10 Surprising Things In Healthcare Reform (Senate version) Part 1

I promised in an earlier blog to list 10 things in the Senate version of the healthcare reform bill that you might not be aware of. Since it’s New Year’s Eve, technically a holiday, I’m only working at partial speed so you only get a partial list today. More to come over the next few days.

1. Support comparative effectiveness research by establishing a non-profit Patient-Centered Outcomes Research Institute to identify research priorities and conduct research that compares the clinical effectiveness of medical treatments.   

In English: The government will fund research to directly compare treatment A to treatment B to determine which works best and is most cost effective.  

Major weakness: the Senate bill specifically notes that the results of such research “may not be construed” as mandates, guidelines, or recommendations for payment, coverage, or treatment or used to deny coverage.

Huh? What is the point of finding out that treatment A works better than treatment B if you don’t use it to make coverage decisions???

Prediction: Most insurers will use this information to make coverage decisions, much to the chagrin of many pharmaceutical and medical device companies. In the not-too-distant-future, Medicare will join the party. After all, the eventual goal of all this is to improve quality and reduce costs, isn’t it?

2. Award five-year demonstration grants to states to develop, implement, and evaluate alternatives to current tort litigation. Preference will be given to states that have developed alternatives in consultation with relevant stakeholders and that have proposals that are likely to enhance patient safety by reducing medical errors and adverse events and are likely to improve access to liability insurance.

In English: The feds will give money to states to explore ways to get doctors to stop practicing defensive medicine so we can bring down malpractice insurance premiums and reduce litigation. You get more money if your proposal also focuses on ways to reduce medical errors (think: cutting off the wrong leg) and make it easier for docs to get malpractice insurance.

This is really important, because despite improved attention to the problem of medical errors over the past decade, we haven’t made all that much progress. And, as noted in an earlier blog, a huge number of ordered tests are unnecessary.

Prediction: We may finally be on our way to the tort reform we need in the healthcare system.

3. Develop a national quality improvement strategy that includes priorities to improve the delivery of health care services, patient health outcomes, and population health. Create processes for the development of quality measures involving input from multiple stakeholders and for selecting quality measures to be used in reporting to and payment under federal health programs.

In English. We’re going to tackle the quality issues within the healthcare system that Josh referred to in his comment. It is shameful that despite spending more per capita than any other country on healthcare, we are less than average in several key indicators.

4. Establish a grant program to support the delivery of evidence-based and community-based prevention and wellness services aimed at strengthening prevention activities, reducing chronic disease rates and addressing health disparities, especially in rural and frontier areas.

In English. This and other components of the bill, including grants to small businesses that implement wellness programs and a requirement that all chain and fast food restaurants post nutritional information about their menu items, begins to get at another major problem in our country and healthcare system: Lifestyle-related illnesses like diabetes and heart disease, and the lack of incentive for physicians to push prevention.

Prediction: The pendulum is swinging away from self indulgence towards restraint on fiscal terms in this country; maybe we’ll start seeing the same when it comes to our personal health.

Tomorrow: Six More Surprising Components of Healthcare Reform

5 Responses to “10 Surprising Things In Healthcare Reform (Senate version) Part 1”

  1. josh Harrison

    Saw this link today at Politico. A reporter there got ahold of a useful working document comparing the house and senate bills. The grid lays out the differences and similarities in as clear a manner as I've seen.



    Josh Harrison

  2. Deb Gordon

    Hi, Michael. .

    I totally agree with you re: the mammogram issue; see my earlier blog on this topic. Unfortunately, science seems to go by the wayside way too often when it comes to determining what should and shouldn't be covered. One interesting thing in the Senate bill is this: “Improve prevention by covering only proven preventive services
    and eliminating cost-sharing for preventive services in Medicare and Medicaid.

    RE: tort reform: I have a feeling that the final bill will weigh more on the Senate side and, if it does not, that other efforts to pursue tort reform will emerge given how significant the issue is when it comes to controlling healthcare costs. I think we're at a tipping point in this regard.


  3. Michael Kirsch, M.D.

    I think we all witnessed with the mammogram debacle how difficult it will be to implement results of comparative effectiveness research. With regard to your plan for demonstration projects for medical malpractice reform, the House bill offers such grants. Except Pelosis stipulated that any state that receives a grant cannot pursue caps on non-economic damages or address attorneys' fees. You call that tort reform. http://www.MDWhistleblower.blogspot.com

  4. Deb Gordon

    Hi, Lori. . thanks for posting. First, the comparative effectiveness institute will be government run; it will fund comparative studies since these are rarely funded by industry (would you want to fund a study that might show your drug is not as good as a competitor's?) So no one has to “join” it. I agree with you that we need more federal funding for research–in lots of areas.

    As for your other point about prevention and Healthy People, I think the big difference here is that there is money that will go to specific community based programs. I also wouldn't call Healthy People 2010 a failure; there were some successes.

  5. Lori

    Thanks for posting details. A friend who is chief of staff for a Congressman told us over the holidays that there were in fact some good proposals in the bills, even if overall we fall short of true health care reform. I'm still trying to get over my disappointment that this is the best we can do, but I'm trying to find the silver linings anyway.

    As to issue #1 (comparative effectiveness), I'll be anxious to see how it pans out. Who will be members of this Institute? How much influence will various medical industries have in the design and conduct of these studies? In my oncology world, we have a number of independent, federally funded cooperative groups that currently design clinical trials based on research priorities, and in recent years, their budgets have been dramatically cut, to the point that entire tumor types have been cut from their programs. How will this new institute be different than what we already do in our cooperative groups? Perhaps we actually need to adequately fund our current research consortia instead of creating new ones.

    I'm also skeptical on issue #3. We have had national quality improvement initiatives in the US for decades. Heck, I remember learning about Healthy People 2000 in public health school in the early 1990s! We still haven't met many of the goals in that program. How will this new initiative differ from Healthy People 2010, the current iteration of the program? Are we again creating redundancy? This new program may go deeper, looking at health care delivery and reimbursement, but given our track record with national health quality improvement programs, I can't help but be skeptical that this is going to achieve its intended ends.

    I look forward to the next 6 items. Happy New Year!


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