Specialists might have to “take a nick” in order to pay primary care physicians more under a new healthcare reform plan unveiled by Sen. Max Baucus (D-Mont.).

by Emily P. Walker, Washington Correspondent, MedPage Today

WASHINGTON, Nov. 12 — Specialists might have to “take a nick” in order to pay primary care physicians more under a sweeping healthcare reform plan unveiled today by Sen. Max Baucus (D-Mont.), chairman of the powerful Senate Finance Committee.

The Baucus white paper, not yet crafted into a bill, pulls largely from the plan of President-elect Barack Obama, but Baucus would mandate that everyone have health insurance. When campaigning, Obama shied away from this politically sensitive issue.

Because the plan is not yet a bill, the Congressional Budget Office has not attached a dollar figure to it.

At a press briefing where he discussed his plan, Baucus also enthusiastically endorsed the concept of a medical home, the concept of all care for a patient being orchestrated by a single clinician, presumably an internist or family physician.

This idea struck a responsive chord at this week’s American Medical Association interim House of Delegates meeting in Orlando, where a medical home model was endorsed. There, primary care physicians called for more pay for the unreimbursed parts of their jobs, and specialists wondered whether that extra slice of the pie would come from them.

It probably would, Baucus said.

The Baucus plan would also reform the sustainable growth rate (SGR) formula. Rather than setting one rate for all, the plan suggests considering a formula that would set different rates for highly reimbursed, fast-growing specialties and those that are not.

The plan also calls for the creation of a Health Insurance Exchange, a nationwide group of private insurance carriers through which any person could buy insurance. Insurers in the exchange would not be allowed to discriminate on the basis of pre-existing conditions.

Under Obama’s plan, all insurers in the exchange would be required to provide plans that are at least as good as those offered to federal employees, but Baucus’ stopped short of such specifics.

The government would provide subsidies for families and small businesses that can’t afford to buy coverage through the exchange.

The thinking, according to Baucus’s policy staffers, is that most people would opt into the exchange, creating jumbo pools of insured people, thereby lowering premiums for everyone.

It will take some time to bring so many people into the exchange, Baucus said. In the meantime, anyone ages 55 to 64 could buy into Medicare and people with disabilities would no longer have to wait two years to be covered under Medicare.

The plan also focuses on defining quality in medicine and would implement an independent “Comparative Effectiveness Institute.” This group would do head-to-head analyses of quality and costs of drugs, devices, and medical procedures. The institute would not offer endorsements of particular interventions, however.

Baucus said his plan would emphasize prevention and give a card to uninsured people that would be good for immunizations and cancer screenings.

Baucus said the plan would cost a significant amount of money during the first five years, but savings gained from improved health, universal coverage and more logical payment schemes would offset costs.

“It’s worth putting money up front to change the system,” Baucus said, adding that even with the current economic crisis, healthcare is a top priority.

“You can’t have economic reform without fixing healthcare,” he said.

A number of members of Congress have talked about major health reform happening in the early days of the next Congress — perhaps even as the very first major item of business.

Sen. Edward Kennedy (D-Mass.) has been hammering down the specifics of a bill he is expected to introduce soon, which is also largely modeled on Obama’s plan.

Baucus said that he and Kennedy do not plan on combining their bills, but said the ailing senator called him and spoke very in “very complimentary” terms about Baucus’s initiative.

“Senator Baucus’s white paper is a major contribution to the debate on health reform,” said Kennedy in a press release. “It provides an important analysis of the urgent need for significant improvements in our healthcare system, and thoughtful recommendations for reform.”

Kennedy said he looks forward to working with Baucus on healthcare reform.

The American Medical Association also lauded Baucus for his plan.

“The forums Chairman Baucus conducted earlier this year with the Finance Committee showed that he and members of the committee are determined to make real progress on health system reform,” said AMA president Nancy Neilson, M.D, a Buffalo, N.Y., internist, in a release.

Baucus has held nine hearings on healthcare reform during the current Congress.

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Published: November 12, 2008

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