Ama Rohack Sections Special Groups Hsr 6-13-2009

AMA Health System Reform 2009 J. James Rohack, MD President-Elect, American Medical Association Director, Scott & White Center for Healthcare Policy Professor of Medicine and Humanities, TAMHSC

AMA Sections/Special Groups Chicago, IL June 13, 2009

Is it time for health system reform? • Does the current system work? • The private sector wants changes • The White House and Congress want reform in 2009 • How will new reforms alter the medical practice environment? • The stakes – clearly – are high

Health Reform 2009 Goals: Medical care that is - Patient Centered - Safe - Effective - Efficient - Equitable - Timely Access, Cost and Quality

AMA Priorities for Health System Reform • • • • • •

Expand coverage and choice Public sector reforms Improve quality and patient safety Reduce costs Enhance prevention and wellness Payment and delivery system reforms

Expand Coverage and Choice • Provide subsidies to low-income (e.g., tax credits) to help purchase health insurance • Enable individuals to purchase insurance through FEHBP or other options • Make regressive tax policies more progressive • Support direct subsidies for high-risk patients (e.g., risk pools, reinsurance) • Require a greater level of individual responsibility • Implement health insurance market reforms • Continue to oppose single-payer plans

Public Sector Reforms • Enroll SCHIP eligible children and expand eligibility to higher percentages of FPL • Eliminate existing Medicaid categorical requirements and establish uniform eligibility for all below 100% of FPL • Replace Medicare SGR with alternative update methodology • Eliminate subsidies for Medicare Advantage • Allow use of public sector contributions to support existing private coverage • Improve physician payment levels

The Medicare Dilemma: Practice Costs vs. Medicare Payment Updates 50% 40% 30%

Practice Costs

20% 10% 0% -10% -20% -30%

Medicare Cuts

-40% -50% 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Physician cost data is from the MEI, a conservative measure of practice cost growth maintained by CMS. Medicare cuts are from the 2008 Medicare Trustees report, with adjustments to reflect Sec. 131 of P.L. 110-275. Prepared by American Medical Association, Division of Economic and Health Policy Research, August 2008.

Improve Quality and Patient Safety • Develop quality measures and appropriateness standards • Develop evidence-based performance measures that enable continual QI and are the basis for rewarding high quality, cost-effective, safe care • Support practice-based solutions (e.g., HIT, decision support, continual performance monitoring) that enable incorporating measurement into practice to support QI • Evaluate and improve PQRI • Facilitate physician involvement with patient safety organizations

Reduce Costs • Reduce the burden of preventable disease and better manage chronic disease • Support comparative effectiveness research • Address variation in the utilization of health care services, particularly at the state/regional level • Make health care delivery more efficient • Reduce non-clinical costs that do not contribute value to patient care

Enhance Prevention and Wellness • Support integrated approach to encourage the adoption of healthy lifestyles for physicians and their patients • Urge the inclusion of wide range of evidencebased preventive services in insurance plans • Support adequate federal funding for biomedical research, including prevention • Encourage CBO to score the long- and shortterm budget deficit reductions and costs associated with prevention • Eliminate racial, ethnic and gender disparities through infrastructure and programmatic change

Payment and Delivery System Reforms • Develop physician-relevant HIT systems (e.g., interoperability) and provide incentives to build the infrastructure • Develop value-based payment methodologies (e.g., patient-centered medical home, management of chronic disease) • Pursue antitrust relief, fair physician contracting, and greater transparency • Enact alternative medical liability reforms

Bending the Spending Curve • The AMA was a participant at the White House on May 11, 2009 in an historic meeting of the private and public sector to achieve a vision of affordable health insurance coverage for all Americans preserving choice of the patient of their physician

Four Ways to Reduce Costs • Administrative simplification, standardization, and transparency to support effective markets • Aligning quality and efficiency incentives so physicians, hospitals, and other health care providers work together towards the same high standards • Coordinated care, using evidence-based best practices to reduce hospitalization and manage chronic disease, and implementing proven clinical prevention strategies • Reducing costs through improved care delivery models, health information technology, workforce deployment and development, and regulatory reforms

Follow up Letter June 1, 2009 • Improve Care Transitions to Avoid Hospital Readmissions • Create Best Practices to Reduce Unnecessary Utilization – – – – –

Low Back Pain PCI for chronic stable angina Induction of Labor/Caesarean sections Sinusitis prescriptions and radiograph Diagnostic imaging: CTA for PTE; MRI of knee, shoulder; CT/MRI of head; Stress Echo; SPECT MPI

• Medication Reconciliation

AMA Fully Engaged • Keys Points I have learned: • Together, we are stronger • Divided into our specialty tribes, we will lose