WASHINGTON – Congress is looking for a new way to pay doctors under Medicare, and it may find the solution, in part, in Buffalo.
That’s the message Dr. Thomas Foels, chief medical officer of Independent Health, brought Wednesday to a House subcommittee.
“We believe there are valuable components of our quality, efficiency and effectiveness programs that are potentially scalable and transferable to communities beyond our own,” Foels told the House Energy and Commerce Committee’s Health subcommittee. “In addition, we have identified a set of critical success factors based upon our experiences that we also believe will help guide innovation on a national level.”
Congress could use the guidance. House lawmakers from both parties are working together to come up with ways to move Medicare, the nation’s largest health care provider, away from the costly fee-for-service model of paying physicians toward a less-costly system that rewards them for the quality of care they provide.
In doing so, House lawmakers have unveiled an outline that would eliminate Medicare’s current “Sustainable Growth Rate” formula for limiting Medicare expenditures, which annually threatens physicians with lower payments, invariably prompting Congress to pass a “doc fix” that obliterates the savings the formula was trying to attain in the first place.
“From the beginning of this process, there has been one clear goal: to remove the annual threat of looming provider cuts by permanently repealing the flawed SGR and replacing it with a system that incentivizes quality care, not simply volume of services,” said Rep. Joe Pitts, the Pennsylvania Republican who heads the health subcommittee.
That’s exactly what Independent Health has been working to do since 2000, Foels told the subcommittee.
He outlined a series of pilot projects that have, over the years, transitioned Independent Health’s payment system for some health services from the fee-for-service model to one in which doctors are rewarded for better medical outcomes.
That approach has paid off in more-efficient health care, Foels told the subcommittee. Since the 2009 creation of a “patient-centered medical home” initiative, in which patients are treated by teams of physicians who coordinate their care, the cost of care for patients under that model has fallen 3.4 percent compared with industry averages.
Independent Health “has helped pioneer efforts in quality improvement, primary-care redesign and implementation of alternative payment systems,” Foels told the subcommittee.
Those efforts prompted the Alliance of Community Health Plans to suggest that Independent Health provide testimony at Wednesday’s hearing, Foels said.
Members of the subommittee “were extremely interested in what we were doing,” he added after the hearing.