As House Republicans work on a statement of principles that should be followed in the health care overhaul, GOP members and allies said at a forum Monday that the focus has to remain on quality of care.

Rep. Michael C. Burgess, R-Texas, the chairman of the Congressional Health Care Caucus, said cost is a major topic for both patients and doctors.

“Quality on health care is hard to define and if it’s hard to define it’s hard to measure,” said Burgess, a member of a health care task force appointed by the House Minority Leader John A. Boehner, R-Ohio. The effort is being led by Rep. Roy Blunt, R-Mo., who is expecrted to update the House conference later this week on the group’s progress.

Mark McClellan, the administrator of the Center for Medicare and Medicaid Services in the Bush administration, said “there is some reason for optimism in this round of health care reform” because the discussion is about better care at lower cost. But under the current reimbursement system, if a physician takes steps to better coordinate care or provide preventive advice, “all those steps mean you’re going to be reimbursed less by Medicare and maybe by private payers,” said McClellan.

McClellan, who is working with the Brookings Institution on bipartisan health care advice for Congress, said measurement, payment changes, benefit changes and better evidence all are needed in the overhaul to improve quality of care. Those providers who produce better outcomes at lower cost should be rewarded, he said.

Medicare has a huge impact on the overhaul because private payers have to follow Medicare’s framework because it accounts for a large share of revenues, he noted. Steps toward accountable care would bring another component into reimbursements, “an element of capitation,” he said, since providers could keep part of the net savings. Capitation is a fixed amount of money paid to a doctor in advance for care, commonly thought of as coming from a managed care organization.

As for private plans, there has been a great deal of attention paid in Congress to the Massachusetts model that uses an exchange to provide consumers with choices among plans, McClellan said. Giving people some financial support to get access to a plan is important, as is the opportunity for patients to save money by choosing plans that cost less, he said.

“Getting people involved in decisions about their coverage and their care does work to [drive] new ways of designing benefits, new ways of paying for care that can lead to better outcomes,” McClellan said. “I hope that remains a key part of the emphasis in reform legislation.”


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