WASHINGTON – Legislation to improve health care for seniors with multiple chronic illnesses by providing financial incentives to doctors to coordinate care of the illnesses was introduced by a bipartisan group of lawmakers Wednesday.
Sponsored by Sens. Ron Wyden, D-Ore., and Johnny Isakson, R-Ga., and Reps. Peter Welch, D-Vt., and Erik Paulsen, R-Minn., the legislation would replace the current system of “accountable care organizations” created under President Barack Obama’s Affordable Care Act with a program to facilitate more coordination between different physicians working with the same patient.
According to the sponsors, the bill would make it easier for seniors to see primary care physicians who would oversee patients’ overall health, as opposed to seeing just separate specialists to manage their multiple chronic conditions.
“The reason for our legislation is there shouldn’t be as many barriers when seniors and providers arrive at the gates of Medicare,” Wyden said. “This is what we need to do to change the debate here in Washington about Medicare.”
According to the Centers for Medicare and Medicaid Services, 68 percent of those on Medicare suffer from more than one chronic illness, such as diabetes, cancer or heart disease. The legislation’s Better Care Program would allow doctors to specifically seek out and specialize in working with chronically ill patients, a practice currently forbidden.
“This specifically incentivizes people to go to look for patients who have multiple chronic conditions,” said Andrew Racine, a professor at the Albert Einstein College of Medicine and a doctor at Children’s Hospital at Montefiore in New York.
The program would also pay doctors in the program a set amount per patient based on an overall expected cost rather than paying per service.
“Under a Better Care Plan, the idea would be that you might need a range of services to keep you as healthy as possible, but it wouldn’t matter how many times you went [to the doctor],” said Ken Willis, Wyden’s press secretary. “The payment would be based on a comparison to the expected cost, and it would just be a single payment, whether you went one time or 25 times.”
Joseph Antos, a scholar in health care and retirement policy for the American Enterprise Institute, a conservative think tank, said in a telephone interview that although the plan might sound good, “talk is cheap.”
“One of the really complicated things here is to determine what are they really paying for. The hard part is identifying what are the services that you expect patients to need, given that they have a wide range of severities,” Antos said. “I respect Ron Wyden. I think his intentions are good. But I have to wonder how much technical advice he got on this one.”
Seniors suffering from multiple chronic conditions account for 93 percent of Medicare spending, according to the CMS. The sponsors say the bill would save billions of dollars by allowing more effective preventive care.
Wyden, currently chairman of the Energy and Natural Resources Committee, is expected to become chairman of the Finance Committee when Sen. Max Baucus, D-Mont., resigns to become ambassador to China.
“We have been working on this for a long time,” Isakson said. “The coincidence of Max Baucus becoming the ambassador to China and Ron Wyden ascending to the chairmanship of the committee is irrelevant to this bill — it’s fortunate.”
