James Roosevelt, Jr., president and CEO of Tufts Health Plan and member of the Obama Presidential Transition Team, said federal policymakers can learn from Massachusetts' reform. "The beauty of what we accomplished in Massachusetts, in addition to providing healthcare coverage in a cost-effective manner, is the legislation shined a light of day on healthcare costs. It was never framed as a true public policy before," said Roosevelt.
In his healthcare proposals, Obama has linked healthcare reform to stimulating the economy. Without major reforms at the federal level, the numbers of uninsured Americans will swell to 54 million within a decade. Losing coverage and facing rising healthcare costs will force many into bankruptcy. Echoing comments made by Obama on Tuesday, Roosevelt, the grandson of President Franklin Roosevelt, said healthcare costs force an American to declare bankruptcy every 30 seconds. "That is wrong and it must change," he said.
The health plan executive said the nation must build its reform program on top of the current employer-based system and not create a new system, such as single-payer, from scratch. "I don't think we can copy any system from another country that started with a different system," he said.
Roosevelt said major healthcare reforms should focus on four areas:
Ensuring quality and effectiveness
Improving the primary care system
Providing transparency for cost and quality
Addressing racial and income disparities
"This is a tall order and I don't have all the answers . . . I will tell you that the winds of change have come to Washington. We do have an unprecedented opportunity. We are on the verge of a national program that is as historic as any legislation in our time," said Roosevelt.
Roosevelt, who predicted senators Ted Kennedy and Max Baucus will present a healthcare reform package in the fall, said the road to reform will not be easy. He suggested healthcare leaders, policymakers, and stakeholders should discuss costs, but the debate should not devolve into fear mongering and inflammatory statements, which he charged is already happening on the topic of comparative effectiveness.
Though Obama expects major healthcare reform within the year, Charlie Baker, president and CEO of Harvard Pilgrim Healthcare, suggested changes should be incremental. He warned that policymakers and industry leaders should not overpromise and under deliver.
"[Health care is] 18% of the [gross domestic product]. It's hard to turn it on a dime," said Baker.
Medicare
As part of his budget plan released that was released Thursday, Obama proposed paying doctors for quality rather than individual services. In order for Medicare to create a quality-based system that is supported by physicians, John Glaser, PhD, chief information officer at Partners Healthcare, a major integrated healthcare system in Boston, said CMS will have to provide "meaningful incentives," such as 10% to 20% increases for providing quality.
Baker said whoever becomes the next Health and Human Services secretary should fix Medicare first. He added Medicare drives the rest of the system and its payment system, which favors specialists over primary care physicians, is a reason why many doctors choose specialties over general practice. "If you don't change Medicare, it's hard to change anything else," said Baker.
Roosevelt, however, said Medicare problems alone are not enough to spark changes, but would need to be part of a larger healthcare reform plan.
Healthcare leaders at Thursday's event questioned whether 100% of physician practices will have electronic health records (EHR) within five years, which is a goal in the stimulus package. Glaser said the feds should create more realistic goals that show progress in areas of e-prescribing and quality reporting. While the stimulus bill calls for doctors to have EHRs, Jonathan Bush, cofounder, president, and CEO of athenahealth, which offers electronic medical records and practice management solutions to physician practices, said industry leaders should not expect to save money from EHRs. In fact, EHRs have a negative return on investment.
Glaser, however, said health officials should not affix a bottom-line return on investment because EHRs help improve care, reduce errors, and improve access to patient records—and there is no price tag on patient safety.
Glaser said Partners has worked to improve EHR efficiency, but acknowledged that doctors still spend more time filling out a digital prescription than it takes writing a prescription. Because of the added time, physicians have resisted the technology, which Glaser said shows the importance of paying doctors extra for using EHRs.
Another issue with the stimulus plan's language is that it requires "meaningful use" of EHRs. Glaser said the question is: What is actually considered "meaningful use" for doctors? He hopes the feds answer that question by the fall.
Comparative effectiveness
Though it comprises a mere $1.1 billion of the $150 billion healthcare portion of the $787 billion stimulus package, comparative effectiveness, which compares different treatments, has received the most opposition of any of the healthcare-related parts of the package. Conservative radio hosts, most notably Rush Limbaugh, have criticized the notion as a step toward socialized medicine.
Baker said the country needs a national debate on the issue. ". . .This one really hits a raw nerve about decision making and ultimately about coverage and what gets paid for and all the rest. I think this is a conversation we desperately need to have," said Baker.
A Pasco County, FL, fund that helped pay for speciality healthcare for uninsured patients is $4,000 in the red, leaving a clinic that refers them with no options. When Premier Community HealthCare Group, a nonprofit primary care clinic, saw uninsured patients who needed serious surgeries or tests, they referred them to the county's Human Services Department. The clinic typically refers about 25 patients a month, but is seeing more as people hit hard by the recession lose jobs and health benefits. About 60% of Premier's patients have no insurance. But this month, county officials told them the money for this fiscal year had all been spent. Because the county's fiscal year begins Oct. 1, that could force some patients to wait seven months for the tests or procedures they need.
Surgeons training at the University of Michigan Health System will no longer use live, healthy dogs to learn surgical procedures that can save people's lives, the university announced. The anesthetized animals were used to teach tracheotomies, how to fix collapsed lungs, and other emergency procedures. In a statement, the U-M Health System said its Graduate Medical Education Committee reviewed simulators and decided to make the switch to a sophisticated type of mannequin for the training. However, some consider animal models superior to simulators.
With an economic stimulus package passed and a timeline for withdrawal from Iraq established, President Obama has turned to healthcare reform. The President's 140-page proposed budget outline represents the opening volley in what promises to be a long and tortuous process whose outcome is far from clear, says Sg2 analyst Stephen Jenkins.
President Barack Obama's prescription for the nation's ailing healthcare system comes with Medicare cuts and tax hikes. But the budget Obama proposed Thursday is not a finished blueprint for overhauling healthcare, but instead the opening bid in a tough negotiation.
China faces a growing burden on its healthcare industry as the number of people with chronic diseases rises, the government said.
The Health Ministry said in a report that 260 million Chinese suffer from chronic diseases, an increase of 4.9% compared to 2003. The figure has been increasing by an average of 10 million every year for the last decade, the agency said. The government found that cases of heart disease and cancer had doubled, while cases of hypertension and diabetes had tripled.