Friends, 
We are at an unprecedented phase in reforming our health care system. We are poised to make changes to a system that has not been modified in substantial form for nearly a generation. We will soon have a bill that makes changes to our health care system to guarantee coverage to all individuals and to align incentives for providers to promote quality of care for patients rather than simply rewarding providers for the quantity of care provided.
This blog is my attempt to loop in my constituents to certain policy issues that touch and inform the health reform debate. I seek to provide thoughtful commentary on issues of interest that affect this discussion that we are having here inside the Beltway. I invite you to send along your thoughts and comments to mcdermotthealthcare@mail.house.gov. I hope that you find this blog helpful and that you will visit often.
-Jim
November 4, 2009
Remarks on the Republican Alternative
Top Immediate Investments in Health Reform
October 27, 2009
October 27, 2009
October 13, 2009
October 6, 2009
November 4, 2009
Top Immediate Investments in Health Reform
We are now at the finish line, about to achieve comprehensive health reform that will provide high quality, affordable, health care to all Americans. As you may know, some of the most significant changes included in reform will not take effect until 2013 and beyond - but others will take effect immediately. Noted here are several important reforms that take effect as soon as the bill is signed into law.
http://waysandmeans.house.gov/media/pdf/111/hcare/top14.pdf
Remarks on the Republican Alternative
Yesterday, the Republicans introduced an alternative health care proposal. The reviews are in: this plan will cover few, will cost billions, and will allow insurers to continue to deny coverage due to pre-existing conditions. Analysis and assessment of the Republican plan reveal its glaring flaws and shortcomings .
http://voices.washingtonpost.com/ezra-klein/2009/11/congressional_budget_office_th.html
http://cbo.gov/ftpdocs/107xx/doc10705/hr3962amendmentBoehner.pdf
Rumors and Myths Don’t Stand Up to Fact
We’ve all heard the rumors and misinformation about how real health reform will cut billions of dollars from Medicare and harm seniors. That is completely unfounded. Today, we can point to two additional endorsements for the health care reform legislation: one from the American Medical Association and one from AARP.
http://www.aarp.org/aarp/presscenter/pressrelease/articles/affordable_health_care_act_endorsement.html
http://www.ama-assn.org/ama/pub/health-system-reform/ama-supports-house-bills.shtml
October 27, 2009
Gaining Momentum
Recent polls suggest that, despite concerted efforts by opponents of a public plan to ensure universal coverage, the public plan is gaining support among the American people. The most recent Washington Post/ABC News poll found that 57% of Americans now favor a public insurance option—a sound majority of Americans. We must have a public option in the final legislation to assure access to coverage and to keep the private insurers honest.
http://www.washingtonpost.com/wp-dyn/content/article/2009/10/19/AR2009101902451.html
Costs Rising, Quality Stagnant
A recent report from the National Committee for Quality Assurance (NCQA) finds that health care quality as reflected by several key measures is not improving. The NCQA report examined the performance of 979 managed care plans that voluntarily submitted information on quality of care, access to care, and member satisfaction. In total, these plans cover about 116 million Americans. Despite the fact that quality is not increasing, premiums certainly are. A recent Commonwealth Fund study illustrates the rapid rise in premiums over the past several years, as well as the projections for significant increases in the coming years.
http://money.cnn.com/2009/10/22/news/economy/healthcare_insurers_reportcard/index.htm?postversion=2009102214
http://www.commonwealthfund.org/Content/News/News-Releases/2009/Aug/Employer-Sponsored-Health-Insurance-Premiums-Increase-119-Percent.aspx
October 13, 2009
Health Reform and Its Impact on Physician Practices
In the current health reform debate, lawmakers are emphasizing the importance of “delivery system reform.” New methodologies are likely to be phased in, including “bundled payments” and “accountable care organizations.” We must move away from the traditional fee-for-service payment structure because it does nothing to encourage providers to render low cost, high quality care. However, we must be mindful of how care is currently being provided to ensure that these new structures will have lasting impact. Accountable care organizations require providers to join together and coordinate their services with one another to provide overall care to patients. We must recognize that not all providers practice in large multi-specialty practices with access to the latest electronic health records and other expensive resources; indeed, nearly 50% of U.S. physicians practice in groups of five or fewer physicians. We must make sure these smaller practices do not get lost in the shuffle as we work to reform the health care system. More valuable information about U.S. physicians is found here:
http://hschange.org/CONTENT/1078/
Health Care is Currently “Rationed”
In the effort to enact significant health care reform, we have heard the cries that health reform somehow represents “rationing” of care. The following article succinctly illustrates how care is already rationed and emphasizes that there is an insurance gatekeeper between each of us and our physicians.
http://www.washingtonpost.com/wp-dyn/content/article/2009/08/03/AR2009080302235.html
October 6, 2009
Putting Physicians on Salary: Been There, Done That?
During the 1990s, hospitals sought to increase market share by acquiring physician practices. When practices were acquired, physicians became hospital employees and were paid a flat salary. Compensating physicians in this manner did nothing to increase (or maintain) physician productivity and the model was abandoned. Despite the failure of the salary model some are proposing that the solution in the health reform debate is returning to a salary-based compensation model. But if we move the pendulum totally in this direction, we may return to a situation where we are drastically overpaying physicians who have little incentive to be productive. Hospitals have already figured it out. Though hospitals are increasingly returning to the employment model, they are coupling physician salaries with other methodologies. Physician salary is coupled with other methodologies designed to impact productivity such as RVU-based productivity compensation, physician co-management models, and the like. This article reminds us what went wrong during the 1990s.
http://www.mdcompliancealert.com/cgi-bin/article.cgi?article_id=290
Moreover, proponents to putting physicians on salary insist that salaries must be fair market value for personally performed services by a physician. Recently, a health system in Iowa paid $4.5 million to the federal government to settle charges that the salaries paid to the physicians were excessive, in violation of federal law. The government argued that the salaries were excessive in order to reward physicians for referrals. Again, putting all physicians on salary is not the only answer to the complex problem of revising the inappropriate incentives in our existing health care system.
http://www.healthleadersmedia.com/content/238053/topic/WS_HLM2_COM/Covenant-Medical-Center-Pays-45M-to-Settle-Stark-Law-Violations.html
Expanding Medicaid
Under all versions of the various health reform bills, Medicaid will be expanded. This is a good effort towards increasing access to health care. However, with providers increasingly declining to accept Medicaid, I am skeptical that this program will guarantee access to health care for those in need if providers do not accept Medicaid as a form of insurance. This article on access to providers is illustrative and suggests that Medicaid patients may have difficulty accessing care—even though they carry a card that is a form of insurance.
http://www.merritthawkins.com/pdf/mha2009waittimesurvey.pdf
Access to Medicare Physician Services
As you know, I am a strong supporter of a robust public option. I support the House Ways and Means Committee’s proposal for a public option tied to Medicare rates for a period of time, in order to save billions of dollars which can be used to expand access to health care. Many complain that tying public option reimbursement to Medicare rates will limit the ability of Medicare beneficiaries to access health care services. A report released on September 28 by the U.S. Government Accountability Office (GAO) suggests that Medicare beneficiaries, for the most part, are not having trouble accessing physician services. Research from the Center for Studying Health System Change appears to confirm the GAO information.
http://www.fiercehealthfinance.com/story/study-most-physicians-still-accepting-medicare-patients/2009-09-08
http://www.gao.gov/new.items/d09559.pdf
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