July 07, 2010
7:49 am
We’re not going to comment in this space on the political wisdom of President Obama’s decision use a recess appointment to install Dr. Donald Berwick as head of the Centers for Medicare and Medicaid Services, thus bypassing the Senate confirmation process. What was certain to be a contentious confirmation debate will now be a contentious debacle on cable talk shows over the merits of using recess appointments for controversial nominees.
We’ll elect not to engage in that particular crossfire. Instead, we want to offer Dr. Berwick not only best wishes in his new position but, more importantly, the advice, counsel and support of leaders from all sectors of American healthcare.
Dr. Berwick has a big job in front of him. Not only has CMS been without a permanent head for far too long, since 2006, but Dr. Berwick will find himself as a point person in the implementation of health reform. CMS will be in the center of one of the most essential components of reform, achieving progress in changing our healthcare delivery and payment systems to focus on quality and value. Fortunately, as HLC members know from our meetings with him, this is a topic on which Dr. Berwick has profound expertise and unbridled enthusiasm.
Making headway on healthcare delivery reform will depend, in large part, on building upon the successes that private sector health providers have already achieved. We stand ready to share these examples with Dr. Berwick and his CMS team and to collaborate with him in moving toward an innovative, consumer-centered, results oriented healthcare system.
July 01, 2010
12:15 pm
The new health reform law mandated that, by July 1, 2010, the federal government create a website to help consumers better understand their health coverage options. That site, healthcare.gov, went live on the Internet this morning.
The site is structured so that people in every state can answer some basic questions about themselves and their healthcare needs and then receive a list of potential options for acquiring some form of health coverage. The Department of Health and Human Services collected information from over 1,000 insurers as well as the Medicaid and Children’s Health Insurance Program in each state in order to create the site’s database. Healthcare.gov also has information on wellness and prevention as well as basic facts about the new health reform law.
HHS has also set up a Twitter feed at @healthcaregov as well as a YouTube site with information videos.
More on the site is found in this story on Politics Daily.
I haven’t had the opportunity to try out the site long enough to test its easy of usage or the breadth of its information, but I applaud HHS for getting the website up and running in such relatively quick time after the passage of health reform legislation. We know from experience with the Medicare Part D planfinder website that it takes time to work out the kinks and create a Web platform that the public can easily understand and access. The federal government has plenty of time to make these improvements before the new health insurance exchanges start in 2014.
June 21, 2010
3:39 pm
Last Friday in this space, we examined the impact public programs like Medicare and Medicaid, with their underpayments for healthcare services, are having on escalating healthcare costs for employers and private payers.
Now, USA Today, in today’s front page headline, is placing a spotlight on another Medicare-related problem. Seniors are having more difficulty finding physicians who will take Medicare patients, a problem only exacerbated by the current congressional stalemate over Medicare payment cuts.
According to the article, on average, Medicare only pays physicians 78 percent of what private insurers do. The American Academy of Family Physicians, the American Osteopathic Association and the American Medical Association all say that doctors are limiting their participation in the program.
John Rother, policy director for AARP, fears that this trend will serve to make the current shortage of primary care physicians even worse. He said this is a problem becoming increasingly visible in states like Illinois, North Carolina and New York.
We’re increasingly seeing the perils of an overreliance on public programs for coverage. Whether it’s cost-shifting to private payers, making healthcare more expensive for millions of Americans, or a reduction in access due to providers being unable to accept low reimbursements, the evidence is mounting that payment reform is essential to achieving a sustainable, workable healthcare system.
June 18, 2010
12:19 pm
A report from the PricewaterhouseCoopers (PwC) Health Research Institute says that U.S. employers will see their healthcare costs increase by nine percent in 2011.
What’s instructive, in terms of setting future health policy, is why those costs are increasing.
According to PwC, hospital and physician costs will account for 81 percent of the health insurance premiums that employers are paying. And the reason those costs are escalating is because hospitals are being forced to shift more costs onto the backs of private payers and employers due to Medicare underpayments. PwC points out that this cost shifting is the primary driver behind higher healthcare costs for businesses.
I’ve always found it mind-boggling when policymakers argue that we can improve our healthcare system and our economy by moving more Americans into public coverage programs. With these programs paying less than the actual cost of delivering healthcare, someone else – employers and private payers, predominantly – has to pick up the slack. PwC points out that, with Medicare reducing payment rates to hospitals in 2011, this cost-shifting will exacerbate. This is not a positive development in an economy struggling to create jobs.
Cyril F. Chang, director of the Methodist Le Bonheur Center for Healthcare Economics, said in HealthLeaders Media that policymakers are trying to reduce healthcare expenditures by reducing Medicare payments. “Right now,” he said, “it seems to me the major instruments they are using to slow down the growth of cost are Medicare cutbacks.”
But we already know what results from this approach. Costs aren’t reduced, but merely shifted over to private payers. The real solution must come from meaningful healthcare delivery and payment reforms. As discussed in this space previously, many private sector providers are already succeeding with innovative delivery reforms. The challenge is to transform these localized successes into national policy, a process that needs to be placed on the fast track.
April 27, 2010
1:06 pm
An interesting, and troubling, piece ran recently in the Wall Street Journal. The article highlighted one of the major shortcomings of the newly enacted health reform law. This article, “Medical Schools Can’t Keep Up,” said covering 32 million more people who haven’t had health insurance outpaces the capacity of the number of doctors we have to attend the new total number of patients. As well, the medical education system won’t be able to produce enough new doctors to meet the demand.
Estimates predict a deficit of doctors potentially reaching a 150,000 gap by 2025. The United States currently has 954,000 physicians. The area in which doctors are needed is in primary care. Yet, that’s the practice fewer medical students have been selecting. Medical training programs have begun to push primary care, but the supply pipeline is definitely behind the curve. The new health law only adds to that problem.
Plus, everyone must train in a medical residency program in order to lawfully practice medicine. But residency slots are limited, and the law’s cuts to Medicare, which pays for medical training programs, don’t help.
Unfortunately, all Americans will feel the effects of this physician shortfall. The Journal reported: “A shortage of primary-care and other physicians could mean more-limited access to health care and longer wait times for patients.”
The Wall Street Journal article reminds us that healthcare coverage doesn’t necessarily equal healthcare access and that more work remains to be done to fulfill the vision of healthcare reform.
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