AUSTIN — Texas’ government and private health insurance plans need new methods of paying caregivers, Senate Republican leaders said Wednesday.
Doctors and hospitals should not be reimbursed for volume of treatment but for quality and good results for patients, said Lt. Gov. David Dewhurst and Sen. Jane Nelson, R-Flower Mound.
They reintroduced two bills that died in the House two years ago. One would try to bring “outcomes-based payments” to Texas’ main health plans for the poor, Medicaid and the Children’s Texas Health Insurance Program.
The other would let private insurers, major employers and government employees’ insurance plans experiment with new financial approaches such as “accountable care organizations.” That’s an arrangement in which doctors and hospitals share risk for bringing care costs below targeted levels but can share in any savings.
“We shouldn’t be rewarding the greater number of tests and treatments you get with more financial rewards,” said Nelson, chairwoman of the Senate Health and Human Services Committee.
Dewhurst, a Republican who presides over the Senate, said the U.S. stands apart from other developed countries, spending more than 21/2 times what they spend, on average, for health care, “often, with poor medical outcomes.”
Dewhurst faulted the payment structure, not providers.
He said the U.S. “is the only country that pays our doctors and our hospitals almost exclusively on how many procedures are done, vs. paying … to follow best practices … and to keep our people healthy.”
He said the legislation would begin rewarding the state’s health care industry for preventive care and treatments that are coordinated to prevent duplication and waste.
Some of the envisioned patient-care organizations would involve large groups of doctors — both primary care healers and specialists — and hospital networks.
The state’s prohibition of the corporate practice of medicine — in which, essentially, a business manager tells a doctor what to do — is seen by some as an obstacle.
Dewhurst said the legislation doesn’t change the law, nor does it assume Congress would pass changes in antitrust laws to allow providers to negotiate prices with employers and insurers. He said the bills would save the state money immediately, though he said “fiscal notes” detailing savings for 2012-13 haven’t been prepared. When you want to get installment loans fast you could check here.
Dan Stultz, president and CEO of the Texas Hospital Association, said hospitals are wary of the bills’ proposed public reporting of — and Medicaid-fee penalties for — things such as staph infections and patients coming back to the hospital when they shouldn’t have had to. Inner-city safety net hospitals have a riskier pool of patients, he said, and the yardsticks used to decide on penalties have to be fair, he said.
Still, Stultz said he’s encouraged.
“Removing antitrust barriers and creating financial incentives, such as … bundled payments and a reduction of reimbursement for preventable complications … and readmissions will help drive the movement toward higher quality, and over time lead to tangible cost savings,” he said.
Dewhurst said that if Texas’ approach were embraced by other states and eventually by the federal government, there could be “a tsunami” of savings.