This well-reasoned manifesto makes the case for an end to unfair billing practices, no more ICD-10 delays, and better access to healthcare for all.
In the spirit of the holidays, here is my wish list for the coming year.
For physicians:
Find a Permanent Fix to the Sustainable Growth Rate
A permanent fix to the SGR debacle should be at the top of the wish list for anyone who cares about healthcare access. How can we expect physicians to do business with the dangling threat of calamitous double-digit cuts in Medicare reimbursements? This is bad policy—if we can even call this "policy"—and it's grossly unfair to physicians.
The "doc fix" has become an embarrassing annual sideshow at the Capitol, but the only solution so far is a new Band-Aid. The American Medical Association and other physicians' associations try each year make a permanent fix their top legislative priority.
Every year they're promised action by Congress, bills are filed, lawmakers pontificate, and promise, and every year those hopes flame out. Congress has had 17 opportunities to permanently fix the SGR and 17 times they've failed to do their job. Find the funding and fix this! For good!
[In the interests of full disclosure, Congress must fix the SGR because I am sick of writing about it.]
For the Poor:
Expand Medicaid in Every State
Political leaders in the states that did not expand their Medicaid programs must put aside their mean-spirited partisanship and make Medicaid expansion work. Feel free to reject Obamacare, but you owe it to the poor and most vulnerable people of your state to come up with an alternative. Beyond that, it's just plain mule dumb!
States that reject Medicaid expansion are losing billions of dollars in federal subsidies. That's money that will pay for medical services, and provider salaries, and in many cases will keep the doors open at cash-strapped hospitals.
And that is money that will circulate in local economies. Let's be clear. Rejecting Medicaid expansion was never about policy or state budgets. It was always about politics. Giving ground on the Patient Protection and Affordable Care Act would be perceived as surrender by hard-right extremists who have resisted the reforms at great expense.
No one has demonstrated that rejecting Medicaid expansion would put a state on a more-solid financial footing. Do the right thing Gov. Scrooge! Expand Medicaid!
For Hospitals and Public Health Policy:
Implement ICD-10 with No More Delays
The argument against ICD-10 implementation is simply untenable, which is why those who oppose the upgrade to the diagnostic coding set had to resort to trickery to get it delayed until Oct. 1, 2015. Enough already!
The United States spends more money on healthcare than any other country in the industrialized world. Coincidentally the United States is also the only country in the industrialized world that still uses ICD-9, a coding set devised in the 1970s.
Yes, doctors have quite a bit on their plates already with fundamental shifts to value-based care, quality metrics, the annual SGR threat (see above) and meaningful use of electronic medical records. The thought of adding another complex mandate that is linked directly to reimbursements is unnerving.
However, this was not a surprise. We've known about ICD-10 since 2009 and there have already been two years of delays. The fact is, our profligate healthcare system needs the granular data that ICD-10 provides to help identify best practices, and track treatment regimes, procedures, outcomes, quality, cost, redundancy, and fraud.
These delays are unfair to the people, hospitals, and other institutions who assumed the implementation dates would be met and who acted appropriately and prepared. Hospitals are spending billions to operate dual systems because of the delay.
And it should be noted that there are thousands of ordinary people who took the time to become certified for ICD-10 in the hopes of improving their lives. They played by the rules, paid their tuition, took the certification courses, but many saw their job prospects evaporate for at least another year with the latest delay.
It's time to move diagnostic coding into the 21st century!
For Consumers:
Eliminate Drive-by Doctoring, Balance Billing
Imagine this scenario: You are seriously injured or become ill, are rushed to the ED and admitted into the hospital for a day or two. Fortunately, you're a responsible citizen who took the time to buy health insurance and your hospital is in the network.
Weeks later, however, you learn that a certain ED doc, hospitalist or other physician contracted to work in your network hospital is not, in fact, in your network. That knowledge comes to you in the form of a thick envelope containing an eye-popping bill detailing potentially tens of thousands of dollars in out-of-network fees that you were not told about beforehand, most likely because you likely were unconscious.
When people in healthcare complain that their industry is over-regulated, ask them how their industry can defend practices such as drive-by doctoring and balanced billing. It's just plain sleazy and if you allow this to happen in your hospital to your patients—people who are in pain, afraid, essentially defenseless and trusting—then shame on you!
People in leadership positions within healthcare need to understand that this issue is on the radar of attorneys general and state and federal lawmakers across the nation. If the healthcare sector doesn't take care of this problem on its own, the government will.
For Veterans:
Eliminate or Greatly Reduce Care Wait Times at the VA
We've heard the horror stories about scandalously long wait times at Veterans Administration hospitals and how administrators at some hospitals cooked the books and gamed the system to collect bonuses for improving care access.
Fortunately, the public outcry has made this an issue that the Obama Administration, Congress, and the VA cannot ignore. Steps must be taken to improve access to care for veterans, many of whom also suffer disproportionately from behavioral health issues related to their service.
If this country can afford to wage war, then it should be able to provide care for the people who answered the call. As a side note, whatever success the VA achieves in improving access to care could almost certainly have civilian applications in a nation that is struggling with a dearth of primary care physicians.
For Insurers:
Reject the Latest Challenge to the PPACA
This latest challenge to reach the U.S. Supreme Court regarding the PPACA may very well be the silliest and least tenable. Essentially the not-just-no-but-Hell-no opponents of Obamacare pored through the massive healthcare reform bill and found what amounts to a typographical error regarding subsidies for consumers using state-sponsored health insurance exchanges.
They took this typo and ran with it, all the way to the U.S. Supreme Court, which is expected to hear the case sometime early next year.
Whether or not you support Obamacare, this case is pure pettifoggery. The fact that four of the most-conservative members of the highest court in the land have determined that this is worthy of review unfortunately speaks volumes about the state of our politics. God help us every one!
John Commins is the news editor for HealthLeaders.