President Barack Obama held a press conference Wednesday outlining his plans on health care reform that has stalled in Congress.  As was predicted, the president asked Congress to schedule a final “up-or-down” vote on health care reform legislation and took it a step further by adding his endorsement of using the budget reconciliation process to finish the process.

“I believe the United States Congress owes the American people a final vote on health care reform,” Obama said.  He continued by mentioning a myriad of other bills that were passed with a simple majority rather than the currently required “super-majority” of 60 votes needed in the Senate to pass legislation.

The Democrats held onto a 60 vote majority until the election of Republican Scott Brown in Massachusetts.

Republican lawmakers insist that using the reconciliation procedure would cause outrage in the public and further the intense partisan gridlock facing the Congress.  Regardless, Obama requested that Congress take action in the next few weeks.  The president also highlighted the Republican ideas that he has agreed to include in his proposal and again told Republicans that starting over is not an option.

IHA will continue to monitor the process along with the new budget numbers and coverage estimates that result from the president’s new proposal.

The editorial page of the Boston Globe provides a brief item on the importance of evidence-based medicine with regard to reducing costs and improving health care.  The editorial points to two examples: A 2007 study that showed that drugs work just as well as stents in treating chest pain and a 2002 study that showed generic drugs work just as well as name brands. 

The central point of the editorial is that neither of these cost-saving approaches has been as widely adopted as one might expect.  Why?  Because the insurance companies – both public and private – have provided few, if any, incentives to adopt them. 

This is yet another illustration of how health care spending is being driven by something other than value.  Instead, it is driven by a system that rewards quantity – a physician who does more testing and procedures will be paid, even if those tests were not the best or possibly even unnecessary. 

The Globe emphasizes evidence-based best practices and notes that “Medicare should have the authority to weigh both comparative effectiveness and cost in steering doctors to the best practices.”  In other words, Effectiveness + Cost = Value. 

In Iowa, we are fortunate to have a health care system that, particularly in the community hospital setting, is dominated by a culture of patient-centered primary care.  This means care tends to be provided in a coordinated fashion with the primary care physician at its foundation.  Patient-centered primary care works when best practices are emphasized.  And when that happens, real value in health care is the result.  

This is why Medicare would save billions of dollars every year if it demanded, as the Globe editorial suggests, the same value from others that Iowa already provides.

President Obama has called for a bipartisan health care reform summit to be held on February 25.  The meeting is expected to bring together members from both parties to discuss action moving forward.

Speaking on behalf of the administration this week, Secretary of Health and Human Services Kathleen Sebelius held a press conference to discuss health care reform and told reporters that that President Obama is willing to “add various elements” to health care legislation suggested by Republican lawmakers during the proposed summit.   But she said he won’t change the entire plan and he is “absolutely not” hitting the reset button on the legislative process.

Obama’s refusal to start at square one has upset several Republicans, who have started to question whether or not they will attend the summit, unless the option to start over is on the table.  Obama has hinted that he may be open to rebooting the process, but doesn’t want Congress wasting another year of partisan tactics and bickering only to end up in the same place.

Sebelius said that the president views the bipartisan meeting as a needed pivot to move reform forward.  Asked if the president will expedite the legislative process following his various sit-downs with congressional Republicans, she replied “I certainly think so.  I think he sees this as a step to actually accelerating the process forward.  He wants to move forward.  He wants a bill at his desk and he sees this as kind of closing the loop and let’s go.”

Meanwhile, in Congress, with nearly all of Washington D.C. “closed” because of back-to-back blizzards, relatively little, if any, progress has been made on health care reform in the past few weeks.  House lawmakers leaving a Democratic Caucus meeting last week said they’re waiting for signals from the Senate on health reform before deciding on a strategy, even as they prepare for stand-alone votes on one or more small-scale provisions.  They said they’re taking time off from health care reform discussions to reconnect with the public and find out what measures can pass the House and Senate.

Senate Finance Committee Chair Max Baucus (D-MT) told reporters following a budget hearing that it will be more clear “in the next couple days” on whether health reform could move through reconciliation.

Speaker of the House Nancy Pelosi (D-CA) announced that she wants to move forward with smaller, more manageable portions of health care reform next week with a repeal of anti-trust exemption for health insurers.  Other possible carve-out bills include the medical loss ratio, banning health plan rescissions and other smaller provisions that can’t be tackled through the complicated reconciliation process, and have enough support to pass.

Congress is scheduled for a week-long recess beginning February 12.

Big-city hospitals are once again trying to defend their big-spending ways.  The CEO of New York-Presbyterian Hospital authored a column that appears in this week’s issue of Modern Healthcare.  Facing a federal health care reform package that, at its foundation, recognizes and rewards value in health care, the CEO once again tries to cloud the picture of just what makes up quality, efficiency and value. 

He immediately trots out the tired old arguments about how the high cost of living and large number of impoverished patients drive up health care costs in certain places.  He doesn’t say exactly where those places are, so I’ll assume he means very large cities, like Manhattan, where his hospital is located. 

The problem with this argument is that there are other, similarly high-cost and high-poverty urban areas where health care costs are notably lower.  For example, according to the Dartmouth Atlas of Health Care, which has studied geographic variation in health care costs – specifically in the Medicare program – for decades, hospitals in Manhattan spend an average of $81,143 on each Medicare patient during the last two years of life (at Presbyterian, it’s $91,113).  In Los Angeles, the cost is $77,411.  In Chicago, it’s $62,565.  In Boston, it’s $57,057.  (In Iowa, it’s $33,864.) 

But it’s not just about how much it costs to provide health care, it’s also about how much health care is provided and whether or not it’s necessary.  The first part is about intensity, and one measure of intensity is the number of days a patient spends in the hospital.  In Manhattan, the typical Medicare patient spends nearly 35 days in the hospital during the last two years of life.  In Los Angeles, it’s 28 days.  In Chicago, it’s 26 days.  In Boston, it’s 21 days. (In Iowa, it’s about 16 days.) 

But doesn’t more time in the hospital – more health care – mean healthier patients?  The studies say no. 

Rather than making excuses about high-cost health care, hospital leaders should follow Iowa’s example by learning what creates high-value health care and then implementing it.  And Medicare should recognize and reward that value.

Senators voted first thing this morning to pass their health care reform bill.  The final vote was originally scheduled for this evening, but Republicans and Democrats struck a deal in which Republicans agreed to end their filibuster to allow the earlier vote.  This morning’s vote was the last in a string of procedural votes that have taken place every day since Monday’s 1 a.m. cloture vote, which ended debate on the bill. 

The Senate reform legislation, estimated to cost $871 billion, would extend coverage to 94 percent of legal residents who are currently uninsured – about 31 million people – by 2019.  The legislation also includes language supported by IHA related to value-based purchasing for hospitals, a low-volume adjustment for rural hospitals and expansion of the 340B program. 

Now that the Senate and House have passed their versions of health care reform legislation (the House bill passed in October), the next step is a conference committee, in which Senate and House leaders will hash out differences between the two bills and eventually merge them into one document that then must pass both chambers.  The conference committee’s timeline remains unclear, as Senator Max Baucus (D-MT) has reportedly stated that preconference negotiations will begin as the Senate passes its bill and will continue over the holidays. 

The goal is to deliver a bill to President Obama before his State of the Union address at the end of January.  But with the House scheduled to be out of session until January 12 and the Senate until January 19, White House officials have reported that they do not expect a conference bill to pass both chambers until after the president’s speech.