Transcript AMA PowerPoint template 2

Health System Reform:
The AMA Physician Perspective
J. James Rohack MD FACC FACP
President
American Medical Association
Harvard Business School
Health Industry Alumni Conference
Boston, Massachusetts
November 6, 2009
Health Reform Goals
• Access, Cost and Quality
• We seek Medical Care that is
•
•
•
•
•
•
Patient-Centered
Safe
Effective
Efficient
Equitable
Timely
American Values
•
•
•
•
Freedom
Choice
Competition
Capitalism
A Quick Look at History
1934 – FDR’s
New Deal.
1950s – Growth of
employer-sponsored
insurance
1912 – TR
calls for
universal
coverage
1940s –
Truman:
public
subsidies
1970s – Attempts
by Presidents
Nixon and Carter,
Sen. Ted Kennedy
1965 – Medicare
and Medicaid
1997 –
SCHIP
1993 – Clinton
proposal defeated
“We want to make sure that
everyone has affordable
quality health insurance.”
“America’s patients and
physicians deserve better
than the status quo.”
“If Congress is committed, we're
committed to work with them to
come up with something that is
going to be right for patients and
right for the physician who cares
for them.”
AMA Criteria: Health System Reform
– Protects the patient-physician relationship
– Provides affordable health insurance for all
– Promotes quality, prevention and wellness
– Repeals the Medicare payment system that
harms seniors' access to care
– Eases medical liability and administrative
burdens
“You did not enter this
profession to be beancounters and paperpushers.
You entered this
profession to be healers
– and that's what our
health care system
should let you be.”
National Health Expenditures
“Bending the Curve”
Trillions of 2009 Dollars
5.0
4.5
4.0
More than $2 trillion in savings
3.5
Baseline
3.0
1.5 percent
slower growth
2.5
2.0
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
Total Health Care
Expenditures
Per Capita US Dollars
Total Expenditure
6000
Australia
5000
Canada
4000
France
3000
Germany
Japan
2000
United Kingdom
United States
1000
0
Year
The Medicare Dilemma
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
Medicare cuts and Massachusetts
• Physician face across-the-board cut of 21.5%,
growing to 40% by 2014 due to a flawed payment
formula, the Sustainable Growth Rate or SGR
• Repeal of SGR would prevent a loss of $320 million
in 2010 for the care of elderly and disabled patients
in Massachusetts
– Each physician would face an average loss of $13,000 in
payments
• Repeal would prevent a loss of $4.9 billion to
Massachusetts physicians over the next five years
• Medicare cuts affect 64,724 employees, 894,938
Medicare patients and 71,260 TRICARE patients in
Massachusetts
Access already an issue
• Compared to the rest of the country, Massachusetts,
at 14 percent, has an above-average proportion of
Medicare patients
• Massachusetts residents face several other
physician access issues already:
– 7.1% of the state’s residents live in a designated primary
care shortage area;
– 6.9% report that they could not see a doctor in the last 12
months due to cost
– 494 emergency department visits per 1,000 population is
among nation’s highest rate
– 29% of the state’s Medicare beneficiaries age 65 and over
live below 150% of the federal poverty level
Medicare Funding Shortfalls as a
Percent of Federal Income Taxes
2042
Total
2019
51%
24%
Part A
Part B
Part D
Source: 2004 Medicare Trustees Report and author’s estimates.
Federal Income Taxes are estimated to be 10.89% of GDP which is the 50 year average.
Administrative Costs Perspective
• A Recent Study Conducted by Sherlock
Company Found that Health Plan
Administrative Costs are Lower than
Medicare when Compared Equivalently.
The Public Plan
Public Plan: The AMA View
• Physician participation should be voluntary
• Patients should have choice
• Public plan should be subject to same
regulations as private plans
• Public plan should be self-sustaining
• Premiums set by market, not linked to
Medicare
Insurance market concentration
AMA Goals for Legislation
• The AMA is committed to achieving health
reform this year that:
– Provides all Americans with affordable, highquality health care
– Reflects the needs of America’s patients and
physicians
– Includes a permanent fix to the flawed
Medicare payment system
– Includes a push for liability reform
– Supports primary care, prevention and
wellness, and Health IT
– Is financially sound
“I recognize that it
will be hard to
[reform the health
care system] if
doctors feel like
they are constantly
looking over their
shoulder for fear of
lawsuits.”
Liability reform grants
• With AMA urging, Obama administration
announced $25 million in grants for states
and health care systems to experiment
with alternatives to costly medical liability
lawsuits
• The grants, up to $3 million each for three
years, include programs in which
providers acknowledge a mistake, offer an
apology and restitution, and take
corrective action
Senate Finance Committee bill
• Creates a national insurance exchange
• Individual mandate to buy insurance,
subsidies for low income people
• No denying coverage for pre-existing
conditions
• Does not repeal the SGR; replaces 21.5%
cut next year with small update
• AMA continues to work with key senators
toward a permanent SGR fix to protect
Medicare
House Status/Timeline
•
•
•
•
Tri-committee versions completed
Bill to full House for debate
Separate vote on a single payer
Bill to conference committee with Senate
Senate Status/Timeline
• H.E.L.P. Committee bill approved
• Finance Committee votes on bill
• Meld H.E.L.P. and Finance into one bill for
action by Senate … or
• Separate Finance bill to Senate
• Bill to conference committee with House
S. 1776: “Medicare Physicians
Fairness Act of 2009”
• Permanently repeals the Sustainable Growth Rate formula
• Eliminates all SGR debt and forecast cuts, starting with 21.5% in 2010
• New Medicare physician baseline starts at zero instead of
cuts, as a placeholder
• AMA will continue to pursue these provisions in the final
legislation
Road map to White House
The Rubik’s Cube Solution
• Scale back scope to resolve
financing/cost concerns
• Key insurance reforms require
universal coverage
• Phase-in approach?
Determinants of Health
Primary Care/Specialty Mix
50
%
50
%
50
%
50
%
55
%
45
%
Primary Care
Specialists
Canada
40
%
France
60
%
Thailand
Singapore
6 7%
Britain
33
%
U.S.
Accountable Care
Organizations
Final Thoughts
• Bill that President hopes to sign has yet to
be written
• Scope and cost will be scaled back
• Negotiations thru December
• President will sign health reform bill before
2010 elections
• Current occupants of Executive Branch
will be there another 3 years
www.hsreform.org