Today, Jim McDermott (D-WA) will introduce legislation designed to reduce regulatory burdens upon, and allow greater innovation and collaboration among doctors and hospitals in order to reduce health care costs in the Medicare and Medicaid programs.
Under the "Improved Health Care at Lower Cost Act of 2013," for the first time, physicians will be permitted to share in the savings generated when they participate in initiatives designed to decrease costs and improve health care quality for their patients. Such initiatives may include rewarding physician participation in evidence-based clinical care protocols, as well as initiatives designed to reduce unnecessary hospital stays.
In introducing the legislation, Mr. McDermott stated, "The only way we are going to be able to bring down health care costs is with creativity. When hospitals and physicians have a common goal, both sides are able to work together for the good of the patient without regard to reimbursement considerations."
The Centers for Medicare and Medicaid Services is currently developing programs designed to encourage more efficient care delivery models, which this legislation will complement.
While allowing for more collaboration, this legislation also recognizes the need for continued federal oversight as these models develop. "Given the novel programs that will be developed, we don't yet know what vehicles unscrupulous providers could use to exploit the system," said McDermott. "We have to balance the need for innovation in the private sector with vigilance in preventing fraud, waste, and abuse."
The legislation requires federal regulators develop appropriate safe harbors for doctors and hospitals under the Physician Self-Referral law and the Anti-Kickback Statute and amends the Civil Monetary Penalty law to permit these arrangements. Such provisions will establish clear and transparent requirements for providers so they are able to avoid incurring substantial penalties and fines.