Senate Finance Committee released last week their first draft of health care delivery system reforms. It’s not the bold agenda they had been ruminating about, but in their comments they allude to many of the payment reform innovations that are necessary to improve patient care and quality and help doctors succeed. Some of the key provisions are:

• SGRrrr reform: Rather than fix the SGR formula, the Committee opts for a two-year patch. This is disturbing, because three years from now, there’s not likely to be a half trillion dollars lying around to fix the rapidly compounding problem. They should find a way to get this nightmare off the table, which we will strongly recommend. Speaker Pelosi, House leaders AND Senate Finance Chair Max Baucus (D-Mont.) do say there is approximately $200 Billion tucked away to significantly wipe out the SGRrr debt. But it’s not apparent in this Senate Finance proposal. AMA and ACC talked this week about working to get the whole thing fixed and behind us.
  
  
• The Finance Committee's proposal provides a 5 percent bonus for primary care doctors, without asking for any particular behavioral response. They also would offer general surgeons a similar bonus if they’re located in to-be-defined surgical shortage areas. CV surgeons are in just as short a supply as general surgeons and should certainly be included. However, if these bonuses are financed by reducing payments to all other doctors as it appears, a lot of tension and infighting is likely among physician specialties. Not good. The ACC wants to help Congress identify new dollars to bolster primary care and increase general reimbursement through reduced readmissions and other efficiencies.
  
  
• Some imaging cuts seem very likely, with good news and bad news. The good news is that appropriate use criteria are referenced in the language as a way to address rising costs; the bad news is that RBMs (radiology benefit managers) are also mentioned.
  
  
• The Finance committee envisions quality of care pilots, “accountable care organizations,” use of registries and clinical decision support tools to improve quality as well as reduce readmission costs, but the details on the innovation recommendations -- including financing -- are not provided.

The Senate Health, Education, Labor and Pensions Committee and the House of Representatives are yet to weigh in. This first view from Senate Finance looks very much like the same concepts we saw in previous years. We will encourage them to be a bit bolder.

*** Sen. Baucus. Image from Wikimedia Commons. ***