Q: As a MedPAC commissioner, you looked at the big picture, which puts you in a good position to comment on the current health reform bills. What do you think of them?
NW: I try to look at both sides in the debate. The Senate bill would provide coverage to 94 percent of Americans. However, that would still leave 25 million people uninsured. The public plan option is currently included in both bills, though this issue is very unresolved. And both include significant insurance industry reforms.
Q: What impact would health reform have on hospitals?
NW: There is the potential for $150 million in payment reductions for hospitals in the Senate version. DSH reductions are in both versions with the expectation that as more uninsured receive coverage there will be less DSH need. Safety-net hospitals worry about this transition. The House bill has more aggressive hospital payment cuts than the Senate bill, but smaller DSH reductions.
Meanwhile, a new payment policy around bundled and episode payments would incent hospitals to work more closely with physicians and other providers. Facilities that are not part of integrated organizations would have more difficulties, but participation would initially be voluntary, and the new policies would transition in over years.
Q: Looking at your own organization, is the Billings Clinic well positioned to embrace this sort of change?
NW: Yes, I believe we are. We have an integrated structure like Mayo Clinic, only we’re much smaller. We have 240 physicians, long-term care services, rural clinics, a 272-bed hospital and six critical access hospitals. We are part-owners of a health plan, called New West, with five other providers in the state. After 10 years of operation, it has 45,000 enrollees and is still growing.
Q: One goal of the health reform bills is to try to reduce readmissions of patients within 30 days of discharge. How do you think that will work out?
NW: Hospitals appear to be ready to embrace this concept as long as it covers only truly preventable conditions. Hospitals should not be penalized if the patient is readmitted for a condition that has nothing to do with the original hospitalization. There is already a Medicare demonstration project involving bundled payments, but the Senate bill in particular would greatly expand these into pilots. In the next few years, however, there would not be mandates requiring all hospitals to do this.
Q: Because you are a former MedPAC commissioner, we’re curious what you think of the independent Medicare Advisory Board in the Senate bill. It would have the same purview as MedPAC but would have more power. Its decisions would become policy unless Congress overruled it.
NW: The details still have to be worked out. My understanding is that the new board would focus largely on payment. There are pros and cons to this with some seeing it as more efficient, and others saying this should be Congress’ role.
Q: When you were on MedPAC, did you feel you needed extra powers like this board would have?
NW: During my tenure, many of MedPAC’s proposals and recommendations found their way into law and regulation.
