Cantwell Negotiates Deal to Pay Doctors for Quality Care, Not Quantity of Services

Amendment delivers long-awaited solution to Washington state's Medicare reimbursement disparity

 WASHINGTON, DC – The Senate Finance Committee’s health care reform bill unveiled today includes newly-accepted language authored by Senator Maria Cantwell (D-WA) to fundamentally transform America’s health care payment system so that it focuses on quality, not quantity of care. The agreement reached in negotiations between Cantwell and Senate Finance Committee Chairman Max Baucus (D-MT), has national implications because it will change the way doctors serving Medicare patients are paid all across the country. Cantwell’s language changes the Medicare reimbursement formula to reward doctors for providing high quality care. The current system has penalized Washington state by rewarding quantity rather than quality.


“I am not a member of the ‘Gang of Six’” Cantwell said in today’s Finance Committee mark-up, referring to the bipartisan Senate group that developed the Committee’s original proposal, “but I am a member of the gang of six million Washingtonians.”


The problem, Cantwell said, is that while Washington state delivers quality, affordable care, nationally we have “a system that rewards doctors for how many patients they see and how many procedures they order.”


For years, a complex formula has paid doctors caring for Medicare patients on a fee-for-service basis. That formula has the unintended effect of punishing Washington state doctors for providing high-quality, cost-effective care because it means they received lower payments.  Cantwell’s proposal, now included in a revised draft of the America’s Healthy Future Act of 2009, changes the Medicare formula to pay providers nationwide based on a ratio of quality to cost, not simply quantity.


“For too long, Washington state has blazed a trail providing coordinated, high-quality care for thousands of patients,” said Cantwell before today’s committee mark-up.  “This deal is a huge win for Washington state, and it finally puts the patient first rather than putting the focus on how physicians get paid.”


For years, Cantwell has worked to reform Medicare’s fee-for-service model to focus on quality.  Most recently, she and Senator Amy Klobuchar (D-MN), who has also been a strong advocate for reforming Medicare’s payment structure, gathered the signatures of 26 bipartisan senators for a letter sent last week to President Barack Obama urging reform of the Medicare system.


“The change included today will help control costs and get the most from our healthcare dollars,” said Senator Klobuchar.  “This will strenghten the strong safety net of Medicare by ensuring funds are there to pay for our seniors' health care.”


Currently, Medicare wastes $120 billion a year, or 30 percent of all Medicare spending.  This waste is due, in part, to incentives in the Medicare physician payment structure.  Cantwell’s amendment provides incentives to doctors to work toward the best outcomes, instead of paying them for ordering more services and spending more money.


Cantwell’s amendment, included in the modified mark released by the Senate Finance Committee today will:


  • Uses quality measures that factor in differences in the health of patients (such as age), and specifies that “quality” must be defined based on health outcomes – doctors get evaluated on the results they produce for patients.  This puts the focus on the patient.
  • Aims to improve coordination and efficiency within the health care delivery system.  It would be used to coordinate other value-based proposals, not compete with them.
  • Sets out a clear timeline for reform, while still providing the flexibility to incorporate new research.  It maintains a focus on the policy changes we know produce results:  all providers must have incentives to produce good patient outcomes in a way that is fair and effective.