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Rep. Ron Kind leads push on Medicare reimbursement reform, Democrat fights for value-based payments

April 15, 2010
In The News

Wisconsin doctors and hospitals who treat Medicare patients can expect a modest bump in pay as a result of provisions in the new health care law.

Rep. Ron Kind and a group of Midwest and Pacific Northwest lawmakers bargained hard to get it.

In the final hours of wrangling, the La Crosse Democrat stomped out of a meeting in House Speaker Nancy Pelosi's office, frustrated over the lack of movement on Medicare reimbursement reform and prepared to vote against the health care reform bill that was President Barack Obama's top priority.

Kind left behind a cadre of Democratic allies — Reps. Bruce Braley of Iowa, Betty McCollom of Minnesota and Jay Inslee of Washington — who continued to negotiate.

The good-cop, bad-cop variation worked.

Hours later, the lawmakers announced that their concerns had been met and they would support the final bill. What they got was $800 million for immediate payments for doctors and hospitals and a commitment from the administration to a value-based system for paying physicians and other providers.

It was a major breakthrough for Kind and other members of the Quality Care Coalition, a group of about 30 to 40 lawmakers from the Midwest, Upper Midwest and Pacific Northwest who have pushed for a fairer payment system under Medicare, the 45-year-old federal health insurance program for seniors.

"We're correcting the unfairness of Medicare reimbursement rates with this measure and taking steps toward historic payment reform that rewards the value of care delivered instead of the quality of care provided," Kind said in a statement announcing the deal.

The $800 million provided in the bill that passed March 21 will be used to compensate doctors and hospitals who traditionally have received less for treating Medicare patients than their counterparts in other parts of the country.

"We're leveling the playing field, and we're rewarding the high-quality work being done in northeast Wisconsin," said Rep. Steve Kagen, D-Appleton.

For example, Medicare reimbursement rates for McAllen, Texas, were $14,945 per enrollee compared to $6,179 in Appleton in 2006, according to the much-cited Dartmouth Atlas of Health Care. Wisconsin's per-enrollee reimbursement average was $6,977, compared to the nation average of $8,304.

That disparity has long been a sore point among lawmakers in states getting the short end of the reimbursement stick. Lawmakers from those states contend that the main problem is Medicare's fee-for-service payment system, which they say favors volume over value.

"For years, we've tried to change reimbursement rates to make them more fair to Wisconsin, and this will begin the process of making that happen," said Rep. Dave Obey, D-Wausau, the House Appropriations Committee chairman. "When reimbursement rates are based more on the quality of care delivered than the number of procedures performed, that will benefit doctors, hospitals, patients and taxpayers alike."

It's unclear how much more money will be available to Wisconsin doctors and hospitals, but early calculations by Wisconsin-based Marshfield Clinic indicate the state will see about a 2 percent increase in temporary Medicare reimbursements, said Brent Miller, the clinic's director of federal relations. Marshfield describes itself as one of nation's largest private, multispecialty group practices.

Under the temporary reimbursement plan, doctors would get $400 million in 2010 and 2011. Hospitals would share $400 million in 2011 and 2012.

Miller applauded the efforts of Wisconsin's lawmakers and others in the Quality Care Coalition, but he singled out Kind for praise.

"Ron Kind goes down in my book as a hero," Miller said. "The guy pulled people together. He understood the issues, and he went to bat on a variety of levels that enormously impressed us at Marshfield Clinic."

Steve Brenton, president of the Wisconsin Hospital Association, also applauded the effort from Kind and others. But he expressed a less enthusiastic assessment of the Medicare reimbursement and value index provisions.

"They are important. On the other hand, the jury is out on how significant they may end up being two or three years from now," Brenton said.