1. The Medicare Improvements for Patients and Providers Act of 2008 A Roadmap for Delivery System Reform

2. History Prelude: MMSEA, 6-month doc fix, and plan for 2008 Cancellation of Feb. mark-up and expanded bipartisan process Separate paths – S. 3101 and S. 3118 House takes up Senate bill – H.R. 6331 Veto override and enactment

3. Key Points of Departure Scope of “beneficiary provisions” –Mental health parity –Prevention –MSP asset tests –LIS barriers to enrollment Offsets –Medicare Advantage Private Fee-for-Service

4. Value-Enhancing Provisions Contract with consensus entity to set priorities and endorse valid measures Extension and expansion of PQRI –Bonuses increased and authorized through 2010 –NQF endorsement required with limited exceptions –Adoption of MMSEA improvements: condition-specific measure groups and registry-based reporting –Group-level reporting for large practices –Posting on website of successful participants Confidential feedback on MD resource use Plan for transition to value-based purchasing of MD services due in early 2010*

5. Value-Enhancing Provisions (cont’d) E-prescribing incentives with mandate Access/Support for primary care –Increase work RVUs –Funding and pilot authority for medical home Imaging –Accreditation requirement for advanced modalities –Test use of appropriateness criteria Value-based purchasing of dialysis services Report on health care disparities

6. What’s Next? Additional steps toward delivery system reform likely next year and beyond Consensus to focus on cost and quality –Value-based purchasing –Primary care –Health IT –“Systemness” –Episode-based payments –Etc. billy_wynne@finance-dem.senate.gov