Health Leaders Voice Their Opinions About House Health Reform Bill

HealthLeaders Media Staff, September 16, 2009

The House Democratic Steering and Policy Committee, which includes top leadership shepherding the tri-committee healthcare reform bill (HR 3200) through the House, received feedback on the bill from several provider groups and other healthcare experts during a healthcare reform forum Tuesday on Capitol Hill.

"We have a moral responsibility to pass health insurance reform, and we will do so this year," said House Speaker Nancy Pelosi (D-CA), who opened the forum. "It is a moral imperative: It is a health issue, [and] it is an economic issue."

While Pelosi mentioned her support of including a public insurance option in the healthcare bill, discussion focused on an array of other reform issues—from state insurance exchanges to comparative effectiveness—found in the 1,000-plus paged bill.

J. James Rohack, MD, president of the American Medical Association (AMA), said the AMA supported the insurance market reform provisions in HR 3200, which are related to "guaranteed issue, guaranteed renewability, modified community rating, pre existing condition limitations, nondiscrimination based on health status, adequacy of provider networks, and transparency."

He said the market reforms "should create a more competitive insurance market" in which plans eventually would compete on price and quality. This would allow patients "to gain more control over their choice of health insurance coverage and their own care," he added.

Tom Priselac, president and CEO of Cedars Sinai Health System, Los Angeles, and chairman of the board of trustees of the American Hospital Association (AHA), said the reform bill's proposal linking hospital readmission performance to Medicare payments was "overly aggressive."

As proposed, beginning in fiscal 2012, payments to hospitals, would be reduced for higher than expected 30 day readmission rates for heart attack, heart failure, and pneumonia. However, this payment cut would apply to all Medicare discharges—not just cases involved in a readmission, he said, which would create penalties that could be "significant."

The examination of hospital readmissions data "is relatively new and more work is needed to determine how to effectively reduce inappropriate readmissions," he said. The proposed policy would "financially punish hospitals without attempting to fix other shortcomings of the healthcare system."

He also said AHA "strongly believes" the legislation should include a pilot for accountable care organizations that allows groups of qualifying providers—including hospitals, hospital physician joint ventures, and hospitals employing physicians—to voluntarily form ACOs and share in the cost savings. However, AHA requested that leadership of an ACO should not be limited to physician groups and physician organizational models, as is currently stated in the House bill.

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