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Can Congress Legislate Quality?

Janice Simmons, for HealthLeaders Media, December 10, 2009

If I had a dollar for each time the word "quality" was mentioned during the current healthcare reform debate on Capitol Hill, I might have enough money to fund healthcare reform.

But while quality in healthcare is important, its viability, along with cost containment and value, has been pushed to the background in light of other issues—such as the public insurance option or abortion—until this week.

On Tuesday, 11 freshman senators unveiled a list called their "value and innovation package" that they say takes ideas from the private and public sector to improve quality and value through delivery system reform. They proposed this as an amendment to the current Senate healthcare reform bill now being debated on the Senate floor.

One of the senators, Mark Warner (D-VA), who years earlier founded the company that became cell phone giant Nextel, said in a briefing introducing the proposal that maybe healthcare should take a page from the business community to move quality and innovation issues to another level.

He said the proposed package could do what the iPhone did to the cell phone—take it to a new level with "a whole new series of apps" and then "move us in a direction that is much stronger at making sure we get cost-containment in place."

Among the areas that Warner and his fellow senators are seeking changes are:

  • Expanding the number of health conditions tested under a national Centers for Medicare and Medicaid Services pilot on payment bundling currently proposed in the Senate bill.
  • Giving the Health and Human Services Secretary greater flexibility in administering the proposed Medicare Shared Savings Program, which would reward accountable care organizations that successfully coordinate care to lower costs and improve the quality of care.
  • Promoting pilot testing of pay for performance programs for providers, such as inpatient psychiatric hospitals, long term care hospitals, inpatient rehab facilities, and hospices.
  • Modernizing the computer and data systems of CMS to support improvements in care delivery.

But will this achieve the quality that we need in healthcare? Even the senators admit that more work needs to be done. So where else do we look. Maybe—like Dorothy says in the "Wizard of Oz"—there's no place like home.

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