Update on Healthcare Reform

Senator Max Baucus', (D-Mont.) "blue print" to overhaul healthcare, with what he described as a "centrist position" has drawn fire from even his own party. It has been mentioned in every media source that a healthcare reform bill would have a heavy foot print, and that would be Senator Baucus. One of the compromises his proposal included was to omit the pubic plan option. 

 

Healthcare providers cannot wait until the song has been sung to start their own planning, knowing that some form of change will happen. Waiting is how much of the healthcare community gets stung.

 

There are some planning-based proposals going around that might be included in a final bill. Even if not all of them pass, we will have more in place by being proactive then reactive, which is the way we have traditionally responded.

 

There will not be the 21.5 percent reduction as proposed, but there would be a 0.5 percent increase. But that does not include the repeal of the sustainable-growth-rate which penalizes physicians and would not stop the scheduled cuts beyond 2010.

 

- Create a 10 percent bonus payment for primary care and general surgery that practice in health professional shortage areas. This bonus would be offset by reducing payments for all other services by 0.5 percent. (You would be surprised in Memphis what areas would not be deemed shortage areas because of the population shift and the shortage of primary care and surgery).

 

- Expand the Medicare physician feedback program and penalize physicians who use significantly more resources than their peers.

 

- Increase the imaging utilization-rate assumption for advanced imaging equipment from 50 percent to 90 percent, which will result in lower practice-expense payments for the technical component. (Most bone-densitometry machines are being used as bone anchors now anyway). 

 

Just as many providers planned earlier to provide services to their patients, in order to make it convenient and get a faster turn around in diagnosis, well here comes the stick.

 

Let's go ahead, draft the patient education information for your patients that explains to them that you will not be able to provide this service to them anymore (particularly the elderly who are going to have to ask a volunteer care giver that you will need for them to pick you up another time) and hope they understand.

 

Require that all eligible health professionals participate in Medicare's Physician Quality Reporting Initiative by 2011.

 

Here is one of the only good things I have seen thus far, and have seen much of the medical community endorsing through preparation and actions by the efforts through the Memphis Medical Society and the Healthy Memphis Common Table. Allow groups of providers to form accountable care organizations, improve quality of care and share in half of the savings achieved over a three-year period. Memphis has been more pro-active in this area than in many parts of the country, as demonstrated through federal and non-profit funds awarded to Memphis to help build this infrastructure.

 

I used to think three years was a long time until I started seeing my nieces and nephews who just a few years ago were sitting on my lap, and are now graduating from high school and college.

 

 

Bill Appling, MBA, FACMPE, is president of Watkins Uiberall Health Care Consulting.  He has faculty appointments at the University of Memphis in the Fogelman College of Economics and Business, where he teaches in the Masters of Health Care Administration program.