Iowa reps tout Medicare breakthrough

By James Q. Lynch

The Gazette

Changes that will reward Iowa providers of low-cost, high-quality Medicare services have been included in the final legislative language of a health-care reform bill the U.S. House is expected to vote on this fall.

The language would change Medicare from fee-for-service to a quality and value-based system. Iowa health-care providers have long argued they are penalized by the reimbursement system which pays them less than providers in 48 other states.

“I think it's a win for real reform and for cost-savings in Medicare and a great win for Iowa, too,” 2

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District Rep. Dave Loebsack, a Mount Vernon Democrat, said Thursday.

Specifically, the compromise would require Medicare to conduct a two-year study on a value-based system, and then switch to a quality-based system unless Congress specifically casts a vote to prevent that change.

The breakthrough will result in real savings and better care for older Americans who receive health-care through Medicare, according to 1

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District Rep. Bruce Braley.

The change will “reduce costly, unneeded procedures that don't improve patient outcomes … all while rewarding doctors in states like Iowa who provide the most efficient and effective health-care,” the Waterloo Democrat said.

A report by the Commonwealth Fund earlier this month found Iowa health-care providers deliver patient outcome second only to their counterparts in Vermont. However, providers and state officials have argued Iowa's low reimbursement rate makes it difficult to attract and retain health-care providers. That compromises patient care, Loebsack said.

The breakthrough resulted from the efforts of a coalition of House members from 17 states high-quality, low-cost states where providers are reimbursed from the Medicare program at some of the lowest rates in the nation, according to 3

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District Rep. Leonard Boswell of Des Moines.

 “Throughout my career in Congress, I have worked to bring attention to how this disparity negatively impacts Iowa's providers,” the seven-term Democrat said. “Now, many of our clinics and hospitals are at a breaking point. The two studies that we have proposed will pave the way for all doctors to be paid fairly for the great care that they provide.”

Winning agreement on the Medicare reimbursement change was critical for Democrats to get the 218 votes they need to send the health-care reform bill to the Senate, Loebsack said.

“There were enough us, including me, who conditioned our support for the bill on making certain that we get the regional disparity issue in Medicare resolved and change the way Medicare reimburses, moving it away from fee-for-service to payment for value,” he said.

Braley and Loebsack are optimistic the language will win approval in the Senate and said House leaders will insist on the language if health-care reform bills go to a conference committee.

Both Democrat Sen. Tom Harkin, chair of the Senate Health Committee, and Republican Sen. Chuck Grassley, ranking member of the Senate Finance Committee, have been working on the change for years.