Lola Butcher

It is always surprising to me that physicians perceive themselves to be victims of America’s health care crisis when, in fact, they are the only ones that can save the system. I don’t blame physicians for the problems–there is too much blame to go around to pin it on just one group–but physicians alone have the power to sabotage any proposed reforms.

That’s real power, and that means physicians must be on board with any changes designed to return from the brink. And the only way they will be truly on board is if they help design the changes. Physicians, America needs you to apply the intelligence that got you through medical school to the nation’s health care quality and cost crisis. No, most of you did not sign up for this when you decided to become a physician, but you are the key to solving this mess. So please, proceed with haste.

Robert Laszewski, president of Health Policy and Strategy Associates and one of health care’s truth tellers, says this nicely in his recent post.

For one thing, the pharmaceutical companies have to pay for all that lobbying effort.  Getting Congress to do your bidding does not come cheap.

The Wall Street Journal reports on a Center for Public Integrity report that the pharmaceutical industry spent $168 million lobbying Congress in 2007, up 32 percent from the previous year.

The Medicare Payment Advisory Commission, which guides the nation’s largest health care payer, is suggesting major changes to the way health care is delivered in America. 

The high cost of health care threatens to overwhelm the United States’ ability to pay for it–and yet the growth of the health care industry is the one bright spot on the country’s economic radar screen.

Huh?

When Peter Orszag, director of the Congressional Budget Office, testifies before the Senate Finance Committee at its health reform summit next week, we can be sure he will pound the drum he has been beating for more than a year: “The rising cost of health care represents the nation’s single most important long-term fiscal challenge.”

And yet the health care industry may be the economy’s savior, reports today’s Washington Post:

By 2016, the Bureau of Labor Statistics predicts health-care employment to double the projected growth of all other industries combined.

“It’s one of those industries that doesn’t seem to be affected by economic downturn,” said Terry Schau, an economist at the bureau. “People get sick, and they’re going to need health care. The state of the economy may affect their ability to pay but not the demand.”

It may not take much more press like this before hospitals may start giving up their tax-exempt status voluntarily.

As reported on the WSJ’s Health Blog, Sen. Charles Grassley is turning the heat on hospitals that get tax-exempt status, questioning whether their public service warrants the special treatment.  The pressure is only going to build on this issue, as hospitals become ever-more business-savvy to compete in a time of a declining reimbursement rates.

Physicians who do not like pay-for-performance programs may rue the day they started complaining about them.

P4P programs, which generally keep patients out of the mix, are easy to accept in comparison to public rating systems that reward patients, via lower copayments, for learning which physicians offer the highest quality care at the lowest cost and taking their symptoms to those doctors.

Physicians are understandly nervous about ratings, which can be misleading or downright wrong. But payers–frustrated that the P4P movement is going nowhere fast–are looking for new ways to reward physicians who will get in line with payers’ cost-effectiveness goals, and physician ratings is one of them.

In Massachusetts, the state medical society sued Group Insurance Commission, which buys insurance for more than 300,000 current and retired state employers, claiming that its physician rating system “fraudulently misleads patients and unfairly affects the reputation of physicians.”

No quaking in Massachusetts. Other payers are undaunted. As reported in the Boston Globe, two of that state’s biggest health plans are moving ahead with physician rating systems instead of waiting for the lawsuit to play out.

The New York state Medicaid program is the latest to announce it’s going to stop paying for some of the so-called health care that hospitals provide that, in fact, hurts more than it helps. Wrong-site surgery, anyone? Foreign object left in during surgery?

FierceHealthcare reports on the latest payer to make the seemingly common-sense move to stop paying for preventable medical errors:

New York’s Medicaid program has decided to stop reimbursing for avoidable hospital complications and medical errors it considers to be “never events.” Starting in October, it won’t pay for care related to 14 conditions, including wrong-site surgery; foreign objects left in the body; medication errors; blood incompatibility; contaminated drugs and patient disability from electric shock. Hospitals that want to receive Medicaid payments will have to prove that such conditions were present on admission to get paid for treating them. Meanwhile, the state expects to keep expanding this list.

This trend, which now includes Centers for Medicare &  Medicaid Services, CIGNA, WellPoint, and lots of others, makes so much sense…and yet why does this feel like a raft of unintended consequences getting ready to be revealed?

It is regrettable that hospital administrators do not recognize, let alone deal with, the unacceptability of preventable medical errors until payers start refusing to send the checks. There’s no doubt that the financial consequences of poor practices that result in infections and other serious medical harm will get hospitals to change their ways. But at what cost? The bureaucracy that is being built up to make the “no pay” trend work will be substantial, adding to the high cost of care. And the high cost of care translates into reduced access for some patients.

Term limits for legislators seemed like a good idea until they were passed–and now they look like big problems. I wonder if we’ll say the same thing about the ‘never event’ trend some day.

Everyone in health care worries about escalating costs–until it comes to their share. Paul Ginsburg, president and CEO at the Center for Studying Health System Change, dropped in on the U.S. Senate Finance Committee this week to share that truth.

From his Senate Finance Committee testimony:

“Reflecting on the U.S. experience with health care cost containment, what is striking is the consistency with which leaders in both the public and private sectors have avoided the idea that real cost containment involves real sacrifice — patients going without services that may provide some benefit, or physicians, hospitals and insurers settling for smaller incomes or profits.”

Regardless how the Democratic contest plays out over the next few days, let’s hope that Barack Obama and his running mate remember that health care is one of the top issues on voters’ minds–and that the Congressional Budget Office has identified the health care crisis as the item that will break America’s back if the problem is not fixed.

The California patient-dumping scandals highlight the fact that America has no health care system. Rather, care is provided–or not–by a bunch of disconnected providers who occasionally throw up their arms in despair and throw patients into the streets. In some cases, literally.

The fact that this happened even once should make every member of the health care industry–and that includes policymakers, payers (and, yes, health care writers)–ashamed that this could happen in our country. The fact that it has happened repeatedly is a cry for leadership to create a real system in which patients are not abandoned.

Hospitals love to brag about saving people’s lives. But those brags ring hollow when patients are being mistreated because hospital administrators do not know what to do with them.