Baucus issues U.S. healthcare reform plan; eyes coverage, self-referral, SGR

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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 health reform in the 111th Congress, which highlights 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, according to the American College of Radiology (ACR). 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, said that he will finance his plan by targeting fraud and waste, increasing price transparency, reforming medical liability laws and creating tax incentives for coverage.

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

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), according to the ACR.

Separate expenditure targets for categories of physician services could penalize those services that are growing faster than others, such as imaging, the ACR said. “This has the advantage of reallocating resources from high-growth, potentially overpaid aspects of healthcare to underutilized, potentially more valuable services such as primary care and prevention,” according to the plan. Baucus encouraged any reform that closely examines the growing costs of advanced imaging utilization and fees.

Congress will begin deliberations in late January on an expansion of the State Children’s Health Insurance Program (SCHIP), which expires after March 31, 2009. Some lawmakers are advocating for a nine-month extension of the current SCHIP program to include an expanded children’s health measure into a Medicare reform package later in the year for political reasons, according to the ACR.