The federal government should use its power as a buyer of health care to spur improvements in quality, leaders of a local group said during a congressional hearing in Green Tree yesterday.

Doing so would save both lives and money, said Karen Wolk Feinstein, chairwoman of the Pittsburgh Regional Healthcare Initiative.

"Improve quality and safety and you will lower cost, save lives and produce a healthier labor force," said Feinstein, whose group has coordinated quality improvement projects in the region.

Feinstein was one of four experts invited to testify before the U.S. House of Representatives' Government Reform Subcommittee on the Civil Service. U.S. Reps. Tim Murphy, R-Upper St. Clair, and Tom Davis, R-Va., listened to the testimony.

The subcommittee oversees the Federal Employees Health Benefits Program, which covers more than 8.6 million individuals, including 2.2 million federal and postal employees. Considering the federal work force, along with people covered by the Veterans Affairs Department, Medicare and Medicaid, the government has tremendous leverage to bring about change, Murphy said.

The practice of linking pay with performance is uncommon in health care, Feinstein said, estimating that current quality incentive programs involve less than 1 percent of annual revenue for hospitals. Feinstein's group tried, but failed, to win a federal contract in 2003 to demonstrate how financial rewards to hospitals for good patient outcomes could work in the context of Medicare.

The government is interested in pay-for-performance programs, said Dan Blair, deputy director of the U.S. Office of Personnel Management, which administers the federal employee health program. He was cautious, however, about fully embracing such a program right now.

"Pay-for-performance is in its very early stages of development, and the programs I've mentioned are still in the pilot stage," Blair said. "We have no mechanism to reward providers directly for superior performance. However, we will continue to monitor developments in the industry."

In the meantime, the government could help consumers by encouraging health plans to get pricing information about medical procedures into the hands of consumers, Feinstein said. That step is crucial, she said, considering the government's interest in Health Savings Accounts, which allow consumers to set aside money to pay for current and future medical expenses on a tax-free basis.

Created by last year's Medicare Modernization Act, the accounts give individuals an incentive for making wise financial decisions about their health, and this can spur needed improvements, Feinstein commented. But consumers must have good information about both quality and the true cost of services.

"Right now, there's an extraordinary lack of information," she said. "Nobody knows what procedures cost."

Davis, the subcommittee chairman, said Health Savings Accounts will soon be an option for federal workers. Some federal retirees worry that younger and healthier workers will opt for the accounts, thereby depleting the pool of money available to care for sicker workers who remain in traditional health plans, he said.

But Davis said the accounts are consistent with an idea he thinks must become more central to health care: personal responsibility.

"People who make wrong choices ought to be paying more," Davis said, commenting on a recent episode of "The Jerry Springer Show" he happened to see. The show featured people who weighed more than 400 pounds each, and the sight, Davis said, prompted him to think: "There's where my health insurance money goes."