Baucus eyes coverage, self-referral with U.S. healthcare reform plan

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U.S. Senator Max Baucus, D-Mont. Image Source:  

Senate Finance Committee Chairman Max Baucus, D-Mont., released a “Call to Action” plan on Wednesday, detailing his vision for healthcare reform, highlighting access to care, unsustainable costs and a lack of quality assurances that currently plague the U.S. healthcare system.  

Baucus noted that nearly 46 million Americans lack health coverage and another 25 million are underinsured.

He plans to increase access to affordable health coverage by strengthening the current employer-based system and creating a nationwide insurance pool called the Health Insurance Exchange that would act as a marketplace for individuals to purchase coverage. Baucus proposed to improve the value of healthcare by reforming the delivery system to focus on primary care, preventive services and chronic care management. Finally, plan financing will come from targeting fraud and waste, increasing price transparency, reforming medical liability laws and creating tax incentives for coverage, he said.

The chairman’s plan addressed the need for physician payment reform and moving away from the current sustainable growth rate (SGR) formula that determines per procedure reimbursement. In transitioning to a new payment methodology, Baucus acknowledged the possibility of replacing the SGR with a system of multiple expenditure targets for different physician service areas, such as was seen in last year’s House-passed Children’s Health and Medicare Protection Act (CHAMP).

Baucus’ plan also calls for increased scrutiny of self-referral practices, particularly within physician-owned specialty hospitals. He said that lawmakers should look into the cost and quality implications of self referral of diagnostic imaging and encouraged any reform that closely examines the growing costs of advanced imaging utilization and fees. “No serious effort at reform can ignore the potential gaming that financial conflicts may create,” according to the plan.
He encouraged any reform that closely examines the growing costs of advanced imaging utilization and fees.

The American Heart Association (AHA) said that Baucus’ blueprint will “help move the debate forward and ensure that high-quality, affordable healthcare is the ultimate goal for all Americans, including the more than 80 million people who suffer from heart disease, stroke or other form of cardiovascular disease.”   

The AHA also noted that the senator’s plan largely aligns with its broad principles on healthcare reform that emphasize affordable high-quality healthcare focusing on prevention, access and elimination of disparities.