Two Approaches to Health Care Spending in NEJM

The debate on health care spending and cost cutting ideas continues in the New England Journal of Medicine (NEJM).  Earlier this month, NEJM published two articles, which discuss two different approaches to addressing the rising cost of health care in America.

The first article, “A Systematic Approach to Containing Health Care Spending,” was authored by 23 health policy experts, including Zeke Emanuel, Donald Berwick, Tom Daschle and Peter Orzag.  The authors put forward several ideas about how they would reduce health care costs over the coming years including, alternatives to fee-for-service Medicare, an expanded use of competitive bidding within the Medicare system, price transparency for health care costs, a greater emphasis on using non-physician providers, and evidence-based clinical practice guidelines reduce the cost of defensive medicine.

The second article, written by Joseph Antos, Mark Pauly, and Gail Wilensky, is called, “Bending the Cost Curve through Market-Based Incentives.” In this article, the authors suggest that insurance subsidies that would enable beneficiaries to purchase their own insurance (one option of which would be traditional Medicare) is the best path forward—allowing for a competitive marketplace with fewer regulatory controls.

So, what do the two sides have in common?  Both articles place blame on the fee-for-service model of Medicare payment suggesting that it leads to waste in the system as providers are encouraged to use more services.  Likewise, both groups of authors suggest some type of bundling for Medicare services and both seem to favor a wider use of competitive bidding across Medicare services.

DBR Hosts Webinar on Value Based Purchasing

Today DBR’s own Julie Scott Allen and Matt Amodeo hosted a  Bloomberg BNA webinar entitled “Beyond ACOs: Value-Based Purchasing and Other Accountable Care Delivery Options.”  This 90-minute webinar featured discussions on:

  • The policy, politics, and economics of value-based purchasing – with a particular emphasis on the payment reform models called for under the Affordable Care Act (ACA);
  • The current political climate including deficit reduction efforts, looming SGR cuts, sequestration, and FY2013 federal budget activities;
  • Supreme Court’s decision on the constitutionality of the ACA and how it will likely affect value-based payment delivery models supported through the ACA;
  • Overview of the current Medicare delivery system reform programs and initiatives including the value-based purchasing program; hospital readmission reduction program; hospital-acquired condition penalty; bundled payment demonstration; bundled payment for care improvement initiative (BPCII); accountable care organizations (ACOs); and
  • Commercial market value-based purchasing models being tested across the country.

Previewing the Supreme Court’s Affordable Care Act Arguments

On March 26, the Supreme Court will start three days of oral argument on the health reform law (Affordable Care Act).  Rather than review all aspects of the health reform law, the Court’s review will focus on four specific questions, all of which have big implications for the millions of issues covered by the law.  The following is a brief review of the four key questions. Continue reading

Registry of Patient Registries Notice

Last week, the Agency for Healthcare Research and Quality released a notice announcing plans to create a “registry of patient registries” (RoPR) – or a centralized clearinghouse – that will be available to the public. The notice states “the purpose of the RoPR is to create a readily available public resource in the model of to share information on existing patient registries to promote collaboration, reduce redundancy, and improve transparency in registry research.” The notice acknowledges the increase in patient registry research and states that the agency has learned from stake holders that the existing site currently does not meet the patient registry research community’s needs. The agency is providing a 60-day comment period and the full notice can be found here. Comments are to be submitted to Doris Lefkowitz, Reports Clearance Officer, AHRQ, by email at:

State of the Union and Health Reform

For some of us in Washington, watching President Obama’s State of the Union Address last night was about waiting to see what he would say about the health care law.  Given the law’s mixed reviews among Americans, it wasn’t too much of a surprise that the entire speech went by with almost no mention of health care.  Obama did make clear he would not go back to a time when insurance companies could cancel an individual’s coverage, but a larger defense of the controversial law was missing.

While this means that health care might not play a huge role in the Obama campaign’s platform for 2012, health reform is by no means a thing of the past.  The coming year promises to be an exciting one for the new law as the Supreme Court examines the constitutionality of the law and implementation of State Health Exchanges gets under way.  Undoubtedly, the law will continue to face a beating from the Republican presidential candidates as they make promises to repeal the law immediately upon taking office.

In the coming months, the talk in Washington will be about what happens if the law is repealed.  How much of the law will actually be thrown out  by the Supreme Court and  if the entire law is thrown out then what happens to the parts that have already been implemented.  It is hard to know the answers to these questions this early in the game, but it will an interesting year trying to figure it all out.