- The Washington Times - Tuesday, April 21, 2009

WASHINGTON (AP) - Older Americans could see big changes in Medicare as a result of a health care overhaul, lawmakers and experts said Tuesday as Congress began working on the sweeping legislation.

Medicare should become the test lab for making the entire health care system less wasteful, experts told a receptive Senate Finance Committee. Savings could be used to strengthen Medicare itself, or plowed into covering the uninsured.

Medicare covers some 45 million Americans who are elderly or disabled, and its policies set the tone for many private insurance companies. The new approach for seniors would stress close follow-up care by their family doctors and nurses. That’s aimed at keeping chronically ill patients from having to be hospitalized repeatedly when problems like high blood pressure get out of control.

Doctors and hospitals would also see big changes. Primary care doctors, the generalists who care for patients day in and day out, would be paid more. Specialists, who tend to order more tests and procedures, would face closer scrutiny of their decisions. Hospitals could be penalized if patients don’t get adequate follow-up care and wind up being repeatedly readmitted for the same problems.

Similar changes would be in store for Medicaid, the federal-state partnership that covers some 50 million low-income people.

“Medicare is going to be the driver to achieve quality reforms, in large part because the other players tend to follow Medicare,” said Sen. Max Baucus, D-Mont., the Finance Committee chairman. Baucus aims to have a bill on the Senate floor this summer that would restrain costs and cover the estimated 50 million uninsured.

On Tuesday, his committee began its work by hearing from a round-table of experts and industry representatives how to revamp the health care delivery system. A line of would-be spectators snaked out the door of the Senate Hart office building, and the hundred or so seats reserved for the public were soon taken.

“These round-table discussions will preview many of the policies that the committee will consider,” said Baucus.

The panel will meet next week in closed session to discuss specific options that would become the building blocks for legislation on changes to Medicare and the broader delivery system.

The committee will then turn to the issues of coverage and financing, holding both open discussion sessions and closed decision meetings. Baucus hopes to craft a bill that Republicans as well as Democrats can support, but he faces a challenge because of fundamental disagreements over the role of government, the responsibilities of individuals and employers, and how to pay for the plan.

Medicare will cost taxpayers about $425 billion this year. Program spending, however, is not evenly divided among beneficiaries. Instead, the sickest 10 percent of the patients account for just under two-thirds of the cost. Medicare spends about $9,000 a year on the average beneficiary. But care for the sickest 10 percent averages more than six times as much per person, according to the Kaiser Family Foundation.

Many of the most frail Medicare recipients have several chronic conditions, for example one common combination is high blood pressure, diabetes and heart failure. The patients may be seeing several specialists, and those doctors may not all know what the others are doing.

Dr. Glenn Steele, president of the Geisinger Health System in central Pennsylvania, told the committee that the key is to replace a fragmented health care system with one that stresses coordination among medical professionals and close monitoring of patients. Geisinger has reduced hospitalizations for its patients with several chronic diseases by about 25 percent, and has cut hospital readmissions in half. Steele said he doesn’t see why the rest of the country can’t get similar results, particularly if Medicare sets the pace.

Medicare “needs to be an engine of innovation, not a stultifying bureaucracy,” said Steele.

Mark McClellan, a former Medicare administrator under President George W. Bush, agreed with Steele’s general approach, but said the government must move carefully. “As we make these changes, it’s important to do it in a way that’s not too radical, not too disruptive,” he said.

Sen. Charles Grassley of Iowa, the panel’s senior Republican, asked if a health care overhaul could be financed by paring fat and waste in Medicare and Medicaid. Some estimates say a third or more of program spending goes for services of little or no value. “If we don’t (cut) we really are setting ourselves up to make costs worse, not better,” said Grassley.

But McClellan said more money will be needed, at least in the short term.

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On the Net:

Senate Finance Committee - http://finance.senate.gov/

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