Sen. Baucus Predicts CMS Will Need More Funds For Health Care Delivery Demos

CMS will need more money than currently budgeted to implement health care delivery reform, according to Senate Finance Committee Chairman Max Baucus, D-Mont.

"I frankly don't recall the President's budget request for the last year, but they're going to need more resources," Baucus said May 20 at a Capitol Hill event held by Premier Inc. to launch two new Accountable Care Organization collaboratives.

According to Baucus, delivery system reforms such as accountable care organizations (ACOs) are probably the most important part of health care reform, even though they were not discussed much during the debate leading up to health care reform passage.

Baucus predicted that Congress, the administration and health care industry stakeholders would need to work just as hard this year to start implementing health reform as they did last year in working to pass a bill.

"I see the effort on health care reform to be about as great during this next year as it was when we wrote the bill," Baucus said.

At the May 20 event, Premier announced that 19 of its member hospital systems had launched an ACO initiative designed to assume accountability for a defined patient population's health care.

The ultimate goal of ACOs is to better coordinate care among providers while shifting payment models away from traditional fee for service toward reimbursement based on patient outcomes and cost effectiveness.

Health care reform legislation encourages the establishment of ACOs, Baucus noted, adding, "this is another part of our efforts to find which segments of delivery system reform make the most sense."

Premier said it expects some of its 19 participants to be among the early applicants for Medicare ACO contracts once CMS opens an ACO program, as early as 2012, as required by the new health care reform law (Also see "Device Tax Will Present "Manageable" Challenges, Analysts Say" - Medtech Insight, 29 Mar, 2010.).

Baucus suggested that ACO programs and other delivery innovations will present challenges.

Warning: Naysayers Will Try To Derail Innovations

"This will be work," Baucus warned. "We've got to be very thoughtful. There will be lots of skeptics [and] naysayers watching closely, looking for opportunities to dismiss new ideas like ACOs and other innovations."

He urged health care providers participating in the new collaborative to do their best to "get it right the first time."

Legal impediments such as the Stark Law, which could challenge how providers in ACOs share reimbursement payments and accountability for care, may need to be addressed by Congress, Baucus acknowledged.

The senator encouraged stakeholders to "come up with constructive ideas and bring them to us so that when we have these oversight hearings, we can start pressing CMS and others about what changes should be made."

One such opportunity is likely to come next month as Don Berwick, President Obama's nominee to fill the administrator position at CMS, comes before the Senate Finance Committee, Baucus said (Also see "CMS Nominee Berwick Poised To Implement Health Reform, If Confirmed" - Medtech Insight, 26 Apr, 2010.).

Health care reform also calls for a new Innovations Center at CMS, which some have said could make CMS a "really cool" place to work, Baucus said.

"Now that may be an oxymoron, but the goal is to get excitement, new creativity, new ideas, energy," he explained.

"It would be great if we could somehow turn a large part of CMS into that kind of culture," he added.

Baucus said he tends to agree with those who say the health reform law does not do enough to control the rate of growth in health care costs, but he applauded the Premier ACO collaborative, noting that its work could go a long way in reducing unnecessary costs.

-Monica Hogan ([email protected])

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