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Solutions for health care challenges must balance quality care, access, finances
Current payment formula is flawed.
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Coming changes in the United States health care system will require significant input from physicians and professional societies, according to two prominent members of the American College of Cardiology.
Rising operational costs that are outpacing stagnant Medicare reimbursements are putting many practitioners in a tough position, according to Jack Lewin, MD, chief executive officer of the ACC. Lewin and James T. Dove, MD, immediate past president of the ACC, presented their assessments of the challenges facing practitioners at the 29th Annual Scientific Sessions of the Heart Rhythm Society, in San Francisco.
“We are stuck with a flawed payment formula for the people who provide health care,” Lewin said. “This is not going to go away any time quickly because of the large amounts of money it would take to guarantee doctors a cost-of-living increase that would be somewhat consistent with the increased costs of doing business.”
One of the most daunting problems, according to Lewin, will be maintaining high-quality care and providing access in the face of rising costs, increased patient volume and long-term projected costs of sustaining the Medicare system.
“To get the baby boomers through Medicare, nobody is talking about what is projected to be needed in supplemental funding to keep the so-called Medicare trust fund solvent,” Lewin cautioned. “U.S. Comptroller David Walker estimates Medicare will be short at least $35 trillion during the next two and a half decades, which works out to be about more than a trillion dollars per year on average. At current expectations, with a continued growth in health care spending that will exceed inflation, we will likely need even more than that to adequately sustain Medicare as the number of beneficiaries increase,” he said.
Lewin and Dove agreed that fundamental changes at the Congressional, clinical and practice levels are needed to meet some of the challenges.
“We can stand on the edge of this burning platform of health care and fight this with fire extinguishers, or we can jump off of this platform into lifeboats with a new strategy,” Dove said during his presentation. “Rescue by politicians, bureaucrats and payers is likely to be more cost and volume controls, or we can look at a strategy that is based on quality, appropriate care as designed by patients and health care professionals.”
Dove proposed a variety of ideas formulated at various meetings and summits throughout 2008, including universal coverage and access, a basic public-approved benefits package independent of Congressional control, improved efficiency and delivery systems that incorporate new technologies, reinvestment of health care savings into the health care system, and team-based approaches to patient management.
“I have attended numerous meetings during this past year, and many people have ideas about changing the health care system that are inconsistent with what we want to accomplish for our patients,” Dove said. “If we are not proactive, we will see a cost/volume, controlled, dysfunctional system that fails to provide patient-centric, appropriate quality care.” – by Eric Raible
For more information:
- Lewin J. What changes we are likely to see in the delivery of health care reimbursement.
- Dove J. What are the implications of changes in the health care system for clinicians in private practice or at universities and clinics?
- Both presented at: Heart Rhythm 2008; May 14-17, 2008; San Francisco.