Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types



Newsletter Article


Where the Trigger Proposal May Not Be Off Target

By John Reichard, CQ HealthBeat Editor

February 15, 2008 -- The "trigger" proposal released Friday by the Bush administration fires lots of blanks as far as Democrats are concerned, but one of the three titles—"Principles of Value-Based Health Care"—drew some praise from a key Senate Democrat Friday.

"There is room here to work together," said Finance Committee Chairman Max Baucus, D-Mont. "Value-based purchasing and health information technology are both smart targets for reforms in Medicare right now."

A closer look at the title shows that it contains a number of elements widely favored at least in some form by policy analysts and a significant number of Democrats.

Embodied in Title 1 of the draft bill, the principles in some respects are similar to those advanced by the administration in its "value-based purchasing plan," but also appear to include additional elements and time frames.

The title requires the HHS secretary to develop and implement a system for encouraging nationwide adoption and use of electronic health records, a hallmark of Democratic and Republican overhaul plans. The records must be "interoperable," meaning they must meet common standards allowing different systems to function together efficiently. The system also would have to make personal health records available to Medicare beneficiaries.

The HHS secretary also would have to provide "price and cost information" to Medicare beneficiaries to help them choose not only among health plans, but also among providers and treatment options. The information would have to cover "episodes of care," a more comprehensive way of gauging cost than simply looking at a specific procedure. Costs could be compared for the various treatments and services that go into treating a bout of illness, say all the various services that go into treating a heart attack, for example.

A summary of the title says that it also requires the HHS secretary to "develop a plan for ensuring that by 2013, quality measures are available and reported with respect to at least 50 percent of the care provided under the Medicare program." The secretary would have to design and implement a system in which a portion of Medicare payments vary with the quality and efficiency of care.

"The system would also include incentives for reducing unwarranted geographic variation in quality and efficiency," the summary said. Dartmouth researchers say huge savings can be reaped if those variations are eliminated.

The system also would require the secretary to adopt incentives for Medicare beneficiaries to use more efficient providers and preventive services known to reduce costs, and to assure a transition into Medicare for those who own health savings accounts.

The secretary would be required to "use and release" Medicare data for quality improvement, performance measurement, public reporting, and other purposes relating to treatment.

The secretary would be authorized to implement these systems through regulation, as long as procedures were followed for public notice and comment.

The various requirements could only be adopted in a given year if they generated savings over the five- and 10-year periods that started on January 1 of the year in question. The regulations could not add to costs in the Medicaid and State Children Health Insurance Programs over those same periods.

Finally, the title provides for the public release of physician-specific measurements of quality and efficiency.

Publication Details