This Quarter in Health Reform: Winter 2015 Roundup

Greetings, Palliative in Practice readers, from the chilly perimeter of spring. This equinox, we mark our wobbling arc around the sun with the rebirth of old things, like debate about the Sustainable Growth Rate, and a call to repeal the Affordable Care Act.  In this time of uncertainty about the future—the acceleration of global warming, our inevitable enslavement by the machines—we take comfort in these perennials as we do the first chirps of spring.  Let’s take a moment to bask in their warmth, even as we must pull up our collars against a brisk wind of change.

1. Dominating the headlines right now is the familiar clamor about the Sustainable Growth Rate (SGR). The SGR is a long-maligned policy originally passed in 1997, which tethers the growth of Medicare spending per beneficiary to the overall growth of the economy. However, since 2003, Congress has prevented the SGR from taking effect through 17 separate short-term suspensions, each referred to as a “doc-fix.” The latest doc-fix is set to expire on April 1. Thus it is the proper time to conduct ritualistic negotiations about permanent reform before passing a hasty and short-term solution.  But this year, in an act that would amount to nothing short of laziness, Congress may give up this periodic ritual and repeal the SGR once and for all.  The current proposal, introduced in both the House and Senate, makes some interesting changes to the ways providers are paid—notably a consolidation of the current pay-for-performance programs administered by CMS–and would increase premiums for high-income seniors.   The bill was just introduced today and is not likely to pass as-is, but rest assured that if a SGR repeal is passed, I’ll give you the important details next quarter.
2. Though SGR change hangs in the air, at least we can take comfort in yet another proposition to repeal the ACA. The House budget Chair, Tom Price, released a budget proposal this week, persuasively titled “A Balanced Budget for a Stronger America.” The document, filled with cohesive arguments like “bad process creates bad policy which is why we ought to eliminate Washington’s bias towards higher spending while strengthening budget enforcement,” calls for repealing the ACA and “starting over with a patient-centered approach to health care reform.”  Nothing says iterative progress and efficient allocation of resources like “starting over,” so I welcome this proposal with open arms.
3. But hang on to your hats for the next bit of news. In January, CMS stated a goal of having 90% of its traditional Medicare payments made through value-based arrangement by 2018. As a point of reference, right now we are at about 20%. As another point of reference, it is currently 2015. That means 2018 is three years away.  This rapid movement away from traditional fee for service is in alignment with the private sector’s efforts to do the same—a large group of payers and health systems have pledged to move 75% of their collective business into value-based arrangements by 2020. Whatever your opinion of current health policies, this movement toward value-based payment presents a large opportunity to change the way care is delivered. Both payers and providers are trying to discern the best way to improve quality while reducing overall costs, and new care paradigms like palliative care are a tremendously effective way to do this.  Indeed, in the face of new payment models, many collaboratives are being formed to figure out the best way to redesign care processes, and palliative care is playing a large role in their discussions.
4. Next, we turn to the states, where action is swift, and in some cases, promising. To wit, legislation that would establish a state palliative care advisory council is pending in a whopping 16 states. These councils would oversee and encourage state palliative care initiatives. The legislation is spearheaded by the American Cancer Society’s Cancer Action Network, which has made palliative care a priority as it fights for access to the best care possible. It’s still mid-season in most states, so we won’t know which bills will pass for at least a few more months, but the trend toward state initiatives in palliative care is clear.
5. Next, and gaining my last top slot for policy developments this quarter, is a promising law that unanimously passed the Washington State Senate last week and will likely pass the House. This bill, SSB 5165, removes the homebound requirement on home health benefits for those seeking palliative care. We have frequently heard that the homebound requirement is a major barrier for both payers and providers who would like to improve access to palliative care in patients’ homes, so we are encouraged by the potential removal of this barrier, and hope to see similar action in other states.

And finally, a most honorable mention goes to Representative Pat Ownbey of Oklahoma, who sponsored and watched the unanimous passage of a palliative care amendment to the state’s hospice advisory council, for this sound bite about palliative care.  If all legislators had this facility with the definition of palliative care, we’d have a much easier go of trying to make change. Follow the link to watch a great 1.5 minute video.

And that’s it for this quarter, folks.   I’m looking forward to next quarter, when the budget proposal will no doubt have passed both houses swiftly, King v. Burwell will have become moot, and we’ll be limbering up to start all over…