Washington Editor

WASHINGTON - Kansas Gov. Kathleen Sebelius won approval Tuesday from the Senate Finance Committee in a 15-to-8 vote as Health and Human Services (HHS) secretary.

Her nomination will now go before the full Senate.

The vote was taken during a quick break at a Senate Finance Committee health reform roundtable on improving the quality and efficiency of care.

Sen. Jon Kyl (R-Ariz.), the only lawmaker during the meeting who voiced an opinion before the vote, raised concern that Sebelius would attempt to use comparative effectiveness research to deny or delay health care.

"Comparative effectiveness research can be used to provide patients and doctors with information so that they can make informed health care decisions," Kyl said. But, he added, "without appropriate safeguards, the government can misuse comparative effectiveness research to deny coverage."

Kyl said answers Sebelius provided to questions he posed during the HHS secretary-designate's April 2 Senate Finance Committee confirmation hearing and since then "made it clear that the administration is unwilling to support pro-patient safeguards." (See BioWorld Today, April 3, 2009.)

The Arizona Republican said Sebelius left him with "no assurances" that HHS, federal health care programs or any new entities, such as the Federal Coordinating Council for Comparative Effectiveness - a 15-member panel of government officials mandated under the American Recovery and Reinvestment Act (ARRA) - will not use the research as a "tool to deny care." (See BioWorld Today, March 23, 2009, and April 15, 2009.)

During Tuesday's meeting, Kyl also said he was concerned that the National Institutes of Health (NIH) was "already taking steps necessary to make cost-based research a priority."

He said he was wary of recent statements made by NIH Acting Director Raynard Kington that cost effectiveness research would provide accurate and objective information "to guide future policies" that support the allocation of health resources for the treatment of acute and chronic conditions. "Allocation for health resources is, of course, a euphemism for denying care based on cost," Kyl asserted.

"I believe in the right of every American to choose the doctor, the hospital and the health care plan of his or her choice, and that no Washington bureaucrat should ever interfere with that right or substitute the government's judgment for that of a physician," he declared, stating that he was opposing Sebelius' nomination to lead HHS.

Kyl was joined by seven other Republicans in voting against the nominee. Republican Sens. Pat Roberts (Kansas) and Olympia Snowe (Maine), however, voted in favor of Sebelius along with 13 Democrats.

During the Finance Committee's more than three-hour roundtable session Tuesday - the first of three such scheduled meetings - lawmakers heard from various experts and stakeholders about techniques and strategies for improving the quality and efficiency of care through reducing fraud and abuse, establishing value-based purchasing programs and better management of patients, especially of those with chronic conditions.

Former FDA and Medicare chief Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institute, said the current fee-for-service payment system has made it difficult for physicians and other health care providers to give their patients the kinds of care that can best improve outcomes.

While most physicians know the steps they can take to help patients comply with medicines and better manage diseases, the providers "just don't get any support for that in most of our current payment systems. So it gets harder and harder to spend time with patients," McClellan insisted.

While physicians would like to spend time entering information into electronic health systems and educating patients about medications, diet and exercise, "none of that gets reimbursed," he lamented.

Reimbursement, McClellan said, must move to a system where providers and patients are accountable for better health outcomes and reducing complications and hospital readmissions. "That is the general direction we are trying to move in, and the big challenge, of course, is how can we do it in a way that is not too disruptive for care today, most of which is not integrated at all, yet still is going to give us some assurance that we are getting real meaningful change quickly," he said.

However, McClellan said, while accountability must be part of any new payment system going forward, physicians and other providers also must be given the flexibility to use their judgment in determining care for patients.

The Centers for Medicare & Medicaid Services, which he noted oversees the largest health care program in the world, also must be given more resources, McClellan said.

John Tooker, CEO of the American College of Physicians, urged Congress to swiftly act to improve the reimbursement system for physicians and other providers. He noted that the U.S. currently is facing a critical shortage of primary care physicians. Without an ample work force of primary care doctors, Tooker argued, any prospects for successful health reform would be impeded.

Many of the witnesses during Tuesday's discussion, in addition to some lawmakers, pointed to the success of employer-based incentive programs that promote preventive medicine and wellness, where employees are rewarded for quitting smoking, reducing their high blood pressure and losing weight.

Employer-based wellness and preventive medicine programs puts the responsibility of health cost savings on Americans rather than only on government, providers and insurers, said Sen. John Ensign (R-Nevada). He called for more employers to offer such programs. Congress has been provided with a number of proposals for reforming health care, McClellan said.

Now it is up to lawmakers to put those proposals together to create a "vision" that will eventually lead to success.