Wednesday, December 16, 2009

Senator Coburn

has an op-ed in the Wall Street Journal decrying rationing in the Senate bill. Most interestingly, he decries an Independent Medicare Advisory Commission and the use of Comparative Effectiveness Research. You might be interested in how his own bill--The Patients' Choice Act--deals with some of these same issues.

Here is a column I wrote about the Patients' Choice Act (which is co-sponsored by Senator Richard Burr, R-NC, my senior Senator). Better yet, read the Patients' Choice Act for yourself. Past posts have discussed this, particularly the creation of a Health Services Commission in the Patients' Choice Act, pages 206-15 of Sen. Coburn's bill. Here is another post focused on his discussion of the Independent Medcare Advisory Commission and my noting that he seems to forget some of what was in his own bill when he criticizes others.

In short, the Patients' Choice Act develops a commission with more teeth than what is included in the Senate bill....and which allows for the imposition of civil penalties on doctors not following the guidelines of the Commissions set up in the Patients' Choice Act, including banning banning doctors not following the guidelines from billing federal insurance programs such as Medicare. Don't take my word for it, read for yourself.

Below are selected parts of Title VIII of the Patients' Choice Act (that Sen. Coburn sponsored) with the language below creating a Health Services Commission (pages 206 and running to page 215). Page numbers are noted, and of course you can read the full bill above.

*Purpose, sec. 801 (b), p. 207
(b) PURPOSE.—The purpose of the Commission is to
11 enhance the quality, appropriateness, and effectiveness of
12 health care services, and access to such services, through
13 the establishment of a broad base of scientific research
14 and through the promotion of improvements in clinical
15 practice and in the organization, financing, and delivery
16 of health care services.

*Duties, sec. 802 (a), p. 207-08
(a) IN GENERAL.—In carrying out section 801(b),
23 the Commissioners shall conduct and support research,
24 demonstration projects, evaluations, training, guideline de
25 velopment, and the dissemination of information, on
1 health care services and on systems for the delivery of
2 such services, including activities with respect to—
3 (1) the effectiveness, efficiency, and quality of
4 health care services;
5 (2) the outcomes of health care services and
6 procedures;
7 (3) clinical practice, including primary care and
8 practice-oriented research;
9 (4) health care technologies, facilities, and
10 equipment;
11 (5) health care costs, productivity, and market
12 forces;
13 (6) health promotion and disease prevention;
14 (7) health statistics and epidemiology; and
15 (8) medical liability.

*The Act also creates, under subtitle B, a sub-unit of the Health Services Commission, a 15 member Forum for Quality and Effectiveness in Health Care.

*Membership, sec. 812, p. 210-11
(a) IN GENERAL.—The Office of the Forum for Qual23
ity and Effectiveness in Health Care shall be composed
24 of 15 individuals nominated by private sector health care

1 organizations and appointed by the Commission and shall
2 include representation from at least the following:
3 (1) Health insurance industry.
4 (2) Health care provider groups.
5 (3) Non-profit organizations.
6 (4) Rural health organizations.

*Duties of the Forum, sec. 813, p. 211-12
24 Commissioners, acting through the Director, shall estab
25lish a program to be known as the Forum for Quality and

p. 212
Effectiveness in Health Care. For the purpose of pro
2moting transparency in price, quality, appropriateness,
3 and effectiveness of health care, the Director, using the
4 process set forth in section 814, shall arrange for the de
5velopment and periodic review and updating of standards
6 of quality, performance measures, and medical review cri
7teria through which health care providers and other appro
8priate entities may assess or review the provision of health
9 care and assure the quality of such care.

*How will guidelines and standards be developed, p. 212
(b) CERTAIN REQUIREMENTS.—Guidelines, stand
11ards, performance measures, and review criteria under
12 subsection (a) shall—
13 (1) be based on the best available research and
14 professional judgment regarding the effectiveness
15 and appropriateness of health care services and pro
16cedures; and
17 (2) be presented in formats appropriate for use
18 by physicians, health care practitioners, providers,
19 medical educators, and medical review organizations
20 and in formats appropriate for use by consumers of
21 health care.

*When they will bring about guidelines, p. 213
15 STANDARDS.—The Commissioners, by not later than Jan
16uary 1, 2012, shall assure the development of an initial
17 set of guidelines, standards, performance measures, and
18 review criteria under subsection (a).

*Enforcement Standards, sec. 814, p. 213-214
23 For each fiscal year, the Commissioners shall adopt the
24 recommendations made for such year in the final report
25 under subsection (d)(2) of section 813 for guidelines,

1 standards, performance measures, and review criteria de
2scribed in subsection (a) of such section.
4sioners, in consultation with the Secretary of Health and
5 Human Services, have the authority to make recommenda
6tions to the Secretary to enforce compliance of health care
7 providers with the guidelines, standards, performance
8 measures, and review criteria adopted under subsection
9 (a). Such recommendations may include the following,
10 with respect to a health care provider who is not in compli
11ance with such guidelines, standards, measures, and cri
12 teria:
13 (1) Exclusion from participation in Federal
14 health care programs (as defined in section
15 1128B(f) of the Social Security Act (42 U.S.C.
16 1320a–7b(f))).
17 (2) Imposition of a civil money penalty on such
18 provider.

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