the driver’s seat, which given the current status of the state’s Medicaid system, would almost assuredly prove disastrous for the universal coverage proposal.
The legislation did receive partisan support of the House Health Care Availability and Access Committee, but may prove a tough sell on the House floor. The sponsor has already indicated that she would like the legislation to serve as the centerpiece of statewide hearings on the issue in the future.
“Universal Health Care a Long Shot in Illinois”
“Doctors Support Universal Health Care: Survey”
Illinois Chamber and Healthcare Council Host First Healthcare Reform Legislative Symposium
The Chamber hosted its first Healthcare Reform Legislative Symposium on April 9th in Springfield. The Symposium focused on providing legislators the opportunity to learn from and discuss innovative and successful healthcare reforms that are taking root in other states and nationally in order to offer a new perspective on the healthcare reform dialogue in Illinois. The Chamber is currently working on follow-up legislative hearings that will feature other state speakers.
The event featured the Secretary of the Indiana Family and Social Services, Mitch Roob, who spoke about Indiana’s recent healthcare reform efforts that took effect on January 1st. The Indiana plan provides for coverage expansion by combining the concept of health savings accounts with high-deductible, back-up commercial health plans to provide coverage for approximately 130,000 Hoosiers. The reform is funded by a 44 cent increase in the state’s cigarette tax and has been hailed nationally as an innovative breakthrough in healthcare reform that provides state-funded coverage expansion while acknowledging the critical role of the consumer and the market.
The event also featured Marcia Salkin, Managing Director of Public Policy for the National Association of Realtors. Marcia, NAR, and NFIB recently joined a group of U.S. Senators, including Illinois Senator Dick Durbin, to announce new bipartisan legislation to offer more incentives to small businesses, such as tax credits, to purchase health insurance. The legislation, known as the Small Business Health Options Program (SHOP), also offers greater coverage flexibility and protections to small businesses that offer health insurance. The proposal is the result of a multi-year effort to offer this support to small businesses and the sponsors are optimistic the legislation will win full congressional approval this year.
“Small Business Health Pools Get Another Shot”
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