Joe, what mechanism is their in the bill to reduce costs? The bill theoretically will reduce payments to physicians under medicare by 25%, but you know damned well that won't happen. The only other cost savings in the bill that I"m aware of is the old "fraud and waste" bullshit. Again, those kind of claims rarely materialize.
http://www.khi.org/news/2009/dec/21/cost-containment-key-feature-reform-bill-expert-sa/
“Really, out of the 2,000 page piece of legislation, 600 (pages) are devoted to insurance expansion but about 900 are devoted to delivery system reform.”
But the proposed changes in how care is delivered and paid for have gotten less media attention than provisions to expand coverage to the tens of millions of uninsured Americans, Barnes said. Also, supporters of the bill have struggled to effectively counter charges leveled early and often by opponents that the measure leaves the important issue of cost containment to another day.
“It’s difficult to explain how we’re going to move away from reimbursing providers based on fee-for-service to value-based purchasing,” Barnes said, referring to proposals that would tie provider payments to quality-of-care measures.
“That’s a pretty wonky concept,” she said. “And yet that’s exactly what the lion’s share of the delivery-system reform is attempting to do, change how we’re paying providers.”
The long list of system-reform and cost-saving provisions in the bill includes:
• A requirement that quality outcome measures be developed for determining how well doctors and hospitals are treating 10 acute and chronic diseases.
• A requirement that the U.S. Department of Health and Human Services develop a strategic framework for collecting and reporting data on provider performance.
• Development of a Web site to allow consumers to compare physicians based on outcomes, patient safety, patient satisfaction and continuity of care.
• Demonstration projects to test whether incentives will help guide Medicare beneficiaries to high-quality providers
• $200 million in grants to small businesses to start and operate wellness programs.
• Incentive payments for doctors who obtain education and training beyond what is required to maintain their board certifications.
• New provisions for testing payment and delivery system innovations developed by the Center for Medicare and Medicaid Innovation.
• A program to encourage hospitals and federal safety-net clinics to form collaborative care networks to provide comprehensive services to low income populations.
Many of the system reforms are pilot projects, but not the kind that most people typically think of, Barnes said.
“These pilot programs have teeth,” she said. “They aren’t just things that will happen as examples across the country and then nothing else will happen. They by and large have the real ability to become the new lay of the land so long as they work.”