On the calendar, Congress is still officially in the middle of its two-week spring recess, but behind the scenes on Capitol Hill, work on healthcare reform has been quietly continuing, according to Nancy Ann DeParle, director of the White House's newly created Office of Health Reform.
DeParle, who has been in her new position for just a month, has been spending 60% to 75% of her time there talking with congressional members and staff who appear far more receptive to a reform package than they did more than 15 years ago. She also says that many other healthcare stakeholders are more open to reform efforts, including healthcare providers, employers, and business groups.
"What I found remarkable is that no one [group] wants the status quo. They don't start off talking about their position. They talk about how we can get everyone covered," said DeParle at media briefing yesterday sponsored by the Kaiser Family Foundation. But this dialogue is not coming from the business community or consumer groups alone but "from the providers themselves. They understand that healthcare costs are out of control and [that's] something that we have to get ahold of."
DeParle, the former administrator of what is now the Centers for Medicare and Medicaid Services, said that unlike the reform efforts during the Clinton administration, "Congress has put its money where its mouth is" and has already enacted a budget resolution that has healthcare reform and a healthcare reserve fund in the budget.
"The administration is providing them with what I'll call active technical assistance and guidance," DeParle said. In Congress, "it's very active work going on," with two Senate committees and three House committees involved in the issue.
"I found the both sides of the aisle were in agreement with the president's principles. While they don't agree on every single point in his plan, they are all saying that they want to work with us constructively," she said. She predicted that at the current course, reform legislation could be ready in both houses by this summer.
But many issues of concern still need to be hammered out, including reforming the Medicare payment system. A number of proposals were made by the president, for instance, to address inequities in the current Medicare Advantage program and to move to a more competitive Medicare system.
This includes the bundling of payments "to get better incentives for hospitals to prevent readmissions" so that they are not encouraged to let patients out early "who haven't received all the care they need—and then they come right back to the hospital," she said. "Those are truly payment reforms—they're not just the usual suspects in Medicare."
"This could extend the Medicare trust fund by at least two years. [This is] a down payment on what needs to be done for Medicare," she said.
In addition, other areas which are expected to have "big impacts on Medicare and Medicaid long term," are receiving interest including the use of health information technology, electronic medical records, and health and wellness promotion.
Also, a review of comparative effectiveness in healthcare, which was included in the stimulus package, will help providers, patients and health plans get a start with "the information they need to really know on which treatments are going to work best for which patients," she said. "That hasn't been out there before, and we expect that to have an impact long term."
Physician leaders are more valuable than ever. At least, that's what hospital and practice leaders keep telling me. While leadership in general is a point of emphasis in difficult times, executives realize that there are limits to what an administrator with an MBA can accomplish when it comes to working with doctors on quality improvement, joint ventures, call coverage, and a whole host of other pressing issues.
Doctors trust other clinicians, and a physician leader with a foot in both worlds—clinical and administrative—can get a lot done. So how much, then, is that worth to an organization?
It depends on the owners, according to results from a recent Medical Group Management Association compensation survey. Hospital-owned groups pay medical directors, with the exception of those in primary care, significantly less than private practices and other ownership models.
The biggest gap is for nonsurgical specialists, who earn $51,900 for medical directorships at practices that aren't hospital-owned and only $24,500 at hospital-owned groups (keep in mind that these numbers reflect only directorship compensation, and not total earnings).
Similar, but smaller, gaps were found for surgical specialists and subspecialists as well. Only primary care medical directors earned more in hospital-owned groups—$20,000 compared to $15,000.
The number of hours spent on directorship duties was fairly uniform, so productivity differences don't explain the payment differences, says David Litzau, MGMA survey analyst. And while the survey only covered medical directors, I suspect the results would be similar for other physician leadership positions. Physicians tend to earn less in hospital-owned practices in general, so while the size of the disparities may be surprising, the fact that they exist isn't.
A private-practice orthopedic surgeon—a physician without administrative or leadership duties—averages about $30,000 more annually than a counterpart in a hospital-owned group, for instance. A familiar practitioner averages nearly $20,000 more in a hospital-owned setting, though.
Still, it raises the question of why we're seeing a growing trend of hospital employment if private practices continue to pay better. The benefits of hospital employment tend to be nonmonetary—better work-life balance and freedom from business hassles—but I would be surprised if the gap doesn't narrow as hospitals look to offer more competitive packages to recruit physician leaders.
The real finding of the survey isn't just that there are differences between hospital-owned and private practices, but that there are disparities across the board when it comes to physician leadership compensation, Litzau says. In addition to the differences based on practice ownership, there were discrepancies by specialty and areas of responsibility.
Medical directors across all specialties earn more when involved with physician recruitment and education, according to the survey. In primary care, directors with those responsibilities earned almost twice as much as their peers.
It seems that hospitals and practices don't always have a solid grasp of how to reward physician leadership. This is the first year MGMA has conducted such an extensive survey of medical director compensation, and Litzau suspects compensation is often determined based more on physicians' and administrators' negotiating skills than market data.
But as recruitment becomes a greater challenge and hospitals seek closer alignment with physicians, we'll probably see physician leadership compensation in all settings continue to rise.
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A proposal that would have taken the first steps toward a government-run single payer system to handle healthcare reimbursements in Colorado was dropped by its sponsor. House Bill 1273, sponsored by Rep. John Kefalas, was scheduled to be heard by the House of Representatives after being approved by the House Business Affairs and Labor Committee on a close party-line vote in March. It also was approved in an initial voice vote earlier this month, but Kefalas apparently lacked the votes needed for final approval.
Amid growing questions about proposed hospital complexes for New Orleans, the public will have its first opportunity to speak directly to U.S. Department of Veterans Affairs officials about preliminary designs for its portion of the project. The meeting comes as some individuals and organizations representing varying interests are asking government officials to reconsider their plans for the adjoining federal hospital and state teaching medical center in a historic but blighted neighborhood.
The Interim LSU Public Hospital in New Orleans is vastly overstaffed compared with its national peers and is planning to shed 300 workers next year as part of $24 million in budget cuts being contemplated by Gov. Bobby Jindal and the Legislature, officials said. The cuts mean the likely closure of a dental clinic, reductions in cancer screenings, changes in residency programs, and reductions in pay for some faculty doctors, said Fred Cerise, MD, who oversees healthcare operations for the Louisiana State University System.
President Barack Obama's top healthcare adviser has announced a compromise is within reach on a government health plan for the middle class that wouldn't drive private insurers out of business. Offering the option of government coverage to workers and their families has become one of the most contentious issues in the debate about overhauling healthcare to cover the uninsured and curb costs.
Nashville-based hospital chain HCA Inc. sold $1.5 billion of 10-year notes in this year's biggest high-yield bond offering, according to data compiled by Bloomberg. The 8.5% bonds priced at 96.76 cents on the dollar to yield 9%, or 624 basis points more than Treasuries of similar maturity.
Latino workers in California and Texas allegedly punished for speaking Spanish in their workplaces will be granted up to $450,000, free English classes, and other relief under a consent decree approved in a class-action lawsuit filed by the U.S. Equal Employment Opportunity Commission in Los Angeles. The lawsuit alleged that Skilled Healthcare Group Inc. and affiliated firms, based in California with facilities in six Western and Southern states, enforced an English-only rule against Latinos but not other ethnic groups speaking Tagalog and other languages.
At Geneva, IL-based Delnor Hospital, there is a patient-first philosophy. That focus on patient care and comfort led to recent construction of a new 52-bed addition and recognition for its focus on a holistic approach toward the healing of mind, body, and spirit. Delnor was recently designated as Planetree's first Patient Centered Hospital in Illinois and one of only six in the nation. Planetree emphasizes patient comfort, dignity and empowerment, along with top healthcare.
Seniors will likely pay more for Medicare's private health plans in 2010, but new consumer protections that come with those plans could ensure they remain an attractive alternative to traditional Medicare.
The changes come as the Obama administration moves to tighten the screws on private plans offered under Medicare. The Centers for Medicare and Medicaid Services recently unveiled stricter terms for insurers offering the Medicare Advantage plans, taking effect next year, and will effectively cut payments to them by as much as 5%.
