Facts & Figures

The Healthcare Quality Coalition (HQC) is a multi-state coalition of health care providers and organizations dedicated to providing cost-efficient, high-quality health care. The HQC has diligently worked this past year with Members of Congress to promote fundamental delivery-system reforms—reforms that address current payment inequities, recognize quality and incentivize value. We believe these fundamental reforms are essential for impacting the delivery of health care into the future. As the Congress nears votes in both the House and the Senate on differing reform approaches, we ask you to keep the following at the forefront of debate:

Support delivery system reforms that promote "value"

The members of the HQC represent world class and nationally renowned healthcare providers throughout the U.S. dedicated to value-based health care – a philosophy and practice of patient care that proves that health care can be measurable and of high quality. In doing so, we can save patients, employers and communities’ precious health care dollars AND improve care. For example, many Coalition members have demonstrated their ability to provide high quality care through measurable and comparison-based projects, such as the Centers for Medicare and Medicaid Services sponsored Physician Group Practice Demonstration and Healthcare Quality Incentive Demonstrations. Other HQC organizations have been recognized for providing high quality care while being responsible fiscal stewards of health care resources.

Unfortunately, the current system does not support this comprehensive approach to care; rather, it supports the delivery of volumes of care over the delivery of value-based care. That is why the HQC strongly urges your efforts to support language contained in both the Senate and House proposal that begin to move the payment system towards high-quality, cost-efficient care. These provisions are:

  • Senate Finance Committee: America’s Health Future Act of 2009
    We urge support and your efforts to maintain language offered by Senator Maria Cantwell (WA) and Senator Amy Klobuchar (MN) that will require a separate payment modifier to the physician payment formula, independent of the Geographic Adjustment Factor. This separate payment modifier will, in a budget neutral manner, pay physicians or groups of physicians differentially based upon the relative quality of care they achieve for Medicare beneficiaries relative to cost. The payment modifier would be implemented beginning in 2013 and shall be applied in a manner that promotes integrated, systems-based care.
  • House Agreement Language
    We urge support and your efforts to maintain language crafted by Representatives Ron Kind (WI), Bruce Braley (IA), Jay Inslee (WA) and Betty McCollum (MN) to analyze and then implement payment adjustments for geographic variations in the delivery and cost of care. Specifically, the language requires the Institute of Medicine (IOM) to study geographic variation, growth in volume and intensity of services in per capita health care spending among Medicare, Medicaid, privately insured and the uninsured. Taking into account these findings, the IOM must then recommend changes to address spending variation in Medicare for items and services under Parts A and B. The IOM is further required to consider whether hospital and physician payments should be modified to incentivize for high-quality care. The IOM is required to consider the adoption of a value index based on a composite of appropriate measures of quality and cost that would adjust provider payments on a regional or provider-level basis.

Support accurate and valid geographic adjustment of Medicare payments

Health care systems that are part of our coalition are among the most cost-efficient in the country in caring for Medicare patients; however, paradoxically, many operate in states with some of the lowest Medicare reimbursement rates. In fact, current geographic disparities are actually greater under Medicare than under commercial insurance. For more information on current geographical disparities, click here.  This disparity flows from the fundamentally flawed Medicare payment methodology and are why the HQC successfully advocated for provisions included in both the Senate and House proposal to begin addressing geographic inadequacies in physician payments.

  • Senate Finance Committee: America’s Health Future Act of 2009
    We urge your support of, and efforts to maintain, language crafted by Senator Charles Grassley (IA) to direct HHS to adjust the Geographic Practice Cost Indexes (GPCI). The amendment requires for 2010 payment adjustment to reflect a blend of 3/4 local and 1/4 national instead of the full difference under current law. For 2011, the adjustment would be a blend of 1/2 local and 1/2 national. The amendment would hold-harmless any areas negatively impacted by the adjustment. The language also directs the Secretary to analyze current methods of establishing practice expense geographic adjustments under the physician fee schedule (PE GPCI) and evaluate data that fairly and reliably establishes distinctions in the costs of operating a medical practice in the different Medicare payment localities.
  • House Agreement Language
    We urge your support of, and efforts to maintain, language crafted by Representatives Ron Kind (WI), Bruce Braley (IA), Jay Inslee (WA) and Betty McCollum (MN) to analyze and make recommendations on the accuracy of geographic adjustments factors in Medicare payments. Specifically, the language requires the Institute of Medicine (IOM) to study the empirical validity, methodology and measurement of such factors, making recommendations to appropriately adjust Medicare payment The language will hold-harmless those negatively impacted until year 2014.

Insurance reform

All the progress being made under points one and two will be undermined if health reform introduces new changes that mimic or replicate the problems encountered with current government-sponsored insurance. HQC advocates for insurance reform that recognizes the efficiencies of commercial market forces and does not expand the current problems health care providers experience with programs like Medicare.

Medicare currently pays less than the cost of providing care. There is a very real concern that if a Medicare-like plan is put in place without substantial changes to the underlying fatally flawed Medicare program there will be a migration of commercially insured to this already inadequate payor. In Wisconsin, if one-third of those who are currently commercially covered were to migrate to a public plan based on Medicare rates, hospitals would lose over $1 BILLION in year one alone. If all commercial physician services were reimbursed at Medicare rates, physician commercial revenue would decline by more than 50%. The end result would be reduced access to care for patients and financial chaos for hospitals and physicians.

Considerable evidence and experience suggest that cooperation across traditional provider groups-physicians hospitals and post-acute facilities, or integrated care models results in high-quality, efficient care, especially when shared accountability for collective performance leads to mutual rewards. The HQC urges you to oppose other approaches that only continue or exacerbate the current problems and, instead, look to health insurance reform that makes quality health care and health insurance affordable and accessible to all through health insurance exchanges or new marketplaces, insurance reforms (ex: guaranteed issue, community rating, and a ban on pre-existing condition exclusions etc), shared responsibilities and the like.

With our cumulative track records of success, the Healthcare Quality Coalition stands ready to assist Congress in addressing these critical issues.

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