Health Care Payment Reform

We have not been hearing enough about what physicians think about the health care reform debate, so yesterday’s New England Journal of Medicine was especially interesting to me.

I was surprised by the survey results that a solid majority of physicians support a public option to increase competition competition for private insurers. I probably should not have been; physicians are getting increasingly frustrated with dealing with private insurers–apparently so frustrated that they are willing to take lower rates from Medicare (or other public insurance) than bear the costs of dealing with private insurers.

Even more interesting was another Perspective piece in yesterday’s New England Journal. The findings of another survey suggest to me that physicians’ low profile in the health care debate does not indicate apathy. Some interesting findings:

• 78 percent of respondents said that addressing societal health policy issues is in the scope of professional obligation of a physician.

• About 73 percent  said physicians are obligated to care for the uninsured and underinsured.

• 54 percent said they were morally opposed to using cost-effectiveness as a factor in deciding which treatments a patient should receive.

The primary care shortage will get much worse when more Americans are covered. That’s a better problem than letting 47 million Americans remain uninsured.

According to Dr. Ted Epperly, president of the Kansas-based American Academy of Family Physicians:

To keep up with the demand for primary care doctors, the country will need to add another 40,000 to the existing 100,000 doctors over the next decade or face a soaring backlog.

Mercer’s annual survey to find out what employers plan to do with their insurance coverage is out, and the consumer-directed health plan movement seems to be a big winner.

If employers kept employee medical plans in 2010 as they were in 2009, costs would rise by almost 9 percent, Mercer found.  That’s not happening in this economy. Employers are going to hold cost growth to 5.9 percent in 2010 by various cost-cutting strategies, including the reduction in benefits that come with CDHPs.

In a press release issued this morning, Mercer partner Linda Havlin says:

We’re expecting to see a real spike in 2010 in both the number of employers offering CDHPs and in the number of employees enrolling in them, as more employers become comfortable with the concept of offering a high-deductible, account-based plan as one choice or their only choice Employers see them as a way to provide more value to employees while at the same time managing cost.

The new issue of Health Affairs tackles the topic that should be on every American’s mind: health care costs. Figuring this out is the moral imperative of our time, but anyone who has an easy pat answer is someone who is not paying attention.

As editor Susan Dentzer puts it:

A MODERN TWIST on Greek myth would feature not Sisyphus, but a health policy-maker condemned to an eternal punishment of trying to tame health care costs. During rare work breaks from rolling the rock up the mountain, she’d read the report of the Committee on the Costs of Medical Care, formed in 1927 and chaired by a member of President Hoover’s cabinet.

As Daniel Fox described in the Milbank Memorial Fund’s Centennial Report, the committee tackled what it termed “‘the one great outstanding question before the medical profession’: how to deliver adequate medical services to all Americans at a reasonable cost.” Then, at her next work break, our suffering policymaker would watch President Obama on television, vowing that “the [health care reform] bill I sign must reflect my commitment…to slow the growth of health care costs over the long run.”

The beginning of an extremely important week for our nation.

Are hospitalists a part of the solution to the problems caused by America’s fragmented health care system? Bob Wachter thinks so, and I think he might be on to something.

Wachter, chief of the division of hospital medicine at University of California-San Francisco, says:

…since hospitals are the target of most robust quality reporting, pay-for-performance, and patient safety mandates, hospitalists share their worldview on these issues as well. If I’m getting money from my hospital, I damn well better help the hospital achieve excellent performance on publicly reported hospital quality data, “no pay for errors”, Joint Commission National Patient Safety goals, patient satisfaction scores, readmission rates, and the other scary things that keep my hospital CMO up at night.

In other words, well-organized hospitalist programs share their hospital’s accountabilities.

I wonder if hospitalists, generally speaking, are in leadership positions in which they can maximize the shared accountabilities that lead to better quality and lower cost care. Your thoughts, please?