Hospital Groups Optimistic About Health Reform : The economy is one reason that health reform may have a greater chance for success in Congress.

Senior editor Joyce Frieden contributed to this report.

Many physician and hospital groups are feeling optimistic about the chances for comprehensive health reform, in response to early signals from the incoming Obama administration.

Laura Allendorf, Washington representative for the Society of Hospital Medicine (SHM), expressed similar sentiments. “Health reform was a top priority for [then-Sen.] Obama during the campaign, and many members of Congress also made health care a key message in their campaigns,” said Laura Allendorf, Washington representative for the Society of Hospital Medicine (SHM). “Consequently, lawmakers are expected to move quickly on a health care bill when the new Congress convenes.”

The economy is one reason that health reform may have a greater chance for success now than it did during the Clinton administration, said Dr. Nancy H. Nielsen, president of the American Medical Association. As more Americans lose their jobs, they are also losing their health insurance, she said, driving policy makers to address the issue of the uninsured. “There may be more tension for change now than there has been in the past,” she said.

Mr. Obama addressed that tension head-on during a press briefing last month to announce former Sen. Tom Daschle (D-S.D.) as his choice for Health and Human Services secretary.

In a move that many agree signals how serious Mr. Obama is about health reform, he tapped Sen. Daschle for not one, but two posts. In addition to serving as HHS secretary, Sen. Daschle is slated to serve as director for a new White House Office on Health Care Reform. Sen. Daschle's HHS position must be confirmed by the Senate; however, the health care czar position does not.

Hospital-related societies also have other legislative priorities for the 2009. For example, the SHM is planning to advocate for changes in Medicare and other payment systems to reward quality and promote better outcomes. “The federal government needs to get better value for the substantial dollars it spends on health care,” Ms. Allendorf said. “SHM will advocate for new reimbursement models that align incentives across providers to improve patient care. We will support [Medicare] demonstrations that test bundling of Part A and B payments for episodes of care, [and] urge Congress to ease legal barriers that hamper the ability of hospitals and physicians to share savings from improved efficiency and quality.”

The SHM also will advocate for improved care coordination, particularly as patients transition from the hospital to the home. The SHM is urging that components of its Project BOOST (Better Outcomes for Older Adults Through Safe Transitions)—a program that uses a team approach to assess patients and develop a plan for safe hospital discharge—be incorporated into congressional health reform plans as a way to improve care transitions and reduce readmission rates, Ms. Allendorf said. Increased funding for comparative effectiveness research is another priority for SHM, she added.

The Federation for American Hospitals has its own health care reform proposal, known as Health Coverage Passport. A health reform white paper written by Sen. Max Baucus (D-Mont.) includes many elements similar to those found in the federation's plan. “Once the new administration comes in, there is going to be a lot of movement” on health reform, said Jeff Cohen, executive vice president for advocacy and political affairs.

The FAH also would like Congress to pass a law barring physicians from referring patients to hospitals in which the physician has a financial interest. The House of Representatives has passed such a ban twice and the Senate has passed it once, but the proposal has yet to become law, Cohen said.

Other legislative priorities for the federation include ensuring that hospitals receive their usual “market basket” payment increase in the Medicare program—based on the price increases for a standard list of goods and services—and pushing for rural hospitals to get their fair share of the “disproportionate share hospital” money that is given to facilities who serve a large number of low-income and uninsured patients.

Meanwhile, the AMA is pushing Congress and the administration to enact permanent Medicare physician payment reform by eliminating the sustainable growth rate formula, which ties physician payments to the gross domestic product. Without congressional action on the payment formula within the next year, physicians will be faced with a projected 21% cut in Medicare payments starting in 2010, Dr. Nielsen said.

If Congress chooses to throw out the SGR formula, legislators likely will need to authorize some fast-track pilot projects to test some of the most promising models for new payment systems such as global and bundled payments, said Robert Doherty, senior vice president of governmental affairs and public policy at the American College of Physicians.