Reporter's Notebook

Wyden Plan May Be Vision For Future Medicare Reforms

By Mary Agnes Carey

January 21st, 2014, 7:56 AM

Key members of both parties and both chambers of Congress stand before the podium to introduce their bipartisan Medicare proposal.  Insurers and health care providers welcome it. Seniors’ groups are on board, too.

Sen. Wyden (Photo by Chip Somodevilla/Getty Images)

If Congress is ever going to overhaul Medicare, it will almost certainly have to happen this way.  Sen. Ron Wyden, the Oregon Democrat widely expected to be the next Senate Finance Committee chairman, last week led a bipartisan group of lawmakers, health care experts and seniors’ advocates backing a plan to better coordinate care given to Medicare beneficiaries.

The proposal is part of the ongoing health policy conversation over shifting Medicare away from paying per service provided to paying for the quality of that care. Sponsors say their measure would modify existing law to make it easier for providers to seek out those patients who have multiple chronic conditions like high blood pressure, high cholesterol, heart disease and diabetes and tailor care to their needs.

Health insurers and providers who want to specialize in chronic care would receive a set amount of money to care for patients and would be responsible for the cost, care and outcomes of their enrolled patients. Doctors and nurses would lead those care teams.

According to the Centers for Medicare and Medicaid Services, 68 percent of Medicare enrollees in 2010 suffered from two or more chronic conditions and accounted for 93 percent of program spending, which was about $487 billion.

Reaching across the aisle on health care is a path Wyden has taken before. In 2009 he co-sponsored health care overhaul legislation with former Sen. Robert Bennett, R-Utah. In 2011 he joined forces with Rep. Paul Ryan, D-Wis. — who later became the GOP vice-presidential nominee in the 2012 presidential race — on a plan to give Medicare beneficiaries more choices for their medical care.  Neither effort prevailed and the partisan battles over the health care law have made bipartisan compromise unlikely on anything — let alone something as politically difficult as overhauling Medicare, a program that now covers 50 million people.

There’s no official “score” yet from the Congressional Budget Office for Wyden’s newest plan, but the bill’s sponsors predict that if it works as envisioned the legislation would reduce federal spending on Medicare by $25 billion annually. That’s barely a dent in the annual Medicare tab but it’s  something all sides could agree on. Republicans and Democrats alike have long sung the praises of coordinated care as a way to reduce costs and improve medical outcomes.

“This is where you have to go if you are serious about Medicare reform,” Wyden said at a news conference where the legislation was unveiled.

Conversations between Wyden and his co-sponsors, fellow Finance member Johnny Isakson, R-Ga., Rep. Peter Welch, D-Vt., and Rep. Erik Paulsen, R-Minn.,  began before President Barack Obama announced his intention to nominate Finance chairman Baucus to be the country’s next ambassador to China.

“Please don’t be confused. We’ve been working on this a long time,” said Isakson. “The coincidence of Max Baucus becoming the ambassador to China and Ron Wyden ascending to the chairmanship of the committee is irrelevant,” said Isakson, who also noted that “it’s fortunate” for the legislation’s prospects that Wyden is poised to chair the Finance panel, which has jurisdiction over Medicare and other health care matters.

It’s unclear what happens next. Elements of the bill may be included in legislation to repeal and replace Medicare’s “sustainable growth rate,” the formula used to pay Medicare physicians.  Maybe the legislation will be attached to another bill or pass on its own. Even if it goes nowhere, it may well be the pathway to Congress finding consensus on Medicare changes in the future.

“We think this kind of approach is looking to really change the tenor of the debate to how do we actually reduce the cost of health care and at the same time provide better quality and better value,” said David Certner, legislative counsel and legislative policy director for government affairs at AARP .

This post was updated to correct the spelling of Rep. Erik Paulsen’s name.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

12 Responses to “Wyden Plan May Be Vision For Future Medicare Reforms”

  1. camaron says:

    I wonder what tea party favorites like Ted Cruz, Mike Lee, Rand Paul and Marco Rubio think about the Wyden Plan? I wonder if these guys are co-sponsors? I wonder if pigs fly?

  2. Mike B. says:

    “Health insurers and providers who want to specialize in chronic care would receive a set amount of money to care for patients and would be responsible for the cost, care and outcomes of their enrolled patients.”

    And when the Federal Government underfunds this program (ie, doesn’t pay the actual costs of caring for these very expensive patients) and the reality that despite ones best efforts “outcomes” are often out of ones control, what then? Who will take care of these patients?

  3. Before you come to any conclusions, read the actual bill. Google “S.1932 – Better Care, Lower Cost Act”

    From the Act: “The qualified BCP (Better Care Program) shall be accountable for the quality, cost, and overall care of enrolled BCP eligible individuals and agree to be at financial risk for that enrolled population.”

    Much of the rest of the legislation involves efforts to define the nature of the Better Care Program provider teams, the patient populations, their risks, and how to establish capitation rates that will reduce spending while increasing quality. Such efforts would be administratively intensive and not very effective.

    Primary care already plays a very important role in providing chronic care. Our efforts would be better directed to reinforcing the primary care infrastructure. Fragmenting Medicare’s risk and shifting it to the providers might be therapeutic for the federal budget, but it places the providers in conflict with their patients over who will come out ahead – the exact opposite of what we want in our health care system.

  4. K says:

    What would “reinforcing the primary care infrastructure” look like? It seems like with delivery system changes and new models of care delivery the concept of “primary care” as its own unique entity is sort of dissolving. There’s sort of a shift now to acheiving the overall wellness of the person on a care continiuum, hence the introduction of entities like ACOs or Patient-centered medical homes, which I think is a fantastic idea. I think care coordination on the whole is how we’re ever going to see significant population health improvement. So I guess my question is, does “primary care” really even have its own infrastructure separate from the infrastructure of a care continiuum comprised of varying types of healthcare providers, and should it really?

  5. Tom says:

    Here’s the bottom line. Doctors and hospitals can’t make huge profits unless their waiting rooms are filled with sick or injured people. Can you spell capitalism? Can you spell supply and demand? Any Republican will tell you, take away demand and you take away profit. So, if Wyden’s plan is to reward providers for wellness, he’ll ruin the profit motive. Any plan that reduces the amount of sick and injured people in waiting rooms is a plan that will ruin healthcare in America because healthcare providers aren’t in this game for altruism. Healthcare providers are in this game to get as wealthy as they can, as quickly as possible. They can’t do that in Canada. They can’t do that in Europe. The only place left in the industrialized world to bilk the healthcare consumer is America. Congress and the healthcare industry made it that way over many decades and they will fight like crazy to protect their niche. If the Wyden’s plan changes that, what reason do doctors or hospitals have to stay in business?

  6. Dave says:

    The old saying that doctors used to live by was “first, do no harm”. That saying is not relevant today. Today, wellness has nothing to do with healthcare. Today, for healthcare providers, it’s about money. Nothing else. The new saying in healthcare is “money talks and BS walks”. Patients with no money have one option if they get sick. Pray…real hard!

  7. Tom says:

    Altruism? In America’s healthcare system? Yeah…right! To borrow a phrase from above, you’ll see altruism in America’s healthcare system when pigs fly!

  8. Mike Ba says:

    Transitioning to a wellness model for which the “better care org” (BCO) gets paid for a population vs. a patient is hard – how do you know that a “well” person is still in your population?

    The transition MUST happen none the less. We need to focus on getting a better system vs. perfect. AND commit to improve the system as we learn of gaps and failures.

    When 1 of 8 of ALL admissions fail medical necessity review by an Independent Review Entity payment for admissions must be replaced.

    Name one other product or service that you would buy if 1 of 8 was a failure?

    There is a difference between a “want” and a “need.” I need glasses, I want laser eye surgery. I need to lose weight by exercising more, I want a pill to do it for me. I need to put ice on my sprained knee and do simple exercises, I want an MRI and physical therapist.

    Look at what happened when all the experts tried to tell the general public when is the best time for mammograms are? I population can be described with “needs” the individual decision maker has “wants.” So let the population pay for the “needs” and the individual pay for the “wants.” Some people won’t have the money for “wants” but they will get what they “need.”

    Lastly, how often do hear the heartbreaking story of “this treatment is the patients only hope…” Hope is not a listed benefit in any health insurance policy. “Hope” care that which is in contradiction to all scientific evidence should be paid/arranged for, etc by some other program/insurance gov’t subsidy/etc than that which pays for wellness – perhaps this could be an expanded role for the education function – Hope care is more closely aligned with experiments that wellness.

  9. brodavefla says:

    “Today, for healthcare providers, it’s about money. Nothing else.” Ridiculous! It depends on the provider. People who work in primary care don’t do it for the big bucks. If you want to improve the healthcare system by rewarding results instead of tasks done, I’m all for that, but don’t say that everyone’s corrupt. It’s untrue, so why say it? Many, many of us in healthcare work for altruistic reasons, but few, few of us can afford to work for free. Do you, Dave & Tom? Yes, as a hospital bedside nurse, I get paid for what I do. I earn it, too, I’ll tell you. The physicians in our multi-disciplinary clinic and hospital system are also on salary, rather than getting paid more–much more, some of them–if they worked for themselves. Healthcare is like the rest of life–nothing changes hands until someone agrees to pay for it.

    Our American healthcare system often produces terrific results on an individualized basis, but spends WAY too much money per patient in total without getting corresponding results such as increased lifespan, lowered infant mortality and so on. I applaud Sen. Wyden and the others for continuing to try to find a way to pay for wellness, not illness.

  10. Patty says:

    Bunk! Nothing but bunk! Providers (hospitals, doctors, medical professionals, medical vocationals, etc.) have had enough time to take control of their industry and stop being pawns of the insurance companies. Where is the AMA? Where is the hospital lobby? Where is the nurses lobby? Where? Why aren’t they calling the shots instead of the insurance companies. If you ask me, healthcare would run very well without insurance companies. Providers have had their chance and they blew it? They gave away the store to the insurance companies. If anything, providers should welcome Obamacare because Obakacare finally begin the reign in the corrupt health insurers. America’s healthcare system is twice as costly as any other nation in the world and yet the results do not come near the results seen in other nations when you consider that America excludes over 50 million citizens for ever seeing a doctor on a regular basis. Yes, it’s true. America has state-of-the-art medical innovation…if you’re wealthy enough to afford it!

  11. K says:

    So this morning the American College of Healthcare Executives put out an article concerning research they’d conducted in 2013 with 1,091 hospital executives, asking them about their top concerns and pressures for the year. Number one is of course, financial challenges. Number two: healthcare reform implementation. Number three: government mandates. The link is here in case no one believes me:
    Concerns about reimbursement from private payers (insurance companies) did not make the list.
    Further, when you look at the breakdown of what constitutes a “financial challenge”, the top 3 concerns are 1: government funding cuts, 2: medicaid reimbursement, 3: medicare reimbursement. Concerns about private payer reimbursement are the 10th item, mentioned by only 35% of hospitals interviewed.
    This research is commensurate with research conducted by the American Hospital Association. I’d wager that most healthcare advocacy groups (AMA, nursing lobbyists, etc.) have conducted similar research within the year.
    What this tells us is that according to our hospitals, doctors, medical professionals, medical vocationals, etc., insurance companies AREN’T the ones calling the shots. They’re NOT the ones creating stress/concern/financial difficulties for our nation’s hospitals. Number one in that arena is government reimbursement decline.
    Providers DON’T welcome Obamacare, they’re worried about it (hence “healthcare reform” and “government mandates” making the list at numbers two and three).
    So Patty, while you might be inclined to think that the government will finally “reign in the corrupt healthcare insurers” with Obamacare, I think the majority of physicians and hospital executives would see things quite differently.
    Why is American healthcare so overpriced, you ask? It’s because when hospitals suffer reimbursement cuts (yes, from both private AND government payers) they’re the ones who have to absorb the cost, and so healthcare prices increase. So I wouldn’t be so quick to exclusively blame commercial providers (since hospitals themselves don’t blame commercial providers).

  12. Walter says:

    In my opinion, so far, nothing this guy above writes makes any sense. I’ve fact checked it. Question: Do you make this stuff up all by yourself or do you have a room filled with tea party morons helping you out? I hope people reading this aren’t taking you seriously. Do you have some political agenda? Or, maybe it’s that you can’t stand the idea that American voters elected a black President…TWICE? Keep posting you mindless drivel because, so far, I can’t stop laughing. You are hilarious! The tea party should be proud having members like you!