Better ways to pay for medical care?

From Massachusetts’ plans to revamp medical spending to the Republican controlled U.S. House plans to change Medicare spending, there are efforts to move from a health care system that pays for services to one that pays for quality services.  To learn more about practical ways to improve health care delivery by changing incentives, listen to Dr. Mark Fendrick, Co-Director of the University of Michigan Center for Value-Based Insurance Design, talk about how value-based insurance can incentivize patients to seek out better health care at lower cost on Getting Better Health Care.

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What’s right and what’s wrong with the U.S. health care system?

What’s right and what’s wrong with the U.S. health care system? Does it need a major overhaul or a few tweaks?

In a two part episode, I discuss the cost of the U.S. health care system with Dr. Robert Berenson, a health care policy expert who has served as a practicing physician, the manager of a large health plan and in senior government positions, including being in charge of Medicare payment policy and private health plan contracting in the Centers for Medicare and Medicaid Services.

Dr. Berenson describes how incentives need to change to get control of our medical costs.  You can hear both of these episodes and others on my online podcast radio program, Getting Better Health Care.

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More doctors don’t equal happy patients, more empathetic doctors do

Researchers from the Dartmouth Institute for Health Policy and Clinical Practice and the Centers for Medicare and Medicaid Services have found that beneficiaries of Medicare who live in areas with a “larger supply of doctors” are not any more likely to be satisfied with the physician care they receive or the time they spend with their doctors than Medicare recipients who live in regions with smaller pools of physicians. Additionally, the study “found no significant differences in access to specialists or availability of tests.

This isn’t surprising.  At DrScore, we’ve found that seeing a caring, friendly doctor is the critical factor in patient satisfaction.  Having more doctors won’t make patients happier, but having more empathetic doctors who show how much they care about their patients does.

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The economy is bad, but doctors still doing well

The monthly newsletter came from my medical specialty society.  There was an article on how much doctors are being paid, pointing out that in 2009 doctors in my specialty experienced an increase in average income of between 7-12 percent, though specialists in general saw a decrease of about 4 percent.

In a down economy with a lot of people hurting and roughly 10 percent unemployment, doctors have been relatively spared from financial pain. As the deficit commission looks into ways to cut costs, reducing payments to doctors will be considered.  I suspect physician organizations will aggressively fight such cuts, pointing out that potential cuts in Medicare would hurt patients.

I don’t want to see patients hurt, but the patriotic side of me says that we doctors shouldn’t be completely spared from the effects of a down economy that is causing our patients to suffer.

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Who decides how much Medicare pays?

The Wall Street Journal (10/27, A1, Mathews, McGinty) reported a committee of doctors called the Relative Value Scale Update Committee (RUC) decides how much Medicare pays for various medical procedures. This committee wields considerable power over how Medicare dollars are spent.

It is good to have doctors deciding this?  Who would be better?  Government regulators?  In private insurance plans, the insurer and the doctor contract for what those prices should be.

We now have a health care system that largely removes from patients the direct responsibility of paying for care.  So if patients aren’t going to decide how much they will pay, it’s left to someone else — either the insurer or the government.  It may seem that leaving this in the hands of doctors may not be a great idea, but the RUC can’t pay doctors whatever it wants. It just sets the relative amount that one procedure gets paid vs. another.  It’s a zero-sum game, so that if one procedure is paid more, another is paid less.

So while the RUC is controlled by physicians, those physicians don’t change Medicare’s overall costs.

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Where is the Institute for Healthcare Improvement (IHI) headed?

With founder Don Berwick leaving to guide the Centers for Medicare and Medicaid Services (CMS), IHI is now headed by former No. 2, Maureen Bisognano. The IHI has been a leader in changes to the U.S. health care system,. Bisognano describes the IHI mission as “will, ideas and execution.”

To learn more about where our health care system is headed, read this interview. It looks like we’re headed toward a health care system that is even more patient-centered, something that is most welcome at DrScore.com.

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Improving access to preventive care services

One way that recent health care reform legislation is supposed to help improve care while lowering costs is by encouraging more preventive care services to be offered. The Center for Medicare & Medicaid Services (CMS) announced new preventive health benefits created under the Affordable Care Act for seniors and persons with disabilities covered by Medicare.

Click here to learn more about these benefits.

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Copay Assistance Cards

Representatives from pharmaceutical companies are continually visiting my office bringing new, ever more generous, “copayment assistance cards” designed to make drugs more accessible.  Insurers often require patients to pay a significant share of the cost for brand name medications. These patient costs can be very high. Pharmaceutical companies are helping patients have easier access to these medications by helping pay those co-payments.

But here’s the problem. The point of the copayment is to help steer patients to lower cost alternative treatments. These copayment assistance programs not only help patients get access to expensive drugs, they eliminate the incentive to choose more cost-effective medications. Without such incentives, pharmaceutical companies don’t have to compete on price.

While I love the idea of my patients having lower cost access to drugs, I am concerned that eliminating the incentive to choose cost effective treatments is going to hurt all patients in the long run through higher drug prices.  While insurance companies are paying for those drugs, the money insurance companies use doesn’t grow on trees, it comes from patients’ pockets. It should be clear to everyone that a copayment assistant card that helps the patient “get the medication for free” doesn’t do that at all; it just means that we’re all paying for it.

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Patients Want to Know What Doctors Think about Reform

Many people are debating health care reform in the United States. I find that my patients don’t debate me about it. Instead, they just want my opinion. They want to know what doctors think. It’s great to have one’s opinion held in such high esteem. Doctors should be playing a critical role in the debate.

Hopefully doctors’ concerns will go beyond concern about Medicare reimbursement cutbacks and medical malpractice reform. While those issues may be important, they aren’t the only issues and may not even be the most important ones. Increasing and ensuring access, controlling costs, and avoiding excessive rationing are the biggest considerations, at least in my opinion.

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Accountability

Physicians are very concerned about an impending 21 percent Medicare pay cut (now due to occur in October) and the “broken” formula that causes it. When any other group asks for legislative largess, physicians are right to ask, “Where will the money come from to pay for this?”

Not long ago one of my Senators sent a message to constituents talking about how he had helped arrange for greater veteran health benefits. Greater veteran health benefits are wonderful, but the Senator didn’t say where the money was coming from. Was it from cuts in another program, was it from new taxes, or was it from increasing our national debt?

As physicians, we should take some leadership. If we want the government to end the plan for the scheduled cut and “fix the broken formula,” we ought to hold ourselves accountable to say where the money should come from. Are we asking for more Medicare taxes to pay for this?

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