Is it possible that I just cannot do the math? Perhaps I just do not have the right perspective to understand the projected economics and concepts put forth in the variety of House and Senate bills flying fast and furious from our nation's brightest on Capitol Hill?
The premise seems to be that everyone can keep his favorite insurance coverage, keep his doctor, reduce her insurance premium, cover 30 to 40 million more people, keep Medicare the wonderful program it is, expand Medicaid to as much as 20% of the population, and, to add sugar to the deal, cut the federal deficit by $130 million.
Let me have some of that Kool-Aid. I can imagine how it's going to happen. They'll squeeze the evil capitalist insurance, pharmaceutical, and hospital industries, and create untold numbers of new government agencies to oversee and implement such efforts. Fortunately, we have seen how effective the government has been at running healthcare.
Medicare and Medicaid fraud has been rampant at about $120 million per year. The revenues to keep Medicare going are expected to be inadequate in just a few years, even without considering the 8,000 new baby-boomer beneficiaries per day who will be coming into the system. Meanwhile, Medicaid has already put a number of states into bankruptcy. I am not inspired.
If we have to legislate coverage, payment, and benefits, the political currencies will distort value and undermine success. When none of the bills include meaningful tort reform, changes that might recapture some of the $60 to $200 billion in estimated costs and better serve the public, something is wrong. The current system promotes cover-up, not safety or quality. It is a paradox that a reform effort to make healthcare an entitlement could be so short-sighted and self-righteous.
I thought Congress got solid negative feedback on the public option and several other elements in this legislation through town hall meetings and polls. However, they must have decided that we spent our gas and won't get in the way as they turn healthcare into another government-bungled bureaucracy.
With the persistence and insight of a testosterone-driven high-schooler with one thing on his mind, they keep coming back with a partisan approach saying "trust us; it's the right thing to do." What you can expect next is "I'm sorry" when they leave us with a single-payer healthcare system that will take decades to correct and which will sap our retirement funds.
There is no hope for an adequate revenue base in a society that has lost its ability to create jobs. The younger generation is looking at tax rates of 50% to 60%, with no guarantee of quality or access when they come of age.
I would much prefer seeing a two-tiered system that is defined in such a way that might preserve some of the attributes of our current system and inspire excellence and service. I would prefer to see the government subsidize physician and ancillary medical professional education that is paid back through work in these community health centers.
Issues with specialist and procedural referrals are solved by affiliation with a university medical center where faculty and residents would provide specialist and surgical care. This may be in urban areas near a medical campus or through telemedical technology which is poised and ready for prime time.
There would be a defined means-based cost sharing for individuals and families who qualify for these programs and initially they would be designed for those who do not qualify for Medicaid or CHIP, but would evolve as capacity allowed. These clinics would not be available to individuals with commercial insurance or outside of an income threshold.
This would allow for the commercial healthcare marketplace to improve on cost as the unreimbursed care moves into the community health clinic paradigm. It would also minimize the cost of education and training so physicians could pursue a career based upon interest more than profit and promote competitive improvements in care and service for the public. I know many might consider this idea a bit far reaching, but I would like to see the private sector supported, not stifled.
We are at a monumental moment in the self-focused eyes of our politicians. We need to move carefully, without partisan pressure, but with common sense. Healthcare is one-sixth of our economy and is an important employment base and focus of innovation for our national productivity. We do not need ultimatums demanding comprehensive health reform that must be done before Christmas. We need to find solutions that do not break our spirit—or our pocketbook.
Russell Libby, MD, is founder of the Virginia Pediatric Group in Fairfax and Herndon, VA. He may be reached at rlibby@vapg.com .For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.
Facilities that are looking for a way to achieve a closer bond between hospital-based practitioners and their peers who work at satellite clinics should work with medical staff leaders to extend medical staff membership and hospital privileges to clinic practitioners.
Although medical staff membership is separate from clinical privileges, linking the two together can result in a medical staff with greater dedication to the organization. Just granting privileges alone will get the practitioners in the door, but what happens after that?
"I don't like the idea of providing access to your hospital without requiring [practitioners] also take on responsibilities that go along with medical staff membership," says Kathy Matzka, CPMSM, CPCS, a medical staff consultant from Lebanon, IL. "I don't think we should let them off the hook and give them a free pass. They need to be integrated into hospital organization."
Therefore, the benefits of hospital privileges, such as increased revenue from seeing more patients, should come with the responsibilities of medical staff membership, such as meeting attendance, according to Matzka.
Extending medical staff membership to practitioners who primarily work at satellite clinic locations is one way to ensure that those practitioners work as a unit with their hospital-based peers. But it's not the only way.
Here are three other tips hospitals can use to build camaraderie between the two groups. Remember that building relationships today can pave the way for smooth working conditions in the future.
Make medical staff meeting attendance mandatory, at least for some meetings. This guarantees that practitioners from multiple locations will gather in a central place to discuss issues that will affect all of them.
Hold social events or departmental meetings at clinic locations. Some clinics may not have appropriate meeting space, but if they do, explore this option. It will help convince satellite practitioners, who typically travel to the hospital for meetings, to attend, and it will give hospital-based practitioners a clearer picture of the off-site facilities.
Include news updates from the clinic in monthly hospital newsletters. Additionally, if the newsletter features a practitioner of the month or highlights the cutting-edge work of a particular team, include a photo along with the article. This will help the hospital-based practitioners get to know the satellite practitioners better.
Emily Berry is an associate editor for Briefings on Credentialing and Credentialing Resource Center Connection, and manages CredentialingResourceCenter.com. You can reach her at eberry@hcpro.com.
After posting an $18 million deficit through the first nine months of the fiscal year, Massachusetts-based Partners HealthCare reported a $45 million gain for the 2009 fiscal year. The state's largest healthcare system had been in danger of recording the first annual loss in its 15-year history, but instead said it had operating income of $164 million for the 12 months ending Sept. 30. That was partly offset by nonoperating losses of $119 million, largely from the hospital group's $4.6 billion investment portfolio, the Boston Globe reports.
A National Labor Relations Board decision has given a major victory to a breakaway union vying with the giant Service Employees International Union to represent tens of thousands of California healthcare workers. The board has called for elections to determine who has the right to represent some 2,300 Kaiser healthcare workers employed at various sites in Southern California. An SEIU affiliate currently represents the workers, but the breakaway group filed a petition in February challenging the SEIU. The balloting will give employees a chance to choose between the two unions.
U.S. Surgeon General Regina Benjamin said during a conference on health disparities in Atlanta that the nation must reverse the downward trend of minorities attending medical, dental and nursing schools. Benjamin said the recent downward trend in minority admissions follows years of gains in these areas. She cited a study that said minorities make up only 6% of U.S. physicians, and she lamented that the percentage was the same in 1910, the Atlanta Journal-Constitution reports.
A handful of letters released this week by medical groups illustrate how divided physicians are over healthcare overhaul legislation, the Wall Street Journal reports. The American Medical Association, for example, sent a letter to Senate Majority Leader Harry Reid saying it supports part, though not all, of the legislation. Nineteen surgical groups, including neurosurgeons, anesthesiologists and gynecologists, wrote to Reid this week saying they flatly oppose the Senate health bill, the Journal reports.