As the healthcare debate moves to the floor of Congress, many proposals to fulfill President Obama's original vow to curb costs have fallen victim to organized interests and politics. And now the scaled-back "Cadillac tax" on high-cost health plans and a nonpartisan Medicare budget-cutting commission are under furious assault, notes the New York Times. "The lobbyists are winning," Representative Jim Cooper, a conservative Tennessee Democrat who teaches health policy, told the Times.
Ezekiel Emanuel, MD, PhD, didn't mention any of the controversy from the heated political debates of August as he delivered an opening address at the MGMA annual conference in Denver on Sunday. Instead, he presented his vision for achieving what he called the "holy grail" in healthcare: Improving quality, lowering costs, and expanding coverage.
Emanuel, special advisor to the director of the White House Office of Management and Budget for health policy, found himself at the center of a political storm earlier this year when Betsy McCaughey—and subsequently Sarah Palin and Representative Michelle Bachmann—used some of his writings about medical ethics to justify claims that reform would lead to "death panels." Fact-checking organizations later said the Emanuel was being taken out of context.
It is ironic that Emanuel would be accused of supporting patient death panels given his solution for the healthcare crisis. During his hour-long address to MGMA attendees, Emanuel advocated redefining the physician-patient relationship toward more "high-touch healthcare."
By that, Emanuel means spending more time with patients and focusing on potentially avoidable complications that represent nearly 15 cents of every healthcare dollar. In addition to many of the typical statistics and graphs that are often seen in healthcare conference keynote presentations, Emanuel pointed to disproportionate spending on a small portion of the population. Physicians average less than 15 minutes per patient visit, but should spend significant more quality time with the 15% of patients who account for nearly three-quarters of all spending. More attention to chronic conditions is needed to improve overall quality, he said.
Emanuel certainly isn't the first to point out that the current reimbursement system discourages a more high-touch care model. He concluded his presentation by calling for a change in the physician reimbursement system, and specifically suggested bundled payments as a potential model.
To work, a bundled payment system would need to be risk-adjusted and discourage potentially avoidable complications; physicians who improved care and reduced avoidable errors could split the savings with a gainsharing model, he said.
Emanuel noted that there aren't enough well-tested bundled payment models, and more experimenting is needed.
The current healthcare reform bills don't included significant payment changes, and although the Obama administration hinted at a switch to a bundled payment system when it released a budget proposal earlier this year, bundled payments haven't been a focus of the more recent healthcare reform debate.
Still, Emanuel believes a payment system change is coming, and he urged MGMA members to consider whether they are ready to adapt to a new model.
Proposals that would require Americans to buy health insurance are under fire from both ends of the political spectrum, with some liberals saying the penalties are too harsh for those who refuse and conservatives denouncing the whole concept. Still, the idea of an "individual mandate" to carry insurance is an integral part of Democratic efforts to expand health coverage to nearly every American.
Despite promises by President Obama and Democratic leaders that their healthcare overhaul would lower costs, the proposals before Congress would probably not cut overall U.S. healthcare spending significantly anytime soon, health policy specialists say. "I think there are some valuable steps being taken to position us in the future for cost containment," Paul Ginsburg, president of the Center for Studying Health System Change, told the Boston Globe. "But there is nothing that is clearly going to be a powerful force for slowing the cost trends."
Massachusetts' plan to shake up how providers are paid could have a hidden price for patients: Controlling the state's soaring medical costs, many healthcare leaders believe, may require residents to give up their freedom to go to any hospital and specialist they want. A growing number of hospital officials and physician leaders warn that the new payment system proposed by a state commission would not work without restrictions on where patients receive care.
Had all gone as planned since 2006, when the Hospital Corporation of America first proposed a 56-bed hospital for Spring Hill, the company would have been preparing for the early 2010 grand opening of the institution. Instead, HCA is re-evaluating its options after three years of court and administrative battles with the two county-owned hospitals that serve the city. Officials of TriStar Health Systems, a division of HCA, said recently they would not appeal a court ruling blocking plans for the hospital on the south side of town. Instead, the company will pursue other options to serve the area's residents.
Hollywood, FL-based Joe DiMaggio Children's Hospital has broken ground on a $130 million expansion project that will include a children's cancer center, a medical and surgical section, a gastrointestinal special procedures area, and 48 private patient rooms. Expansion became necessary because of an increase in patients, said Nina Beauchesne, administrator for the children's hospital and pediatric services for Memorial Healthcare System.
More than 200 patients at Cedars-Sinai Medical Center in Los Angeles were inappropriately exposed to high doses of radiation from CT brain scans used to diagnose strokes. About 40% of the patients lost patches of hair as a result of the overdoses, a hospital spokesman said. The overdoses went undetected for 18 months as patients received eight times the dose normally delivered in the procedure, raising questions about why it took Cedars-Sinai so long to notice that something was wrong. As a result of the discovery, the FDA issued an alert urging hospitals nationwide to review their safety protocols for CT scans.
President Obama's campaign for a healthcare overhaul has entered a new phase after weeks of making a mass-market case, reports the New York Times. The new, niche-marketing phase is aimed at securing the votes of 60 senators and holding together a coalition of wary industry groups like the drug and insurance companies who have made their own deals, according to the Times.
Minnesota nurses are protesting Gov. Tim Pawlenty's move to eliminate subsidized healthcare for more than 30,000 low-income adults. Members of the Minnesota Nurses Association and their supporters will march to the Republican governor's Capitol office on October 12 to demand that he reverse the spending cut. The Minnesota Nurses Association is a union with 20,000 registered nurses as members.
