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Turns out that within the bill is the key to transforming American medicine, if only we use it for the powers of good. The Center for Medicare and Medicaid Innovation was established to” test innovative payment and service delivery models to reduce program expenditures under the applicable titles while preserving or enhancing the quality of care furnished to individuals under such titles. In selecting such models, the Secretary shall give preference to models that also improve the coordination, quality, and efficiency of health care services furnished to applicable individuals defined in paragraph (4)(A).” In English, to allow innovators to innovate, leading rapidly to better care. As someone who believes that there is a place for government in health care delivery, especially for those who rely on the government, either because of age or disparity, to provide access to quality healthcare. Don Berwick will be all over this. This program is seen as a potential game changer for the following reasons:

  • Because it is set up to run “pilots” instead of “demonstrations” the approval of Congress isn’t necessary for every project and rapid replication is possible for successful pilots
  • 18 possible programs were offered as a choice rather than Congress dictating care based on their collective (or individual) whim
  • Budget neutrality is not required, meaning that you don’t have to predict outcome (or be afraid to attempt it) prior to starting a program
  • Funding ($10,000,000,000) is adequate to try several things at once

Mnay of these ideas have been through small pilot efforts already so it may be that transformation will be on a fast track. The list of projects include:

Being in Family Medicine, I spend a lot of time thinking about the here and now and not random worries about the future. I was glad to see that i09 came up with a list of dystopias now prevented (and one possible new one) yesterday. I have to say I wasn’t too worried about the mutant plague or the creation of a permanent unhealthy underclass but I WAS convinced that spending 50% of all of our American output on healthcare was never a good idea. Regarding the socialist totalitarian state, try listening to the radio between Mobile and Montgomery and you’ll discover that we entered into that in 1910 (dang that Teddy Roosevelt).

The House of Representatives passed the Senate Health bill and then passed a packages of fixes to send back to the Senate. If the Senate does pass the package, the law will look like this. Below are highlights of the new law for Family Medicine:

  • Establish a national Medicare pilot program to develop and evaluate paying a bundled payment for acute, inpatient hospital services, physician services, outpatient hospital services, and post-acute care services for an episode of care that begins three days prior to a hospitalization and spans 30 days following discharge. If the pilot program achieves stated goals of improving or not reducing quality and reducing spending, develop a plan for expanding the pilot program. (Establish pilot program by January 1, 2013; expand program, if appropriate, by January 1, 2016)
  • Create the Independence at Home demonstration program to provide high need Medicare beneficiaries with primary care services in their home and allow participating teams of health professionals
    to share in any savings if they reduce preventable hospitalizations, prevent hospital readmissions, improve health outcomes, improve the efficiency of care, reduce the cost of health care services, and achieve patient satisfaction. (Effective January 1, 2012)
  • Establish a grant program to support the delivery of evidence-based and community based prevention and wellness services aimed at strengthening prevention activities, reducing chronic disease rates and addressing health disparities, especially in rural and frontier areas. (Funds appropriated for five years beginning in FY 2010)
  • Provide states with new options for offering home and community-based services through a Medicaid state plan rather than through a waiver for individuals with incomes up to 300% of the maximum SSI payment and who have a higher level of need and permit states to extend full Medicaid benefits to individual receiving home and community-based services under a state plan. (Effective October 1, 2010
  • Provide a 10% bonus payment to primary care physicians and to general surgeons practicing in health professional shortage areas, from 2011 through 2015; Create new demonstration projects in Medicaid to pay bundled payments for episodes of care that include hospitalizations (effective January 1, 2012 through December 31, 2016); to make global capitated payments to safety net hospital systems (effective fiscal years 2010 through 2012); to allow pediatric medical providers organized as accountable care organizations to share in cost-savings (effective January 1, 2012 through December 31, 2016);and to provide Medicaid payments to institutions of mental disease for adult enrollees who require stabilization of an emergency condition(effective October 1, 2011 through December 31,2015)
  • Establish the Community-based Collaborative Care Network Program to support consortiums of health care providers to coordinate and integrate health care services, for low-income uninsured and underinsured populations.(Funds appropriated for five years beginning in FY 2011)
  • Establish a grant program to support the delivery of evidence-based and community based prevention and wellness services aimed at strengthening prevention activities, reducing chronic disease rates and addressing health disparities, especially in rural and frontier areas. (Funds appropriated for five years beginning in FY 2010)
  • Increase the number of Graduate Medical Education (GME) training positions by redistributing currently unused slots, with priorities given to primary care and general surgery and to states with the lowest resident physician-to-population ratios (effective July 1, 2011
  • Increase flexibility in laws and regulations that govern GME funding to promote training in outpatient settings (effective July 1, 2010); and ensure the availability of residency programs in rural and underserved areas. Establish Teaching Health Centers, defined as community based, ambulatory patient care centers, including federally qualified health centers and other federally-funded health centers that are eligible for Medicare payments for the expenses associated with operating primary care residency programs. (Initial appropriation in fiscal year 2010)
  • Increase workforce supply and support training of health professionals through scholarships and loans; support primary care training and capacity building; provide state grants to providers in medically underserved areas; train and recruit providers to serve in rural areas; establish a public health workforce loan repayment program; provide medical residents with training in preventive medicine and public health; promote training of a diverse workforce; and promote cultural competence training of health care professionals. (Effective dates vary) Support the development of interdisciplinary mental and behavioral health training
  • Support the development of training programs that focus on primary care models such as medical homes, team management of chronic disease, and those that integrate physical and mental health services. (Funds appropriated for five years beginning in fiscal year 2010)

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